1. Safety and efficacy of irreversible electroporation (IRE) for the treatment of liver tumors
Petter Frühling Kirurgkliniken Hudiksvall, Anders Nilsson Röntgen Akademiska Sjukhuset, Frans Duraj, prof em Ulf Haglund,
Agneta Norén Kirurgkliniken Akademiska Sjukhuset.
Irreversible electroporation (IRE) is a safe treatment modality for a selected group of patients with liver tumors and offers high local tumor control at 3 and 6 months.
The treatment of patients with liver tumors is complex, often involving a combination of modalities such as surgery, chemotherapy, and some form of ablative modality.
IRE is a novel ablative modality, which can be used close to vital structures such as bile ducts or blood vessels without causing thermal injury.
IRE exposes the cell to high-voltage electrical pulses, which causes instability of the lipid bilayer by changing the transmembrane potential across the cell. Small molecules can now travel in and out of the cell, altering the homeostasis of the cell and contribute to its death.
Metastasis under the remaining left portal branch in a patient with colorectal cancer and previous right hemihepatectomy.
Same patient post-IRE-ablation contrast enhanced ultrasound (CEUS), longitudinal section showing the ablation zone around the intact portal vein including smaller branches.
Introduction
A single-center clinical trial was performed to assess safety and efficacy of IRE for the treatment of liver tumors in humans.
Method
38 malignant tumors on 30 patients were treated. The diagnoses were colorectal cancer with liver metastases (CRLM)(n=23), hepatocellular carcinoma (HCC) (n=8) and other metastases (n=7).
Inclusion criteria were tumor size <3cm, 1-2 tumors. Ablation success was defined as no evidence of residual tumor as observed on contrast-enhanced computed tomography (CE-CT) at 1 and 6 months, or contrast enhanced ultrasound (CE-US) at 3 months,
Results
Ablation success at 3 and 6 months was 78.9%, and 65.8% respectively.
No statistically significant difference between tumor volume (<5cm3 vs >5cm3, p=0.518), and between diagnosis (CRLM vs HCC, p=0.084) in terms of local recurrence.
13 patients had a transient increase in serum liver transaminases, 2 patients suffered from cardiac arrhythmia, 1 patient developed a hematoma, 1 patient developed an infection, and 1 patient developed a portal vein thrombosis and a bile duct stricture in the ablated area (treated with percutaneous transhepatic cholangiography (PTC) drainage catheter and stent in vena porta).
No mortalities occurred at 30 days. .
My research as a PhD student focuses on various aspects of the treatment for patients with colorectal cancer with metastases to the liver. .
Uppsala Akademiska SjukhusetSjukhus/Universitet
Petter Frühling ST läkare
Kirurgkliniken Hudiksvalls sjukhus, Doktorand vid Institutionen för kirurgiska vetenskaper
Akademiska sjukhuset ing 70 1 tr
UPPSALA
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