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Article: Irreversible electroporation: state of the art.

Wagstaff, Peter Gk / Buijs, Mara / van den Bos, Willemien / de Bruin, Daniel M / Zondervan, Patricia J / de la Rosette, Jean Jmch / Laguna Pes, M Pilar

OncoTargets and therapy

2016 Volume 9, Page(s) 2437–2446

Abstract: ... to thermal sink caused by large blood vessels in the proximity of the tumor. Irreversible electroporation ... IRE) is a novel ablation modality based on the principle of electroporation or electropermeabilization ...

Abstract	The field of focal ablative therapy for the treatment of cancer is characterized by abundance of thermal ablative techniques that provide a minimally invasive treatment option in selected tumors. However, the unselective destruction inflicted by thermal ablation modalities can result in damage to vital structures in the vicinity of the tumor. Furthermore, the efficacy of thermal ablation intensity can be impaired due to thermal sink caused by large blood vessels in the proximity of the tumor. Irreversible electroporation (IRE) is a novel ablation modality based on the principle of electroporation or electropermeabilization, in which electric pulses are used to create nanoscale defects in the cell membrane. In theory, IRE has the potential of overcoming the aforementioned limitations of thermal ablation techniques. This review provides a description of the principle of IRE, combined with an overview of in vivo research performed to date in the liver, pancreas, kidney, and prostate.
Language	English
Publishing date	2016-04-22
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2495130-4
ISSN	1178-6930
ISSN	1178-6930
DOI	10.2147/OTT.S88086
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Article: Irreversible Electroporation (IRE) for Prostate Cancer (PCa) Treatment: The State of the Art.

Faiella, Eliodoro / Santucci, Domiziana / Vertulli, Daniele / Vergantino, Elva / Vaccarino, Federica / Perillo, Gloria / Beomonte Zobel, Bruno / Grasso, Rosario Francesco

Journal of personalized medicine

2024 Volume 14, Issue 2

Abstract: We evaluated the most recent research from 2000 to 2023 in order to deeply investigate the applications of PCa IRE, first exploring its usage with primary intent and then salvage intent. Finally, we discuss the differences with other focal PCa treatments. ...

Abstract	We evaluated the most recent research from 2000 to 2023 in order to deeply investigate the applications of PCa IRE, first exploring its usage with primary intent and then salvage intent. Finally, we discuss the differences with other focal PCa treatments. In the case of primary-intent IRE, the in-field recurrence is quite low (ranges from 0% to 33%). Urinary continence after the treatment remains high (>86%). Due to several different patients in the studies, the preserved potency varied quite a lot (59-100%). Regarding complications, the highest occurrence rates are for those of Grades I and II (20-77% and 0-29%, respectively). Grade III complications represent less than 7%. Regarding the specific oncological outcomes, both PCa-specific survival and overall survival are 100%. Metastasis-free survival is 99.6%. In a long-term study, the Kaplan-Meier FFS rates reported are 91% at 3 years, 84% at 5 years, and 69% at 8 years. In the single study with salvage-intent IRE, the in-field recurrence was 7%. Urinary continence was still high (93%), but preserved potency was significantly lower than primary-intent IRE patients (23%). In addition, Grade III complications were slightly higher (10.8%). In conclusion, in males with localized low-intermediate-risk prostate cancer, IRE had an excellent safety profile and might have positive results for sexual and urinary function.
Language	English
Publishing date	2024-01-25
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm14020137
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Article ; Online: Irreversible electroporation and electrochemotherapy in oncology: State of the art.

Tasu, Jean-Pierre / Tougeron, David / Rols, Marie-Pierre

Diagnostic and interventional imaging

2022 Volume 103, Issue 11, Page(s) 499–509

Abstract: ... electropermeabilization, is also known as "electroporation". Under certain conditions, electroporation can be irreversible ... leading to cell death. Irreversible electroporation has demonstrated efficacy for the treatment of liver ... tumors such as melanoma. Irreversible and reversible electroporation are both not thermal ...

