Percutaneous Ablation of Peribiliary Tumors with Irreversible Electroporation

doi:10.1016/j.jvir.2013.10.012

Journal of Vascular and Interventional Radiology

Volume 25, Issue 1, January 2014, Pages 112-118

https://doi.org/10.1016/j.jvir.2013.10.012 Get rights and content

Abstract

Purpose

To assess biliary complications after irreversible electroporation (IRE) ablation of hepatic tumors located < 1 cm from major bile ducts.

Materials and Methods

A retrospective review was conducted of all percutaneous IRE ablations of hepatic tumors within 1 cm of the common, left, or right hepatic ducts at a single institution from January 2011 to September 2012. Computed tomography imaging performed before and after treatment was examined for evidence of bile duct dilatation, stricture, or leakage. Serum bilirubin and alkaline phosphatase levels were analyzed for evidence of biliary injury.

Results

There were 22 hepatic metastases in 11 patients with at least one tumor within 1 cm of the common, left, or right hepatic duct that were treated with IRE ablations in 15 sessions. Median tumor size treated was 3.0 cm (mean, 2.8 cm ± 1.2, range, 1.0–4.7 cm). Laboratory values obtained after IRE were considered abnormal after four treatment sessions in three patients (bilirubin, 2.6–17.6 mg/dL; alkaline phosphatase, 130–1,035 U/L); these abnormal values were transient in two sessions. Two patients had prolonged elevation of values, and one required stent placement; both of these conditions appeared to be secondary to tumor progression rather than bile duct injury.

Conclusions

This clinical experience suggests that IRE may be a treatment option for centrally located liver tumors with margins adjacent to major bile ducts where thermal ablation techniques are contraindicated. Further studies with extended follow-up periods are necessary to establish the safety profile of IRE in this setting.

Section snippets

Materials And Methods

We obtained institutional review board approval to perform a retrospective review of all patients who underwent ablation using IRE for hepatic tumors with margins within 1 cm of the common hepatic duct or the first-order branches of the common duct (the left and right hepatic duct before further branching) performed at our institution from January 2011 to September 2012. The shortest distance between the tumor margin and the closest bile duct was measured on CT images (LightSpeed 16/LightSpeed

Electrode Placement

Needle placement was performed under CT (LightSpeed 16) or positron emission tomography (PET)/CT (Discovery PET/CT 690; GE Medical Systems) guidance. Electrodes were placed such that the active exposed needle tip of each probe was approximately parallel to its companion. Image reconstructions along the electrode axis were performed to measure distance between the tips of the electrodes to adjust treatment parameters on the IRE planning console accordingly. The number of electrodes used depended

Results

From January 2011 to September 2012, 11 patients with at least one hepatic tumor with radiographic margins located within 1 cm of a major bile duct were treated with IRE in 15 sessions. Patient demographics are listed in Table 1. Eight patients had more than one liver metastasis and were concurrently treated in one session with additional IRE (n = 4), radiofrequency ablation (n = 3), and microwave ablations (n = 1). Radiofrequency ablation and microwave ablations were performed in different

Discussion

IRE is assumed to work by creating permanent nanopores in cell membranes that lead to an increased influx of extracellular ions. These ions are cleared by adenosine triphosphate–dependent ion pumps resulting in intracellular depletion of adenosine triphosphate, which subsequently leads to cell death by apoptosis (16) with tissues reaching a maximum apoptotic rate after 24 hours (17). Animal studies investigating IRE in the liver have shown minimal effects on the biliary tree with no

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Cited by (139)

