Irreversible electroporation of unresectable soft tissue tumors with vascular invasion: effective palliation

BMC Cancer

Robert CG Martin¹  Prejesh Philips¹  Susan Ellis¹  David Hayes¹  Sandeep Bagla¹ 

[1] Department of Interventional Radiology, INOVA, Alexandria, VA, Egypt

关键词: Safety;    Pancreatic tumors;    Liver tumors;    Vascular invasion;    Locally advanced tumors;    Irreversible electroporation;   

Others  :  1125294
DOI  :  10.1186/1471-2407-14-540

 received in 2014-01-03, accepted in 2014-07-15,  发布年份 2014

【 摘 要 】

Background

Irreversible electroporation (IRE) has recently been added as an additional therapeutic ablative option in patients with locally advanced cancers (LAC) involving vital structures. IRE delivers localized electric current by peri-tumoral discrete probes to attain irreversible changes in cell membrane leading to cell death. The aim of this study was to evaluate the long-term effects of IRE in the treatment of locally advanced tumors.

Methods

A prospective IRB approved evaluation of 107 consecutive patients from 7 institutions with tumors that had vascular invasion treated with IRE from 5/2010 to 1/2012. LAC was defined as primary tumor with <5 mm from major vascular structure based on pre-operative dynamic imaging or intra-operative criteria.

Results

IRE as utilized in LAC in the liver (N = 42, 40%) and pancreas (N = 37, 35%), with a median number of lesions being 2 with a mean target size of 3 cm. IRE attributable morbidity rate was 13.3% (total 29.3%) with high-grade complications seen in 4.19% (total 12.6%). No significant vascular complications were seen, and of the high-grade complications, bleeding (2), biliary complications (3) and DVT/PE (3) were the most common. Complications were more likely with pancreatic lesions (p = 0.0001) and open surgery (p = 0.001). Calculated local recurrence free survival (LRFS) was 12.7 months with a median follow up of 26 months censured at last follow up. The tumor target size was inversely associated with recurrence free survival (b = 0.81, 95% CI: 1.6 to 4.7, p value = 0.02) but this did not have a significant overall survival impact.

Conclusions

IRE represents a novel therapeutic option in patients with LAC involving vital structures that are not amenable to surgical resection. Acceptable to high local disease control and the long LRFS can be achieved with this therapy in combination with other multi-disciplinary therapies.

【 授权许可】

   
2014 Martin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Neumann E, Schaefer-Ridder M, Wang Y, Hofschneider PH: Gene transfer into mouse lyoma cells by electroporation in high electric fields. Embo J 1982, 1:841-845.
• [2]Davalos RV, Mir IL, Rubinsky B: Tissue ablation with irreversible electroporation. Ann Biomed Eng 2005, 33:223-231.
• [3]Maor E, Ivorra A, Leor J, Rubinsky B: The effect of irreversible electroporation on blood vessels. Technol Cancer Res Treat 2007, 6:307-312.
• [4]Bower M, Sherwood L, Li Y, Martin R: Irreversible electroporation of the pancreas: definitive local therapy without systemic effects. J Surg Oncol 2011, 104:22-28.
• [5]Charpentier KP, Wolf F, Noble L, Winn B, Resnick M, Dupuy DE: Irreversible electroporation of the liver and liver hilum in swine. HPB (Oxford) 2011, 13:168-173.
• [6]Charpentier KP, Wolf F, Noble L, Winn B, Resnick M, Dupuy DE: Irreversible electroporation of the pancreas in swine: a pilot study. HPB (Oxford) 2010, 12:348-351.
• [7]Cannon R, Ellis S, Hayes D, Narayanan G, Martin RC 2nd: Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol 2013, 107:544-549.
• [8]Martin RC 2nd, McFarland K, Ellis S, Velanovich V: Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma. J Am Coll Surg 2012, 215:361-369.
• [9]Martin RC 2nd, McFarland K, Ellis S, Velanovich V: Irreversible electroporation in locally advanced pancreatic cancer: potential improved overall survival. Ann Surg Oncol 2012, 20(Suppl 3):S443-S449.
• [10]Martin RC: Irreversible electroporation of locally advanced pancreatic head adenocarcinoma. J Gastrointest Surg 2013, 17(10):1850-1856.
• [11]Martin RCG: Irreversible electroporation: a novel option for treatment of hepatic metastases. Curr Colorectal Cancer Rep 2013, 9:191-197.
• [12]Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 2000, 92:205-216.
• [13]Grambsch PM, Therneau TM, Fleming TR: Diagnostic plots to reveal functional form for covariates in multiplicative intensity models. Biometrics 1995, 51:1469-1482.
• [14]Chang DC, Reese TS: Changes in membrane structure induced by electroporation as revealed by rapid-freezing electron microscopy. Biophys J 1990, 58:1-12.
• [15]Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST, Wong J: Learning curve for radiofrequency ablation of liver tumors: prospective analysis of initial 100 patients in a tertiary institution. Ann Surg 2004, 239:441-449.
• [16]Yan TD, King J, Sjarif A, Glenn D, Steinke K, Morris DL: Learning curve for percutaneous radiofrequency ablation of pulmonary metastases from colorectal carcinoma: a prospective study of 70 consecutive cases. Ann Surg Oncol 2006, 13:1588-1595.
• [17]Thomson KR, Cheung W, Ellis SJ, Federman D, Kavnoudias H, Loader-Oliver D, Roberts S, Evans P, Ball C, Haydon A: Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol 2011, 22:611-621.
• [18]Hildebrand P, Leibecke T, Kleemann M, Mirow L, Birth M, Bruch HP, Burk C: Influence of operator experience in radiofrequency ablation of malignant liver tumours on treatment outcome. Eur J Surg Oncol 2006, 32:430-434.
• [19]Orgera G, Krokidis M, Monfardini L, Bonomo G, Della Vigna P, Fazio N, Orsi F: High intensity focused ultrasound ablation of pancreatic neuroendocrine tumours: report of two cases. Cardiovasc Intervent Radiol 2011, 34:419-423.
• [20]Orsi F, Zhang L, Arnone P, Orgera G, Bonomo G, Vigna PD, Monfardini L, Zhou K, Chen W, Wang Z, Veronesi U: High-intensity focused ultrasound ablation: effective and safe therapy for solid tumors in difficult locations. AJR Am J Roentgenol 2010, 195:W245-W252.
• [21]Zhang L, Zhu H, Jin C, Zhou K, Li K, Su H, Chen W, Bai J, Wang Z: High-intensity focused ultrasound (HIFU): effective and safe therapy for hepatocellular carcinoma adjacent to major hepatic veins. Eur Radiol 2009, 19:437-445.