Abstract	Thermal tumor ablation techniques including radiofrequency, microwave, LASER, high-intensity focused ultrasound and cryoablation are routinely used to treated liver, kidney, bone, or lung tumors. However, all these techniques are thermal and can therefore be affected by heat sink effect, which can lead to incomplete ablation, and thermal injuries of non-targeted tissues are possible. Under certain conditions, high voltage pulsed electric field can induce formation of pores in the cell membrane. This phenomenon, called electropermeabilization, is also known as "electroporation". Under certain conditions, electroporation can be irreversible, leading to cell death. Irreversible electroporation has demonstrated efficacy for the treatment of liver and prostate cancers, whereas data are scarce regarding pancreatic and renal cancers. During reversible electroporation, transient cell permeability can be used to introduce cytotoxic drugs into tumor cells (commonly bleomycin or cisplatin). Reversible electroporation used in conjunction with cytotoxic drugs shows promise in terms of oncological response, particularly for solid cutaneous and subcutaneous tumors such as melanoma. Irreversible and reversible electroporation are both not thermal ablation techniques and therefore open a new promising horizon for tumor ablation.
MeSH term(s)	Humans ; Electrochemotherapy/methods ; Medical Oncology ; Electroporation/methods ; Neoplasms/surgery ; Antineoplastic Agents
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2022-10-17
Publishing country	France
Document type	Journal Article ; Review
ZDB-ID	2648283-6
ISSN	2211-5684 ; 2211-5684
ISSN (online)	2211-5684
ISSN	2211-5684
DOI	10.1016/j.diii.2022.09.009
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Article ; Online: Irreversible electroporation

Wagstaff PGK / Buijs M / van den Bos W / de Bruin DM / Zondervan PJ / de la Rosette JJMCH / Laguna Pes MP

OncoTargets and Therapy, Vol 2016, Iss Issue 1, Pp 2437-

state of the art

2016 Volume 2446

Abstract: ... caused by large blood vessels in the proximity of the tumor. Irreversible electroporation (IRE) is ... kidney, and prostate. Keywords: irreversible electroporation, IRE, tumor, ablation, focal therapy, cancer ... a novel ablation modality based on the principle of electroporation or electropermeabilization ...

Abstract	Peter GK Wagstaff,1 Mara Buijs,1 Willemien van den Bos,1 Daniel M de Bruin,2 Patricia J Zondervan,1 Jean JMCH de la Rosette,1 M Pilar Laguna Pes1 1Department of Urology, 2Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands Abstract: The field of focal ablative therapy for the treatment of cancer is characterized by abundance of thermal ablative techniques that provide a minimally invasive treatment option in selected tumors. However, the unselective destruction inflicted by thermal ablation modalities can result in damage to vital structures in the vicinity of the tumor. Furthermore, the efficacy of thermal ablation intensity can be impaired due to thermal sink caused by large blood vessels in the proximity of the tumor. Irreversible electroporation (IRE) is a novel ablation modality based on the principle of electroporation or electropermeabilization, in which electric pulses are used to create nanoscale defects in the cell membrane. In theory, IRE has the potential of overcoming the aforementioned limitations of thermal ablation techniques. This review provides a description of the principle of IRE, combined with an overview of in vivo research performed to date in the liver, pancreas, kidney, and prostate. Keywords: irreversible electroporation, IRE, tumor, ablation, focal therapy, cancer
Keywords	Irreversible electroporation ; IRE ; tumor ; ablation ; focal therapy ; cancer ; Neoplasms. Tumors. Oncology. Including cancer and carcinogens ; RC254-282 ; Internal medicine ; RC31-1245 ; Medicine ; R
Subject code	616
Language	English
Publishing date	2016-04-01T00:00:00Z
Publisher	Dove Medical Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Experimental and Numerical Investigation of Parameters Affecting High-Frequency Irreversible Electroporation for Prostate Cancer Ablation.

Aycock, Kenneth N / Vadlamani, Ram Anand / Jacobs, Edward J / Imran, Khan Mohammad / Verbridge, Scott S / Allen, Irving C / Manuchehrabadi, Navid / Davalos, Rafael V

Journal of biomechanical engineering

2022 Volume 144, Issue 6

Abstract: ... Due to its nonthermal mechanism, H-FIRE offers several advantages over state-of-the-art treatments ... dysfunction. High-frequency irreversible electroporation (H-FIRE) is a promising alternative ablation modality ... in vitro and compare them to conventional irreversible electroporation (IRE). Experiments were performed ...

