Abstract
Purpose
This study was designed to assess efficacy and safety in the treatment of perivascular malignant liver lesions using percutaneous, computed tomography (CT)-guided irreversible electroporation (IRE).
Methods
Fourteen patients (mean age 58 ± 11 years) with 18 malignant liver lesions were consecutively enrolled in this study. IRE was performed in patients not eligible for surgery and lesions abutting large vessels or bile ducts. Follow-up exams were performed using multislice-CT (MS-CT) or MRI.
Results
Medium lesion diameter was 20 ± 5 mm. Ten of 14 (71 %) were successfully treated with no local recurrence to date (mean follow-up 388 ± 160 days). One case left initial tumor control unclear and additional RFA was performed 4 weeks after IRE. Complications occurred in 4 of 14 (29 %) cases. In one case, intervention was terminated and abdominal bleeding required laparotomy. In two cases, a postinterventional hematothorax required intervention. In another case, abdominal bleeding could be managed conservatively. No complications related to the bile ducts occurred.
Conclusions
Percutaneous IRE seems to be effective in perivascular lesions but is associated with a higher complication rate compared with thermoablative techniques.
Similar content being viewed by others
References
Davalos RV, Mir IL, Rubinsky B (2005) Tissue ablation with irreversible electroporation. Ann Biomed Eng 33:223–231
Appelbaum L, Ben-David E, Faroja M et al (2014) Irreversible electroporation ablation: creation of large-volume ablation zones in in vivo porcine liver with four-electrode arrays. Radiology 270(2):416–424
Edd JF, Horowitz L, Davalos RV et al (2006) In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE Trans Biomed Eng 53:1409–1415
Rubinsky B (2007) Irreversible electroporation in medicine. Technol Cancer Res Treat 6:255–260
Rubinsky B, Onik G, Mikus P (2007) Irreversible electroporation: a new ablation modality—clinical implications. Technol Cancer Res Treat 6:37–48
Sun QK, Wang W, Jia WD (2014) Radiofrequency ablation is a valuable therapeutic option in the treatment of liver metastases from gastrointestinal stromal tumors. Cardiovasc Intervent Radiol 37(2):552–553
Lee DH, Lee JM, Lee JY et al (2013) Radiofrequency ablation for intrahepatic recurrent hepatocellular carcinoma: long-term results and prognostic factors in 168 patients with cirrhosis. Cardiovasc Intervent Radiol. doi:10.1007/s00270-013-0708-x (in press)
Di Vece F, Tombesi P, Ermili F et al (2013) Coagulation areas produced by cool-tip radiofrequency ablation and microwave ablation using a device to decrease back-heating effects: a prospective pilot study. Cardiovasc Intervent Radiol. doi: 10.1007/s00270-013-0733-9 (in press)
Ahmed M, Brace CL, Lee FT Jr et al (2011) Principles of and advances in percutaneous ablation. Radiology 258:351–369
Crocetti L, Lencioni R (2008) Thermal ablation of hepatocellular carcinoma. Cancer Imaging 8:19–26
Faroja M, Ahmed M, Appelbaum L et al (2013) Irreversible electroporation ablation: is all the damage nonthermal? Radiology 266:462–470
Cannon R, Ellis S, Hayes D et al (2013) Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol 107:544–549
Lee YJ, Lu DS, Osuagwu F et al (2012) Irreversible electroporation in porcine liver: short- and long-term effect on the hepatic veins and adjacent tissue by CT with pathological correlation. Investig Radiol 47:671–675
Maor E, Ivorra A, Leor J et al (2007) The effect of irreversible electroporation on blood vessels. Technol Cancer Res Treat 6:307–312
Choi JW, Lu DS, Osuagwu F et al (2014) Assessment of chronological effects of irreversible electroporation on hilar bile ducts in a porcine model. Cardiovasc Intervent Radiol 37(1):224–230
Kingham TP, Karkar AM, D’Angelica MI et al (2012) Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg 215:379–387
Niessen C, Jung EM, Wohlgemuth WA et al (2013) Irreversible electroporation of a hepatocellular carcinoma lesion adjacent to a transjugular intrahepatic portosystemic shunt stent graft. Korean J Radiol 14:797–800
