Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go

 

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Abstract

Irreversible electroporation (IRE) is the latest in the series of image-guided locoregional tumor ablation therapies. IRE is performed in a nearly non-thermal fashion that circumvents the „heat sink effect“ and allows for IRE application in proximity to critical structures such as bile ducts or neurovascular bundles, where other techniques are unsuitable. IRE appears generally feasible and initial reported results for tumor ablation in the liver, pancreas and prostate are promising. Additionally, IRE demonstrates a favorable safety profile. However, site-specific complications include bile leaking or vein thrombosis and may be more severe after pancreatic IRE compared to liver or prostate ablation. There is limited clinical evidence in support of the use of IRE in the kidney. In contrast, pulmonary IRE has so far failed to demonstrate efficacy due to practicability limitations. Hence, this review will provide a state-of-the-art update on available clinical evidence of IRE regarding feasibility, safety and oncologic efficacy. The future role of IRE in the minimally invasive treatment of solid tumors will be discussed.

Key points:

• Preclinical findings of IRE have been successfully translated into clinical settings.

• Non-thermal ablation is able to prevent the "heat sink effect" and collateral damage.

• IRE should primarily be applied to tumors adjacent to sensitive structures (e. g. bile ducts).

IRE efficacy appears promising in the liver, pancreas and prostate with tolerable morbidity.

• In contrast, there are no evidential benefits of IRE in the lung parenchyma.

Citation Format:

• Savic LJ, Chapiro J, Hamm B et al. Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go. Fortschr Röntgenstr 2016; 188: 735 – 745

Zusammenfassung

Die irreversible Elektroporation (IRE) ist eine neuartige Gewebeablationstechnik zur bildgesteuerten lokoregionalen Tumortherapie. Im Gegensatz zu thermischen Methoden stellt die IRE ein überwiegend nicht-thermisches Ablationsverfahren dar, dessen Wirksamkeit folglich nicht durch den „heat sink effect“ limitiert wird. Ein weiterer Vorteil ist die Anwendbarkeit der IRE in Tumoren, welche unmittelbar an sensiblen Strukturen wie Gefäßnerven-Bahnen und Gallenwegen lokalisiert sind. In bisherigen Studien konnte die Durchführbarkeit der IRE in verschiedenen Tumorentitäten erfolgreich demonstriert werden. Hinsichtlich der klinischen Wirksamkeit konnten insbesondere für die Ablation in Leber-, Pankreas- und Prostatatumoren erste vielversprechende Ergebnisse verzeichnet werden. Komplikationen waren insgesamt selten und traten am häufigsten durch Verletzung von Gallengängen oder Blutgefäßen und dabei eher bei IRE in Pankreas- als in Leber- oder Prostatatumoren auf. Die praktische Ausführbarkeit von IRE in der Niere wurde bisher nur in wenigen Studien gezeigt. Für den Einsatz des Verfahrens bei pulmonalen Raumforderungen konnten aufgrund eingeschränkter Durchführbarkeit bisher keine Vorteile gezeigt werden. Die folgende Übersichtsarbeit stellt eine strukturierte Zusammenfassung zum Stand der klinischen Forschung bereit und diskutiert potentielle Indikationen für IRE in der minimalinvasiven Ablationstherapie solider Tumoren.

Kernaussagen:

• Präklinisch gewonnene Erkenntnisse wurden erfolgreich in die klinische Anwendung der IRE übertragen.

• Durch nicht-thermische Ablation können „heat-sink-effect“ und Koagulationsverletzungen unbeteiligter Strukturen umgangen werden.

• Die IRE sollte vorrangig bei Tumoren in unmittelbarer Umgebung sensibler Strukturen (z. B. Gallengängen) Anwendung finden.

• Insbesondere für Leber, Pankreas und Prostata zeigt die IRE eine gute onkologische Wirksamkeit bei geringer Komplikationsrate.

• Währenddessen konnten für die Anwendung bei Lungentumoren keine Vorteile der IRE gegenüber gängigen Verfahren gezeigt werden.

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