Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.
Technol Cancer Res Treat. 2013 Jun;12(3):233-41. doi: 10.7785/tcrt.2012.500317. Epub 2013 Jan 25.
The aims of this study were to evaluate the safety, feasibility and tumour response of _irreversible electroporation, a non-thermal ablation technique, for the treatment of unresectable hepatocellular carcinoma. The endpoints were safety and local treatment efficacy. Patients with unresectable tumours and tumours not amenable for radiofrequency _ablation because of their vicinity to organs vulnerable to thermal damage such as the bowel or because they were close to large blood vessels that would limit efficacy of ablation due to the heat sink effect were treated with irreversible electroporation using percutaneous _ultrasound and/or computed tomography guided electrode placement between November 2008 and _December 2009. Early, late, minor and major complications were recorded. Tumour response was determined on triphasic helical computed tomography follow-up at one month, then every three months post-procedure. Eleven patients received IRE therapy to 18 HCC lesions (Mean diameter 2.44 ± 0.99 cm; range 1.0-6.1 cm) with five patients having more than one treated HCC. Mean follow-up was 18 months (range 14-24 months). Six patients required repeat treatments for local residual or recurrent disease; two of these also had IRE for distant intrahepatic recurrence. No serious complications were observed despite seven lesions lying adjacent to important structures or organs. Four patients developed transient urinary retention and seven developed transient local post-procedure pain. After IRE therapy, 13 (72%) lesions were completely ablated with 93% success for lesions ≤ 3 cm (13/14). The local recurrence-free period was 18 ± 4 months and the distance recurrence free period was 14 ± 6 months. These preliminary results suggest that IRE is a safe and feasible technique for local ablation of HCC, particularly for lesions less than 3 cm. No major complications were encountered during this study even for tumours close to essential structures or organs.
本研究旨在评估不可逆电穿孔（IRE）作为一种非热消融技术治疗不可切除肝癌的安全性、可行性和肿瘤反应。终点是安全性和局部治疗效果。对于因靠近易受热损伤的器官（如肠道）而无法进行射频消融的不可切除肿瘤，或因靠近大血管而限制消融效果的热沉效应而不适合进行射频消融的肿瘤，采用经皮超声和/或计算机断层扫描引导的电极放置进行不可逆电穿孔治疗，治疗时间为 2008 年 11 月至 2009 年 12 月。记录早期、晚期、轻微和严重并发症。在术后一个月的螺旋 CT 三期增强扫描时评估肿瘤反应，然后每三个月评估一次。11 例患者的 18 个 HCC 病灶接受了 IRE 治疗（平均直径 2.44±0.99cm；范围 1.0-6.1cm），其中 5 例患者有多个治疗的 HCC。平均随访时间为 18 个月（14-24 个月）。6 例患者因局部残留或复发疾病需要重复治疗，其中 2 例还因肝内远处复发而接受了 IRE。尽管有 7 个病灶紧邻重要结构或器官，但未观察到严重并发症。4 例患者出现短暂性尿潴留，7 例患者出现短暂性局部术后疼痛。IRE 治疗后，13（72%）个病灶完全消融，3cm 以下病灶成功率为 93%（13/14）。局部无复发生存期为 18±4 个月，远处无复发生存期为 14±6 个月。这些初步结果表明，IRE 是一种安全可行的 HCC 局部消融技术，尤其适用于小于 3cm 的病灶。即使对于靠近重要结构或器官的肿瘤，本研究也未发生重大并发症。
