SIR 2024
Interventional Oncology
Jyoshitha Tella, BS (she/her/hers)
Medical Student
LECOM Erie
Financial relationships: Full list of relationships is listed on the CME information page.
Andrew Klobuka, MD
Interventional Radiology Attending
Allegheny Health Network
Disclosure information not submitted.
Pulsed Electrical Field (PEF) ablation, provided by the Aliya system, offers a precise solution for targeting focal tumor growth in proximity to critical anatomical structures that are traditionally resistant to thermal ablation methods. The PEF system delivers localized high-voltage, brief electrical pulses to alter a cell's transmembrane potential, inducing cellular imbalance and initiating non-thermal programmed cell death without harming cellular proteins or the extracellular matrix. This case series centers on the treatment of focal liver masses adjacent to the portal vein or inferior vena cava (IVC), focusing on the technology's safety profile.
Materials and Methods:
This case series enrolled six patients with isolated liver lesions: three with hepatocellular carcinoma (HCC), two with pancreatic adenocarcinoma metastatic to the liver, and one with hepatic adenoma. Depending on lesion location, ultrasound or CT scans guided the procedure. Local anesthesia was administered using 1% lidocaine. A 19-gauge Aliya needle was introduced into the lesion, and the inner stylet was replaced with the electrical field probe. For HCC masses, a 3.1 cm lesion required 7 activations, a 3 cm lesion required 8 activations, and a 1.5 cm lesion had 5 activations. Metastatic lesions necessitated 7 activations for a 2 cm mass and 10 activations for a 3 cm lesion. The hepatic adenoma, measuring 2 cm, required 7 activations. Post-ablation imaging revealed the expected accumulation of hyperechoic/hyperattenuated content within the lesion, with no immediate hemorrhagic complications. All patients tolerated the procedure well, with follow-up imaging planned for 60 days post-ablation.
Results:
Lesions were effectively ablated, even when located near critical structures like the portal vein or IVC. Patients reported minimal post-ablation side effects and were all discharged home same-day. Post-ablation imaging confirmed the integrity of portal vein and IVC anatomy, with no signs of acute hemorrhage.
Conclusion:
PEF therapy's precise ablation mechanism preserves sensitive structures adjacent to the treatment zone, including nerves and blood vessels, while safely achieving tumor ablation. These findings suggest that PEF therapy offers a viable option for lesions previously considered unsuitable for thermal ablation techniques. Ongoing follow-up imaging may reveal further reductions in tumor size or complete regression, with varying degrees of fibroplasia.