Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes

Abstract

Aim Irreversible electroporation (IRE) is a non-thermal ablative option in patients unsuitable for standard thermal ablation, due to its potential to preserve collagenous structures (vessels and ducts) and a reduced susceptibility to heat sink effects. In this series from two large tertiary referral hepatobiliary centres, we aim to assess the safety/outcomes of hepatic IRE. Materials and Methods Bi-institutional retrospective, longitudinal follow-up series of IRE for primary hepatic malignancy; [hepatocellular carcinoma ( n = 20), cholangiocarcinoma ( n = 3)] and secondary metastatic disease; colorectal ( n = 28), neuroendocrine ( n = 1), pancreatic ( n = 1), breast ( n = 1), gastrointestinal stromal tumour (GIST, n = 1) and malignant thymoma ( n = 1). Outcome measures included procedural safety/effectiveness, time to progression and time to death. Results Between 2013 and 2017, 52 patients underwent percutaneous IRE of 59 liver tumours in 53 sessions. All tumours were deemed unsuitable for thermal ablation. Cases were performed using ultrasound (US) or computed tomography (CT) guidance. A complete ablation was achieved in n = 44, (75%) of cases with an overall complication rate of 17% ( n = 9). Of the complete ablation group, median time to progression was 8 months. At 12 months, 44% were progression-free (95% CI 30–66%). The data suggest that larger lesion size (> 2 cm) is associated with shorter time to progression and there is highly significant difference with faster time to progression in mCRC compared with HCC. Median survival time was 38 months. Conclusion This bi-institutional review is the largest UK series of IRE and suggests this ablative technology can be a useful tool, but appears to mainly induce local tumour control rather than cure with HCC having better outcomes than mCRC.

Percutaneous image guided electrochemotherapy of hepatocellular carcinoma: technological advancement

“…IRE, though, is executed percutaneously in many cancer centers, with the aid of image guidance. 34 Due to similar technological approach, electrochemotherapy can also be performed percutaneously. Same principles must be followed -careful pre-treatment planning, image guided electrode insertion and safe delivery of electric pulses with ECG synchronization.…”

Ablation of Intrahepatic Cholangiocarcinoma

“…53 A more recent study of IRE for hepatic tumors which were "deemed unsuitable for thermal ablation" had a similar small cohort of 3 IHC out of 59 primary and metastatic liver tumors and IHC was not included in the tumor type grouping data used to compare outcomes. 54 The nonthermal technology offered by IRE may be advantageous in treating primary and recurrent IHC in patients where the tumor is located adjacent to sensitive structures.…”

Irreversible Electroporation For Liver Tumors: A Review Of Literature

“…The survival of patients was reported to be 90% (95% CI 72-97%), 65% (95% CI 40-81%), 52% (95% CI 22-75%) at 12, 24 and 36 months respectively. The median time of progression was found to be eight months but was significantly faster in the colorectal cancer metastatic group than the HCC group [11]. Cheung et al studied the efficacy of IRE in 11 patients with 18 HCC tumors.…”

“…This was in contrast to other studies. Niessen et al and Mafeld et al demonstrated complete ablation in 92.2% and 75% of the tumors at six weeks and four to eight weeks of follow-up respectively [8,11]. Zeng et al compared IRE efficacy in large and medium-size liver tumors.…”

“…Other adverse effects highlighted in other studies include fever, mild right pleural effusion, mild hemoperitoneum, subcapsular hematomas, atrial fibrillation and partial portal vein thrombosis [4,11,15].…”