Abstract	While the primary goal of focal therapy for prostate cancer (PCa) is conserving patient quality of life by reducing oncological burden, available modalities use thermal energy or whole-gland radiation which can damage critical neurovascular structures within the prostate and increase risk of genitourinary dysfunction. High-frequency irreversible electroporation (H-FIRE) is a promising alternative ablation modality that utilizes bursts of pulsed electric fields (PEFs) to destroy aberrant cells via targeted membrane damage. Due to its nonthermal mechanism, H-FIRE offers several advantages over state-of-the-art treatments, but waveforms have not been optimized for treatment of PCa. In this study, we characterize lethal electric field thresholds (EFTs) for H-FIRE waveforms with three different pulse widths as well as three interpulse delays in vitro and compare them to conventional irreversible electroporation (IRE). Experiments were performed in non-neoplastic and malignant prostate cells to determine the effect of waveforms on both targeted (malignant) and adjacent (non-neoplastic) tissue. A numerical modeling approach was developed to estimate the clinical effects of each waveform including extent of nonthermal ablation, undesired thermal damage, and nerve excitation. Our findings indicate that H-FIRE waveforms with pulse durations of 5 and 10 μs provide large ablations comparable to IRE with tolerable levels of thermal damage and minimized muscle contractions. Lower duration (2 μs) H-FIRE waveforms exhibit the least amount of muscle contractions but require increased voltages which may be accompanied by unwanted thermal damage.
MeSH term(s)	Electroporation ; Heart Rate ; Humans ; Male ; Muscle Contraction ; Prostatic Neoplasms/surgery ; Quality of Life
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	243094-0
ISSN	1528-8951 ; 0148-0731
ISSN (online)	1528-8951
ISSN	0148-0731
DOI	10.1115/1.4053595
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Article ; Online: Chemical Enhancement of Irreversible Electroporation: A Review and Future Suggestions.

Chen, Ying / Moser, Michael A J / Luo, Yigang / Zhang, Wenjun / Zhang, Bing

Technology in cancer research & treatment

2019 Volume 18, Page(s) 1533033819874128

Abstract: ... electroporation region enhanced and the irreversible electroporation region enhanced. Specifically, the state ... Irreversible electroporation has raised great interest in the past decade as a means of destroying ... cancers in a way that does not involve heat. Irreversible electroporation is a novel ablation technology ...

Abstract	Irreversible electroporation has raised great interest in the past decade as a means of destroying cancers in a way that does not involve heat. Irreversible electroporation is a novel ablation technology that uses short high-voltage electrical pulses to enhance the permeability of tumor cell membranes and generate irreversible nano-sized structural defects or pores, thus leading to cell death. Irreversible electroporation has many advantages over thermal therapies due to its nonthermal mechanism: (1) reduced risk of injury to surrounding organs and (2) no "heat-sink" effect due to nearby blood vessels. However, so far, it has been difficult for irreversible electroporation to completely ablate large tumors (eg, >3 cm in diameter). In order to overcome this problem, many preclinical and clinical studies have been performed to improve the efficacy of IRE in the treatment of large size of tumors through a chemical perspective. Due to the distribution of electric field, irreversible electroporation region, reversible electroporation region, and intact region can be found in the treatment of irreversible electroporation. Thus, 2 types of chemical enhancements of irreversible electroporation were discussed in the article, such as the reversible electroporation region enhanced and the irreversible electroporation region enhanced. Specifically, the state-of-the-art results regarding the following approaches that have the potential to be used in the enhancement of irreversible electroporation were systematically reviewed in the article, including (1) combination with cytotoxic drugs, (2) calcium electroporation, (3) modification of cell membrane, and (4) modification of the tumor cell microenvironment. In the end, we concluded with 4 issues that should be addressed in the future for improving irreversible electroporation further in a chemical way.
MeSH term(s)	Algorithms ; Animals ; Antineoplastic Agents/pharmacology ; Calcium/pharmacology ; Cell Survival/drug effects ; Cellular Microenvironment/drug effects ; Electroporation/methods ; Electroporation/standards ; Humans ; Models, Theoretical ; Surface-Active Agents/pharmacology
Chemical Substances	Antineoplastic Agents ; Surface-Active Agents ; Calcium (SY7Q814VUP)
Language	English
Publishing date	2019-10-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2146365-7
ISSN	1533-0338 ; 1533-0346
ISSN (online)	1533-0338
ISSN	1533-0346
DOI	10.1177/1533033819874128
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Article ; Online: Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go.

Savic, L J / Chapiro, J / Hamm, B / Gebauer, B / Collettini, F

RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin

2016 Volume 188, Issue 8, Page(s) 735–745

Abstract: ... a state-of-the-art update on available clinical evidence of IRE regarding feasibility, safety and ... Unlabelled: Irreversible electroporation (IRE) is the latest in the series of image-guided ... Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go. Fortschr Röntgenstr ...

