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Does Drug-Eluting Bead TACE Enhance the Local Effect of IRE? Imaging and Histopathological Evaluation in a Porcine Model

  • Peter IsfortEmail author
  • Philip Rauen
  • Hong-Sik Na
  • Nobutake Ito
  • Saskia von Stillfried
  • Christiane Kuhl
  • Philipp Bruners
Laboratory Investigation
  • 3 Downloads

Abstract

Objectives

We conducted an in vivo trial on swine to compare the ablation volumes of irreversible electroporation (IRE) followed by drug-eluting beads transarterial chemoembolization (DEB-TACE) versus IRE only.

Materials and Methods

Nine swine underwent CT-guided IRE in one liver lobe and IRE immediately followed by DEB-TACE in a different liver lobe. For DEB-TACE, 100–300 µm beads (DC-Beads®) were loaded with 50 mg doxorubicin. For IRE, the NanoKnife® was used employing two electrodes according to the vendor’s protocol. Imaging follow-up was performed including CT-based lesion volume assessment using contrast-enhanced CT (venous phase) on days 1, 3, and 7 after the procedure. Three animals were killed for histopathological analysis after each follow-up.

Results

Ablation volumes in CT in the IRE + DEB-TACE group were 15.4 ± 10.5 ml on day 1, 8.7 ± 5.6 ml on day 3, and 1.6 ± 0.7 ml on day 7. In the IRE group, the corresponding values were 5.2 ± 5.2 ml on day 1, 1.0 ± 1.2 ml on day 3, and 0.1 ± 0.1 ml on day 7. On day 1 and day 3, ablation volumes of IRE + TACE group were significantly larger than in the IRE group (p < 0.05). 96% of beads were depicted in or around ablative lesions. 69% of these beads were found in the surrounding hemorrhagic infiltration and 31% within the ablative lesion itself.

Conclusions

Combination of IRE immediately followed by DEB-TACE resulted in larger ablation volumes compared to IRE alone, suggesting that local efficacy of IRE can be enhanced by post-IRE DEB-TACE.

Keywords

Irreversible electroporation Transarterial chemoembolization Drug-eluting bead TACE Hepatocellular carcinoma Experimental study 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

References

  1. 1.
    Bower M, Sherwood L, Li Y, Martin R. Irreversible electroporation of the pancreas: definitive local therapy without systemic effects. J Surg Oncol. 2011;104(1):22–8.CrossRefGoogle Scholar
  2. 2.
    Perera M, Krishnananthan N, Lindner U, Lawrentschuk N. An update on focal therapy for prostate cancer. Nat Rev Urol. 2016;13(11):641–53.CrossRefGoogle Scholar
  3. 3.
    Niessen C, Igl J, Pregler B, et al. Factors associated with short-term local recurrence of liver cancer after percutaneous ablation using irreversible electroporation: a prospective single-center study. J Vasc Interv Radiol. 2015;26(5):694–702.CrossRefGoogle Scholar
  4. 4.
    Dollinger M, Jung EM, Beyer L, et al. Irreversible electroporation ablation of malignant hepatic tumors: subacute and follow-up CT appearance of ablation zones. J Vasc Interv Radiol. 2014;25(10):1589–94.CrossRefGoogle Scholar
  5. 5.
    Chung DJ, Sung K, Osuagwu FC, Wu HH, Lassman C, Lu DS. Contrast enhancement patterns after irreversible electroporation: experimental study of CT perfusion correlated to histopathology in normal porcine liver. J Vasc Interv Radiol. 2016;27(1):104–11.CrossRefGoogle Scholar
  6. 6.
    Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng. 2005;33(2):223–31.CrossRefGoogle Scholar
  7. 7.
    Kotnik T, Frey W, Sack M, Haberl Meglic S, Peterka M, Miklavcic D. Electroporation-based applications in biotechnology. Trends Biotechnol. 2015;33(8):480–8.CrossRefGoogle Scholar
  8. 8.
    Lammer J, Malagari K, Vogl T, et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol. 2010;33(1):41–52.CrossRefGoogle Scholar
  9. 9.
    Ni JY, Liu SS, Xu LF, Sun HL, Chen YT. Transarterial chemoembolization combined with percutaneous radiofrequency ablation versus TACE and PRFA monotherapy in the treatment for hepatocellular carcinoma: a meta-analysis. J Cancer Res Clin Oncol. 2013;139(4):653–9.CrossRefGoogle Scholar
  10. 10.
    Dev SBRD, Widera G, Hofmann GA. Medical applications of electroporation. IEEE Trans Plasma Sci. 2000;28(1):206–23.CrossRefGoogle Scholar
  11. 11.
    Vollherbst D, Bertheau RC, Fritz S, et al. Electrochemical effects after transarterial chemoembolization in combination with percutaneous irreversible electroporation: observations in an acute porcine liver model. J Vasc Interv Radiol. 2016;27(6):913–21.CrossRefGoogle Scholar
  12. 12.
    Lee EW, Chen C, Prieto VE, Dry SM, Loh CT, Kee ST. Advanced hepatic ablation technique for creating complete cell death: irreversible electroporation. Radiology. 2010;255(2):426–33.CrossRefGoogle Scholar
  13. 13.
    Lee EW, Wong D, Tafti BA, et al. Irreversible electroporation in eradication of rabbit VX2 liver tumor. J Vasc Interv Radiol. 2012;23(6):833–40.CrossRefGoogle Scholar
  14. 14.
    Appelbaum L, Ben-David E, Sosna J, Nissenbaum Y, Goldberg SN. US findings after irreversible electroporation ablation: radiologic-pathologic correlation. Radiology. 2012;262(1):117–25.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyRWTH Aachen University HospitalAachenGermany

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