Irreversible Electroporation For Hepatocellular Carcinoma: Longer-Term Outcomes At A Single Centre
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CLINICAL INVESTIGATION
INTERVENTIONAL ONCOLOGY
Irreversible Electroporation For Hepatocellular Carcinoma: Longer-Term Outcomes At A Single Centre E. Freeman1
•
W. Cheung2 • A. Majeed1,3 • W. Kemp1,3 • S. K. Roberts1,3
Received: 26 June 2020 / Accepted: 22 September 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Background and Aims Irreversible electroporation (IRE) is a non-thermal ablation technique for unresectable hepatocellular carcinoma (HCC) not amenable to standard thermal ablation. The aim of this study was to report our longer-term outcomes using this treatment modality. Method We identified all patients at our institution who underwent IRE for HCC between December 2008 and October 2019 as recommended after multi-disciplinary team review. Demographic, clinical, tumour response and survival data up until 1 March, 2020 were analysed. The primary outcome was local recurrence-free survival (LRFS) in patients who had a complete response (CR). Secondary outcomes included CR rates, procedure-related complications and the incidence of death or liver transplantation. Results A total of 23 patients (78% males, median age 65.2 years) received IRE therapy to 33 HCC lesions during the study period with the median tumour size being 2.0 cm (range 1.0–5.0 cm). Twenty-nine (87.9%) lesions were successfully ablated after one (n = 26) or two (n = 3) procedures. The median follow-up time for these lesions was 20.4 months. The median overall LRFS was 34.5 (95% CI 24.8 -) months with a 6- and 12-month LRFS of
& S. K. Roberts [email protected] 1
Department of Gastroenterology, Alfred Hospital, The Alfred55 Commercial Rd, Melbourne 3004, Australia
2
Department of Radiology, Alfred Hospital, Melbourne, Australia
3
Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
87.9% (95% CI 75.8–100) and 83.6% (95% CI 70.2–99.7), respectively. Tumours \ 2 cm had a 12-month LRFS of 100% (95% CI 100–100). Conclusion IRE appears to be an efficacious local ablative method for early stage HCC not amenable to standard ablative techniques, with very good CR rates and longerterm LRFS, particularly for smaller lesions. Further studies comparing this technique to more widely accepted ablative methods such as radiofrequency and microwave ablation are warranted. Keywords Irreversible Electroporation Hepatocellular Carcinoma Survival Recurrence Ablation Liver Neoplasms Radiofrequency Ablation Microwave Ablation Tumour Electroporation
Introduction Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide and accounts for more than 80% of primary liver cancers [1]. Despite improved screening, universal hepatitis B vaccination and the advent of highly effective direct acting antiviral therapies for Hepatitis C, the World Health Organization (WHO) still estimates that over 1 million people will die from liver cancer in 2030 [2]. While the imple
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