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irreversible electroporation for Hepatocellular Carcinoma Abutting the Diaphragm:A Prospective Single-center Study

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Journal of Clinical and Translational Hepatology 2022年第2期10卷 190-196页

作者： Yangyang Ma Zhixian Chen Bing Liang Rongrong Li Jianyu Li Zhonghai Li Mao Lin Lizhi Niu Central Laboratory Affiliated Fuda Cancer HospitalJinan UniversityGuangzhouGuangdongChina Department of Oncology Affiliated Fuda Cancer HospitalJinan UniversityGuangzhouGuangdongChina Department of Surgery and Anesthesia Affiliated Fuda Cancer HospitalJinan UniversityGuangzhouGuangdongChina Department of Ultrasound Affiliated Fuda Cancer HospitalJinan UniversityGuangzhouGuangdongChina Department of Radiology Affiliated Fuda Cancer HospitalJinan UniversityGuangzhouGuangdongChina

Background and Aims:irreversible electroporation(IRE)is an emerging local ablation therapy which may be effective for unresectable *** study aimed to evaluate the safety and efficacy of percutaneous IRE in the treatment of hepatocellular carcinoma(HCC)abutting the ***:A total of 26 participants with 39 tumors abutting the diaphragm were prospectively evaluated between July 2015 and September *** associated with IRE were recorded,and the survival benefit of IRE was *** factors associated with time to local tumor progression(LTP)were analyzed using univariate and multivariate Cox regression ***:No major complications or treatmentrelated deaths *** technical success rate was 96.2%(25/26)and complete ablation rate was 92.3%(36/39).The median followup period was 16.7 months(range:3.0-43.0 months),the LTP occurred in 15.2%of tumors and median time to LTP was 20.4 ***,tumor size(hazard ratio:1.24[95%confidence interval:0.38,3.81],p=0.03)was the only factor associated with time to ***:This study shows for the first time that percutaneous IRE is a safe and effective ablation technology for HCC abutting the diaphragm.

关键词： irreversible electroporation Hepatocellular carcinoma Diaphragm Safety Efficacy

irreversible electroporation Ablation for Atrial Fibrillation: Status and Challenges

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Cardiology Discovery 2022年第1期2卷 41-50页

作者： Fei Xie Yonggang Chen Xinhua Chen Zhihong Zhao Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province HangzhouZhejiang 310003China The First Affiliated Hospital of Zhejiang University School of Medicine HangzhouZhejiang 310003China Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital Shanghai 201318China

Pulsed electric field(PEF)is a novel energy source by which high-voltage electric pulses are used to create irreversible *** is non-thermal and highly tissue-dependent in which specific targeting of the atrial myocardium is achieved and sparing of adjacent tissues is feasible,theoretically increasing the safety of the procedure,which could potentially break the trade-off between effective lesions and collateral damage and substantially improve risk-benefit ratios in atrial fibrillation(AF)*** recently published trials have shown a clear effect of AF ablation,large-scale clinical trials are *** clinical evidence has demonstrated significant efficacy in achieving durable pulmonary vein isolation without ablation-related adverse ***,their putative benefits regarding efficacy,efficiency,and safety remain to be proven in randomized controlled trials.

关键词： Atrial fibrillation irreversible electroporation Ablation

irreversible electroporation versus radiofrequency ablation for malignant hepatic tumor:A prospective single-center double-arm trial

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Journal of Interventional Medicine 2022年第2期5卷 89-94页

作者： Boyu Liu Dianxun Fu Yong Fan Zhe Wang Xu Lang Department of Radiology Tianjin Medical University General HopitalAnshan Rood 154#Heping DitricTianjin300052China