Title translation	Irreversible Elektroporation: Übersicht und Ausblick.
Abstract	Unlabelled: Irreversible electroporation (IRE) is the latest in the series of image-guided locoregional tumor ablation therapies. IRE is performed in a nearly non-thermal fashion that circumvents the "heat sink effect" and allows for IRE application in proximity to critical structures such as bile ducts or neurovascular bundles, where other techniques are unsuitable. IRE appears generally feasible and initial reported results for tumor ablation in the liver, pancreas and prostate are promising. Additionally, IRE demonstrates a favorable safety profile. However, site-specific complications include bile leaking or vein thrombosis and may be more severe after pancreatic IRE compared to liver or prostate ablation. There is limited clinical evidence in support of the use of IRE in the kidney. In contrast, pulmonary IRE has so far failed to demonstrate efficacy due to practicability limitations. Hence, this review will provide a state-of-the-art update on available clinical evidence of IRE regarding feasibility, safety and oncologic efficacy. The future role of IRE in the minimally invasive treatment of solid tumors will be discussed. Key points: • Preclinical findings of IRE have been successfully translated into clinical settings.• Non-thermal ablation is able to prevent the "heat sink effect" and collateral damage.• IRE should primarily be applied to tumors adjacent to sensitive structures (e. g. bile ducts).IRE efficacy appears promising in the liver, pancreas and prostate with tolerable morbidity.• In contrast, there are no evidential benefits of IRE in the lung parenchyma. Citation Format: • Savic LJ, Chapiro J, Hamm B et al. Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go. Fortschr Röntgenstr 2016; 188: 735 - 745.
MeSH term(s)	Ablation Techniques/adverse effects ; Ablation Techniques/methods ; Electrochemotherapy/adverse effects ; Electrochemotherapy/methods ; Evidence-Based Medicine/trends ; Humans ; Neoplasms/diagnosis ; Neoplasms/surgery ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Treatment Outcome
Language	English
Publishing date	2016-08
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	554830-5
ISSN	1438-9010 ; 0340-1618 ; 0936-6652 ; 1433-5972 ; 1438-9029
ISSN (online)	1438-9010
ISSN	0340-1618 ; 0936-6652 ; 1433-5972 ; 1438-9029
DOI	10.1055/s-0042-104203
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Article: Palliative therapy in pancreatic cancer-interventional treatment with radiofrequency ablation/irreversible electroporation.

Paiella, Salvatore / De Pastena, Matteo / D'Onofrio, Mirko / Crinò, Stefano Francesco / Pan, Teresa Lucia / De Robertis, Riccardo / Elio, Giovanni / Martone, Enrico / Bassi, Claudio / Salvia, Roberto

Translational gastroenterology and hepatology

2018 Volume 3, Page(s) 80

Abstract: ... in specialized centers of pancreatology. This review depicts the state of the art of the two techniques. ... and irreversible electroporation (IRE) demonstrated to be safe and effective in obtaining a local ...

Abstract	Pancreatic cancer (PC) is a solid tumor with still a dismal prognosis. Diagnosis is usually late, when the disease is metastatic or locally advanced (LAPC). Only 20% of PC are amenable to surgery at the time of diagnosis and the vast majority of them, despite radically resected will unavoidably recur. The treatment of LAPC is a challenge. Current guidelines suggest to adopt systemic therapies upfront, based on multi-drugs chemotherapy regimens. However, the vast majority of patients will never experience conversion to surgical exploration and radical resection. Thus, there a large subgroup of LAPC patients where the only therapeutic chance is to offer palliative treatments, such as interventional ablative treatments, in order to obtain a cytoreduction of the tumor, trying to delay its growth and spread. Radiofrequency ablation (RFA) and irreversible electroporation (IRE) demonstrated to be safe and effective in obtaining a local control of the disease with some promising oncological results in terms of overall survival (OS). However, they should be adopted as a treatment strategy to adopt in parallel with other systemic therapies, within multidisciplinary choices. They are not free from complications, even serious, thus they should applied only in specialized centers of pancreatology. This review depicts the state of the art of the two techniques.
Language	English
Publishing date	2018-10-26
Publishing country	China
Document type	Journal Article ; Review
ISSN	2415-1289
ISSN	2415-1289
DOI	10.21037/tgh.2018.10.05
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Article: Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go

Savic, L. J. / Chapiro, J. / Hamm, B. / Gebauer, B. / Collettini, F.