Electrolysis products, reactive oxygen species and ATP loss contribute to cell death following irreversible electroporation with microsecond-long pulsed electric fields
2024, Bioelectrochemistry
Membrane permeabilization and thermal injury are the major cause of cell death during irreversible electroporation (IRE) performed using high electric field strength (EFS) and small number of pulses. In this study, we explored cell death under conditions of reduced EFS and prolonged pulse application, identifying the contributions of electrolysis, reactive oxygen species (ROS) and ATP loss. We performed ablations with conventional high-voltage low pulse (HV-LP) and low-voltage high pulse (LV-HP) conditions in a 3D tumor mimic, finding equivalent ablation volumes when using 2000 V/cm 90 pulses or 1000 V/cm 900 pulses respectively. These results were confirmed by performing ablations in swine liver. In LV-HP treatment, ablation volume was found to increase proportionally with pulse numbers, without the substantial temperature increase seen with HV-LP parameters. Peri-electrode pH changes, ATP loss and ROS production were seen in both conditions, but LV-HP treatments were more sensitive to blocking of these forms of cell injury. Increases in current drawn during HV-LP was not observed during LV-HP condition where the total ablation volume correlated to the charge delivered into the tissue which was greater than HV-LP treatment. LV-HP treatment provides a new paradigm in using pulsed electric fields for tissue ablation with clinically relevant volumes.
Outcomes of Irreversible Electroporation for Perihilar Cholangiocarcinoma: A Prospective Pilot Study
2022, Journal of Vascular and Interventional Radiology
To investigate the safety and efficacy of percutaneous or open irreversible electroporation (IRE) in a prospective cohort of patients with locally advanced, unresectable perihilar cholangiocarcinoma (PHC).
In a multicenter Phase I/II study, patients with unresectable PHC due to extensive vascular involvement or N2 lymph node metastases or local recurrence after resection for PHC were included and treated by open or percutaneous IRE combined with palliative chemotherapy (current standard of care). The primary outcome was the number of major adverse events occurring within 90 d after IRE (grade ≥3), and the upper limit was predefined at 60%. Secondary outcomes included technical success rate, hospital stay, and overall survival (OS).
Twelve patients (mean age, 63 y ± 12) were treated with IRE. The major adverse event rate was 50% (6 of 12 patients), and no 90-d mortality was observed. All procedures were technically successful, with no intraprocedural adverse events requiring additional interventions. The median OS from diagnosis was 21 mos (95% confidence interval, 15–27 mos), with a 1-y survival rate of 75% after IRE.
Percutaneous IRE in selected patients with locally advanced PHC seems feasible, with a major adverse event rate of 50%, which was below the predefined upper safety limit in this prospective study. Future comparative research exploring the efficacy of IRE is warranted.
Irreversible electroporation for liver cancer ablation: A meta analysis
2022, European Journal of Surgical Oncology
To evaluate the efficacy and safety of IRE in the treatment of hepatic malignant tumors, especially the damage to the gastrointestinal tract, bile ducts, and vital vessels.
The relevant literatures published from January 1, 2010 to July 1, 2021 were searched from PubMed and Embase databases. The following keywords were applied: “irreversible electroporation”, “IRE”, “unresectable Hepa∗ cancer”, “ablation” and “ablation therapy".
Twenty-six studies were identified covering 807 participants and 1115 lesions. The complete ablation rate of liver cancer by IRE was 86% (95% CI: 81%–90%). The incidence of IRE-related complications was 23% (95% CI: 17%–28%), but most of them were minor, major complications such as biliary fistula, intestinal fistula and massive hemorrhage were rare.
Meta-analysis showed that IRE ablation is safe and effective for liver cancer treatment. Bile duct, intestine and blood vessels adjacent to the tumors are rarely damaged by IRE ablation.
Calculating transmembrane voltage on the electric pulse-affected cell membrane: Using molecular dynamics and finite element simulations
2024, Research Square
Multi-parameter Effect Analysis and Large Living Animal Experimental Study of Synergistic Pulse-enhanced Irreversible Electroporation Ablation
2023, Gaodianya Jishu/High Voltage Engineering
Percutaneous image-guided ablation for hepatic metastases
2023, Journal of Medical Imaging and Radiation Oncology

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: S.B.S. received an unrestricted grant and equipment from AngioDynamics and is a consultant for Covidien and Johnson&Johnson. None of the other authors have identified a conflict of interest.

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Clinical StudyPercutaneous Ablation of Peribiliary Tumors with Irreversible Electroporation

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Materials And Methods

Electrode Placement

Results

Discussion

J Vasc Interv Radiol

HPB

J Vasc Interv Radiol

J Vasc Interv Radiol

J Am Coll Surg

Biochem Biophys Res Commun

J Vasc Interv Radiol

J Am Coll Surg

Int J Heat Mass Transfer

Urology

Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer. I. Treatment by hepatic resection

Ann Surg

Resection of hepatic metastases from colorectal cancer: biologic perspectives

Ann Surg

The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment

Ann Surg

Quality improvement guidelines for radiofrequency ablation of liver tumours

Cardiovasc Intervent Radiol

Clinical Study
Percutaneous Ablation of Peribiliary Tumors with Irreversible Electroporation