Lu DS, Raman SS, Vodopich DJ et al (2002) Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: assessment of the “heat sink” effect. AJR Am J Roentgenol 178:47–51
Cheung W, Kavnoudias H, Roberts S et al (2013) Irreversible electroporation for unresectable hepatocellular carcinoma: initial experience and review of safety and outcomes. Technol Cancer Res Treat 12:233–241
Deodhar A, Monette S, Single GW Jr et al (2011) Renal tissue ablation with irreversible electroporation: preliminary results in a porcine model. Urology 77:754–760
Wendler JJ, Porsch M, Huhne S et al (2013) Short- and mid-term effects of irreversible electroporation on normal renal tissue: an animal model. Cardiovasc Intervent Radiol 36:512–520
Martin RC II, McFarland K, Ellis S et al (2013) Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival. Ann Surg Oncol 20(Suppl 3):443–449
Martin RC II, McFarland K, Ellis S et al (2012) Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma. J Am Coll Surg 215:361–369
Neal RE II, Rossmeisl JH Jr, Garcia PA et al (2011) Successful treatment of a large soft tissue sarcoma with irreversible electroporation. J Clin Oncol 29:e372–e377
Charpentier KP (2012) Irreversible electroporation for the ablation of liver tumors: are we there yet? Arch Surg 147:1053–1061
Silk MT, Wimmer T, Lee KS et al (2014) Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol 25:112–118
Kasivisvanathan V, Thapar A, Oskrochi Y et al (2012) Irreversible electroporation for focal ablation at the porta hepatis. Cardiovasc Intervent Radiol 35:1531–1534
Philips P, Hays D, Martin RC (2013) Irreversible electroporation ablation (IRE) of unresectable soft tissue tumors: learning curve evaluation in the first 150 patients treated. PLoS One 8:e76260
Ben-David E, Appelbaum L, Sosna J et al (2012) Characterization of irreversible electroporation ablation in in vivo porcine liver. AJR Am J Roentgenol 198:W62–W68
Bruix J, Sherman M, Practice Guidelines Committee AAftSoLD (2005) Management of hepatocellular carcinoma. Hepatology 42:1208–1236
Sun QK, Wang W, Jia WD (2014) Radiofrequency ablation is a valuable therapeutic option in the treatment of liver metastases from gastrointestinal stromal tumors. Cardiovasc Intervent Radiol 37(2):552–553
Poggi G, Montagna B, DIC P et al (2013) Microwave ablation of hepatocellular carcinoma using a new percutaneous device: preliminary results. Anticancer Res 33:1221–1227
Vogl TJ, Dommermuth A, Heinle B et al (2014) Colorectal cancer liver metastases: long-term survival and progression-free survival after thermal ablation using magnetic resonance-guided laser-induced interstitial thermotherapy in 594 patients: analysis of prognostic factors. Investig Radiol 49(1):48–56
Vogl TJ, Freier V, Nour-Eldin NE et al (2013) Magnetic resonance-guided laser-induced interstitial thermotherapy of breast cancer liver metastases and other noncolorectal cancer liver metastases: an analysis of prognostic factors for long-term survival and progression-free survival. Investig Radiol 48:406–412
Mulier S, Ni Y, Jamart J et al (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171
Charpentier KP, Wolf F, Noble L et al (2011) Irreversible electroporation of the liver and liver hilum in swine. HPB (Oxford) 13:168–173
Minami Y, Kudo M (2013) Radiofrequency ablation of liver metastases from colorectal cancer: a literature review. Gut Liver 7:1–6
Vogl TJ, Zegelman A, Bechstein WO et al (2013) Treatment of liver metastases of colorectal carcinoma: overview of hyperthermal ablation methods. Dtsch Med Wochenschr 138:792–798
Conflict of interest
Achim Eller, Axel Schmid, Joachim Schmidt, Matthias May, Michael Brand, Marc Saake, Michael Uder, and Michael Lell declare that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eller, A., Schmid, A., Schmidt, J. et al. Local Control of Perivascular Malignant Liver Lesions Using Percutaneous Irreversible Electroporation: Initial Experiences. Cardiovasc Intervent Radiol 38, 152–159 (2015). https://doi.org/10.1007/s00270-014-0898-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-014-0898-x