SIR 2024
Interventional Oncology
Julia Gallagher, BA (she/her/hers)
Medical Student
University of South Florida Morsani College of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Vaiva Gustainyte, DO
Assistant Professor of Oncologic Sciences; Assistant Member of Interventional Radiology
H. Lee Moffitt Cancer Center
Disclosure information not submitted.
Aditya Garg, BA
Medical Student
University of South Florida Morsani College of Medicine
Disclosure information not submitted.
Ghassan El-Haddad, MD
Senior Member Interventional Radiology, Medical Director Radiopharmaceutical Therapy Program
Moffitt Cancer Center and Research Institute
Financial relationships: Full list of relationships is listed on the CME information page.
Junsung Choi, MD
SR MBR DIAGRADINT
H. Lee Moffitt Cancer Center
Disclosure information not submitted.
Bela Kis, MD, PhD, FSIR (he/him/his)
Section Head of Interventional Radiology, Senior Member and Vice Chair in the Diagnostic Imaging & Interventional Radiology Program
Moffitt Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Irreversible electroporation (IRE) is a non-thermal ablation technique that uses high-voltage electrical pulses to disrupt cell membranes and induce apoptosis. IRE has been implemented as a treatment for primary and metastatic liver tumors. Due to its non-thermal properties, IRE is often performed on tumors located near critical anatomic structures where heat-based ablation cannot be applied. The purpose of this study was to evaluate the safety and efficacy of IRE of liver tumors adjacent to sensitive structures (≤ 0.5 cm) including major bile ducts, gallbladder, stomach, and bowel. The diaphragm, large blood vessels, and the heart were not regarded as critical structures since in our practice we use heat-based ablation adjacent to these.
Materials and Methods:
This single institution retrospective study included 23 patients (11 males, 12 females, mean age 64.5 years) who underwent IRE of 25 liver tumors adjacent to sensitive structures between May 2013 and October 2022. Of the 25 lesions, 8 tumors were hepatocellular carcinoma and 17 were metastases (8 colorectal, 3 neuroendocrine, 2 breast, 1 melanoma, 1 leiomyosarcoma, 1 cholangiocarcinoma, 1 gallbladder). The safety of IRE was evaluated based upon procedural and post-procedural adverse events and lab values 3 months following the procedure.
Results:
The median distance to a critical structure was 0 cm (range 0-0.5 cm), and the median tumor size was 1.7 cm. A median of 4 IRE needles/procedure were used. The distances between needles were 1.5 to 2.0 cm. The median number of pulses was 90 with a median minimum voltage of 2200 V and maximum of 3000 V. There were 3 grade 3 post-procedural complications (decreased oxygen saturation and 2 lab toxicities) and 33 grade 1 and 2 complications. There was no biliary stricture or occlusion or biloma development. A grade 1 focal abscess developed when the ablation zone extended into a bowel loop. The median follow-up was 20.2 months (range 4.1-54.0 months). 48% of patients (n=11) had tumor recurrence with a median tumor recurrence time of 20.6 months (95% CI 3.6 -37.6 months). There was no significant difference between the distance to critical structures in the recurrence and non-recurrence groups (p=0.225).
Conclusion:
IRE ablation of liver tumors located near major bile ducts and the gallbladder is safe and effective. IRE ablation extending into the bowel wall can promote bacterial transmigration leading to abscess or peritonitis.