Irreversible Electroporation: a Novel Option for Treatment of Hepatic Metastases
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COLORECTAL CANCER HEPATIC METASTASES (KK TANABE, SECTION EDITOR)
Irreversible Electroporation: a Novel Option for Treatment of Hepatic Metastases Robert C. G. Martin II
Published online: 7 April 2013 # Springer Science+Business Media New York 2013
Abstract Irreversible electroporation (IRE) has shown promise for ablation of lesions in proximity to vital structures in the preclinical and now clinical setting. Studies of patients undergoing IRE for treatment of metastatic colorectal cancer to the liver were reviewed for patient and tumor characteristics, treatment-related complications, and local recurrence-free survival (LRFS) for ablated lesions. LRFS was calculated according to the Kaplan–Meier method, with secondary analyses stratified by procedural approach (laparotomy, laparoscopy, percutaneous) and tumor histological characteristics. Initial IRE success has been achieved in 95 % of treatments. The LRFS rates at 3, 6, and 12 months were 97.4 %, 94.6 %, and 59.5 %. There was a trend toward higher recurrence rates for tumors larger than 4 cm (hazard ratio 3.236, 95 % confidence interval 0.585-17.891; p=0. 178). IRE is a safe and effective treatment for metastatic colorectal cancer to the liver near vital structures. Continued evaluation is needed to determine optimal probe design and techniques. Keywords Metastatic colorectal cancer . Irreversible electroporation . Liver ablation
Introduction Hepatic resection remains the most effective therapy for colorectal liver metastasis (CLM), with a greater than 5year overall survival achieved in more than 50 % of patients. However, even in patients with liver-only disease, the location of that disease and/or poor underlying liver function mean that the number of patients who are candidates for this potentially curative approach is relatively small. In light of R. C. G. Martin II (*) Department of Surgery, Division of Surgical Oncology, University of Louisville, 315 East Broadway, Suite 314, Louisville, KY 40202, USA e-mail: [email protected]
the limited applicability of surgical resection to many patients with CLM, a number of ablative technologies have been developed to provide liver-directed therapy. Among these are radiofrequency ablation (RFA) [1–3], ethanol ablation [4, 5], laser ablation [6–8], cryoablation [9], highintensity focused ultrasound [10], microwave ablation [11, 12], and stereotactic body radiation therapy [13•]. These thermal ablative technologies all rely on transfer of thermal energy to the surrounding tissue for its effect. Similar limitations in relation to size and location have limited the use and effectiveness of these modalities. Studies of livers explanted after RFA have demonstrated that the rate of complete tumor necrosis falls below 50 % when there are vessels larger than 3 mm abutting the tumor, a consequence of the heat sink effect [14]. There is similar difficulty in achieving complete ablation for lesions in a subcapsular location or close to the gallbladder [15, 16]. Similar limitations around safety have also been demonst
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