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Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes

Lookup NU author(s): Sebastian Mafeld, Dr Peter Littler

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

Irreversible electroporation (IRE) is a non-thermal ablative option in patients unsuitable for standard thermal ablation, due to its potential to preserve collagenous structures (vessels and ducts) and a reduced susceptibility to heat sink effects. In this series from two large tertiary referral hepatobiliary centres, we aim to assess the safety/outcomes of hepatic IRE.Bi-institutional retrospective, longitudinal follow-up series of IRE for primary hepatic malignancy; [hepatocellular carcinoma (n=20), cholangiocarcinoma (n=3)] and secondary metastatic disease; colorectal (n = 28), neuroendocrine (n = 1), pancreatic (n = 1), breast (n = 1), gastrointestinal stromal tumour (GIST, n = 1) and malignant thymoma (n = 1). Outcome measures included procedural safety/effectiveness, time to progression and time to death.Between 2013 and 2017, 52 patients underwent percutaneous IRE of 59 liver tumours in 53 sessions. All tumours were deemed unsuitable for thermal ablation. Cases were performed using ultrasound (US) or computed tomography (CT) guidance. A complete ablation was achieved in n = 44, (75%) of cases with an overall complication rate of 17% (n = 9). Of the complete ablation group, median time to progression was 8 months. At 12 months, 44% were progression-free (95% CI 30–66%). The data suggest that larger lesion size (> 2 cm) is associated with shorter time to progression and there is highly significant difference with faster time to progression in mCRC compared with HCC. Median survival time was 38 months.This bi-institutional review is the largest UK series of IRE and suggests this ablative technology can be a useful tool, but appears to mainly induce local tumour control rather than cure with HCC having better outcomes than mCRC.


Publication metadata

Author(s): Mafeld S, Wong JJ, Kibriya N, Stenberg B, Manas D, Bassett P, Aslam T, Evans J, Littler P

Publication type: Article

Publication status: Published

Journal: CardioVascular and Interventional Radiology

Year: 2019

Volume: 42

Issue: 4

Pages: 577-583

Print publication date: 01/04/2019

Online publication date: 21/11/2018

Acceptance date: 09/11/2018

Date deposited: 23/11/2018

ISSN (print): 0174-1551

ISSN (electronic): 1432-086X

Publisher: Springer US

URL: https://doi.org/10.1007/s00270-018-2120-z

DOI: 10.1007/s00270-018-2120-z


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