Clinical StudyPercutaneous Ablation of Peribiliary Tumors with Irreversible Electroporation
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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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.