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren

2016 Volume 188, Issue 08, Page(s) 735–745

Abstract: ... a state-of-the-art update on available clinical evidence of IRE regarding feasibility, safety and ... Irreversible electroporation (IRE) is the latest in the series of image-guided locoregional tumor ... Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go. Fortschr Röntgenstr ...

Abstract	Irreversible electroporation (IRE) is the latest in the series of image-guided locoregional tumor ablation therapies. IRE is performed in a nearly non-thermal fashion that circumvents the „heat sink effect“ and allows for IRE application in proximity to critical structures such as bile ducts or neurovascular bundles, where other techniques are unsuitable. IRE appears generally feasible and initial reported results for tumor ablation in the liver, pancreas and prostate are promising. Additionally, IRE demonstrates a favorable safety profile. However, site-specific complications include bile leaking or vein thrombosis and may be more severe after pancreatic IRE compared to liver or prostate ablation. There is limited clinical evidence in support of the use of IRE in the kidney. In contrast, pulmonary IRE has so far failed to demonstrate efficacy due to practicability limitations. Hence, this review will provide a state-of-the-art update on available clinical evidence of IRE regarding feasibility, safety and oncologic efficacy. The future role of IRE in the minimally invasive treatment of solid tumors will be discussed. Key points: Preclinical findings of IRE have been successfully translated into clinical settings. • Non-thermal ablation is able to prevent the "heat sink effect" and collateral damage. • IRE should primarily be applied to tumors adjacent to sensitive structures (e. g. bile ducts). IRE efficacy appears promising in the liver, pancreas and prostate with tolerable morbidity. • In contrast, there are no evidential benefits of IRE in the lung parenchyma. Citation Format: Savic LJ, Chapiro J, Hamm B et al. Irreversible Electroporation in Interventional Oncology: Where We Stand and Where We Go. Fortschr Röntgenstr 2016; 188: 735 – 745
Keywords	irreversible electroporation ; pancreas ; lung ; prostate ; liver ; kidney ; safety ; interventional procedures ; treatment effects ; abdomen ; thorax ; ablation procedures ; ablation
Language	English
Publishing date	2016-04-13
Publisher	© Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	554830-5
ISSN	1438-9010 ; 1438-9029 ; 0340-1618 ; 0936-6652 ; 1433-5972
ISSN (online)	1438-9010
ISSN	1438-9029 ; 0340-1618 ; 0936-6652 ; 1433-5972
DOI	10.1055/s-0042-104203
Database	Thieme publisher's database

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Article ; Online: Nonthermal irreversible electroporation: fundamentals, applications, and challenges.

Golberg, Alexander / Yarmush, Martin L

IEEE transactions on bio-medical engineering

2013 Volume 60, Issue 3, Page(s) 707–714

Abstract: ... on the development of NTIRE, its current state-of-the-art, challenges, and future needs. ... electroporation (NTIRE), has rapidly emerged. The exact mechanisms responsible for cell death by NTIRE ... a nonthermal tissue ablation using intensive pulsed electric fields, called nonthermal irreversible ...

Abstract	Tissue ablation is an essential procedure for the treatment of many diseases. In the last decade, a nonthermal tissue ablation using intensive pulsed electric fields, called nonthermal irreversible electroporation (NTIRE), has rapidly emerged. The exact mechanisms responsible for cell death by NTIRE, however, are currently unknown. Nevertheless, the technique's remarkable ability to ablate tissue in the proximity of larger blood vessels, to preserve tissue architecture, short procedure duration, and shortened postoperative recovery period rapidly moved NTIRE from bench to bed side. This work provides an overview on the development of NTIRE, its current state-of-the-art, challenges, and future needs.
MeSH term(s)	Animals ; Diagnostic Imaging ; Electroporation ; Histocytochemistry ; Humans ; Liver/chemistry ; Liver/diagnostic imaging ; Liver/pathology ; Melanoma/diagnostic imaging ; Melanoma/pathology ; Melanoma/surgery ; Minimally Invasive Surgical Procedures ; Radiography ; Swine ; Ultrasonography
Language	English
Publishing date	2013-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	160429-6
ISSN	1558-2531 ; 0018-9294
ISSN (online)	1558-2531
ISSN	0018-9294
DOI	10.1109/TBME.2013.2238672
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