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Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience

  • Clinical Investigation
  • Interventional Oncology
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CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the efficacy and safety of irreversible electroporation (IRE) in the treatment of unresectable hepatocellular carcinoma (HCC).

Materials and Methods

A retrospective study was conducted from September 2014 to June 2017. A total of 21 HCCs in 21 patients with cirrhosis were treated with IRE. There were eight subcapsular or exophytic, ten perivascular and three peribiliary tumors. The median tumor size was 26 mm (range 14–40 mm). The technical success of the procedure was recorded. Median follow-up, median time to local recurrence, median local tumor progression-free survival (PFS) and complications were recorded.

Results

Technical success was achieved in all the patients. The median follow-up was 10 months (range 2–30 months). The median time to local recurrence and local tumor PFS were 4 months (range 3–4 months) and 7 months (range 3–30 months), respectively. The tumor-related factor that was significantly associated with local PFS was the size. Maximum tumor diameter < 25 mm was significantly associated with local tumor PFS (p = 0.045). Other parameters including tumor location, segmental portal vein thrombosis, baseline alpha-fetoprotein level and underlying etiology did not affect local tumor PFS. Complications were noted in nine patients and were classified as grades 1 and 2. No procedure-related mortality was encountered.

Conclusion

IRE is an effective treatment for ablation of small HCCs. Larger prospective studies with strict selection criteria will establish the safety and efficacy of IRE in the treatment of unresectable HCC in patients who cannot undergo thermal ablation.

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References

  1. Lu DS, Yu NC, Raman SS, et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology. 2005;234:954–60.

    Article  PubMed  Google Scholar 

  2. Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng. 2005;33:223–31.

    Article  PubMed  CAS  Google Scholar 

  3. Charpentier KP. Irreversible electroporation for the ablation of liver tumors: are we there yet? Arch Surg. 2012;147:1053–61.

    Article  PubMed  Google Scholar 

  4. Cannon R, Ellis S, Hayes D, Narayanan G, Martin RC II. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol. 2013;107:544–9.

    Article  PubMed  Google Scholar 

  5. Cheng RG, Bhattacharya R, Yeh MM, Padia SA. Irreversible electroporation can effectively ablate hepatocellular carcinoma to complete pathologic necrosis. J Vasc Interv Radiol. 2015;26:1184–8.

    Article  PubMed  Google Scholar 

  6. Kingham TP, Karkar AM, D’Angelica MI, et al. Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg. 2012;215:379–87.

    Article  PubMed  Google Scholar 

  7. Niessen C, Beyer LP, Pregler B, et al. Percutaneous ablation of hepatic tumors using irreversible electroporation: a prospective safety and midterm efficacy study in 34 patients. J Vasc Interv Radiol. 2016;27:480–6.

    Article  PubMed  Google Scholar 

  8. 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;26:694–702.

    Article  PubMed  Google Scholar 

  9. Scheffer HJ, Nielsen K, van Tilborg AA, et al. Ablation of colorectal liver metastases by irreversible electroporation: results of the COLDFIRE-I ablate-and-resect study. Eur Radiol. 2014;24:2467–75.

    Article  PubMed  CAS  Google Scholar 

  10. Scheffer HJ, Vroomen LG, Nielsen K, et al. Colorectal liver metastatic disease: efficacy of irreversible electroporation—a single-arm phase II clinical trial (COLDFIRE-2 trial). BMC Cancer. 2015;15:772.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Silk MT, Wimmer T, Lee KS, et al. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol. 2014;25:112–8.

    Article  PubMed  Google Scholar 

  12. Sugimoto K, Moriyasu F, Kobayashi Y, et al. Irreversible electroporation for nonthermal tumor ablation in patients with hepatocellular carcinoma: initial clinical experience in Japan. Jpn J Radiol. 2015;33:424–32.

    Article  PubMed  Google Scholar 

  13. Distelmaier M, Barabasch A, Heil P, et al. Midterm safety and efficacy of irreversible electroporation of malignant liver tumors located close to major portal or hepatic veins. Radiology. 2017;285:1023–31.

    Article  PubMed  Google Scholar 

  14. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40:1141–6.

    Article  CAS  Google Scholar 

  15. Sutter O, Calvo J, N’Kontchou G, et al. Safety and efficacy of irreversible electroporation for the treatment of hepatocellular carcinoma not amenable to thermal ablation techniques: a retrospective single-center case series. Radiology. 2017;284:877–86.

    Article  PubMed  Google Scholar 

  16. Zeng J, Liu G, Li ZH, et al. The safety and efficacy of irreversible electroporation for large hepatocellular carcinoma. Technol Cancer Res Treat. 2017;16:120–4.

    Article  PubMed  Google Scholar 

  17. Potretzke TA, Ziemlewicz TJ, Hinshaw JL, et al. Microwave versus radiofrequency ablation treatment for hepatocellular carcinoma: a comparison of efficacy at a single center. J Vasc Interv Radiol. 2016;27:631–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yang W, Yan K, Wu G-X, et al. Radiofrequency ablation of hepatocellular carcinoma in difficult locations: strategies and long-term outcomes. World J Gastroenterol. 2015;21:1554–66.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Livraghi T, Goldberg SN, Lazzaroni S, et al. Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions. Radiology. 2000;214:761–8.

    Article  PubMed  CAS  Google Scholar 

  20. Manini MA, Sangiovanni A, Martinetti L, et al. Transarterial chemoembolization with drug-eluting beads is effective for the maintenance of the Milan-in status in patients with a small hepatocellular carcinoma. Liver Transpl. 2015;21:1259–69.

    Article  PubMed  Google Scholar 

  21. Yang Y, Qin Z, Du D, Wu Y, Qiu S, Mu F, Xu K, Chen J. Safety and short-term efficacy of irreversible electroporation and allogenic natural killer cell immunotherapy combination in the treatment of patients with unresectable primary liver cancer. Cardiovasc Interv Radiol. 2018. https://doi.org/10.1007/s00270-018-2069-y.

    Article  Google Scholar 

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Acknowledgements

Karthik Rayasam and Kiruthika Palani, Residents of the Department of Radiodiagnosis and Imaging helped in data collection.

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Authors and Affiliations

  1. Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Naveen Kalra, Ujjwal Gorsi, Harish Bhujade, Shreedhara B. Chaluvashetty & Niranjan Khandelwal

  2. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Pankaj Gupta

  3. Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Ajay Duseja, Virendra Singh, Radha K. Dhiman & Yogesh K. Chawla

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  1. Naveen Kalra
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  2. Pankaj Gupta
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  5. Shreedhara B. Chaluvashetty
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  9. Yogesh K. Chawla
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  10. Niranjan Khandelwal
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Correspondence to Naveen Kalra.

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The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Procedural informed consent was obtained from all individual participants included in the study.

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Kalra, N., Gupta, P., Gorsi, U. et al. Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience. Cardiovasc Intervent Radiol 42, 584–590 (2019). https://doi.org/10.1007/s00270-019-02164-2

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  • DOI: https://doi.org/10.1007/s00270-019-02164-2

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