Objective:irreversible electroporation(IRE)is a nonthermal ablation technique for the treatment of malignant liver *** has demonstrated efficacy and safety in the treatment of malignant liver tumors and its unique advantages in the treatment of nearby vascular *** study aimed to compare the efficacy,safety,and intermediate-term outcomes of IRE and radiofrequency(RF)therapy in malignant liver ***:Twenty-four patients with primary or secondary liver malignancies were included in this prospective,double-arm clinical *** were randomly divided into the IRE and RF *** primary outcome was the efficacy(local ablation control evaluation at 90 days).The secondary outcomes were safety(procedure-related complications at≤90 days)and intermediate-term survival(at 24 months).Results:The ablation assessment at 90 days after surgery with m RECIST for IRE versus RF were 70%,20%,0%,and 10%versus 92.9%,7.1%,0%,and 0%(CR,PR,SD,and PD,respectively).The complication rates of IRE versus RF with Clavien-Dindo classification were 16.7%,25%,0%,8.3%,and 8.3%versus 8.3%,50%,0%,0%,and 0%(Grade I,II,Ⅲ,IV,and V,respectively).The average overall survival(OS)was 17.55 months in the IRE group(95%CI 15.13-22.37)and 18.75 months in the RF group(95%CI 12.48-22.61).There was no statistical difference between the IRE and RF groups in terms of efficacy(p=0.48),safety(p=0.887),or 24-month OS(p=0.959).Conclusions:IRE ablation revealed similar efficacy and safety in a short-term follow-up,and similar OS in midterm survival as RF ablation in treating malignant hepatic tumors.

关键词： irreversible electroporation Radiofrequency ablation Efficacy Intermediate-term survival Prospective trial

Safety and feasibility of irreversible electroporation for the pancreatic head in a porcine model

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World Journal of Gastrointestinal Oncology 2022年第8期14卷 1499-1509页

作者： Li Yan Bin Liang Jian Feng Hang-Yu Zhang Hao-Sheng Chang Bing Liu Yong-Liang Chen Faculty of Hepato-Pancreato-Biliary Surgery Institute of Hepatobiliary Surgery of Chinese PLAKey Laboratory of Digital Hepetobiliary SurgeryThe First Medical CentreChinese PLA General HospitalBeijing 100853China Department of Hepatopancreatobiliary Surgery Peking University Shougang HospitalBeijing 100144China

BACKGROUND irreversible electroporation(IRE)is a local non-thermal ablative technique which has been suggested as a potential cancer ***,the specific anatomic characteristics of the pancreatic head make it challenging to perform any local ablation in this ***,the safety and feasibility of IRE in the pancreatic head region should be further *** To evaluate the safety of IRE in pancreatic head region including its effects on pancreatic ducts,vessels,and adjacent gastrointestinal *** Eight landrace miniature pigs underwent IRE of pancreatic head tissue successfully,with a total of 16 lesions *** testing including white blood cell(WBC)count and serum amylase before IRE with follow-up laboratory analysis and pathological examination at 1,7,14,and 28 d postablation were *** All pigs tolerated the ablation procedure without serious perioperative *** elevated WBC count and amylase were observed at 24 h post-IRE,suggesting an acute pancreatic tissue damage which was confirmed by pathological *** endothelial cells and pancreatic duct epithelial cells in ablation zone were also positive in terminal deoxynucleotidyl transferase dUTP nick end labeling *** was extensive duodenum mucosa damage with local hemorrhage 24 h after ablation,while regeneration of new villous structures were observed at 7 and 28 d ***’s trichromatic staining showed that the extracellular matrix was still intact in vessels and pancreatic ducts,and even in the *** IRE ablation to the pancreatic head may be safe and feasible without long-term damage to the surrounding vital ***,risks of stress injuries in acute phase should be taken into consideration to prevent severe perioperative complications.

关键词： irreversible electroporation Pancreatic head Duodenum Safety Feasibility Stress injury

irreversible electroporation for liver metastasis from pancreatic cancer: A case report

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World Journal of Clinical Cases 2020年第2期8卷 390-397页

作者： Yang-Yang Ma Juan-Juan Shi Ji-Bing Chen Ke-Chen Xu Li-Zhi Niu Central Laboratory Fuda Cancer HospitalJinan UniversityGuangzhou 510665Guangdong ProvinceChina Department of Oncology Fuda Cancer HospitalJinan UniversityGuangzhou 510665Guangdong ProvinceChina

BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. irreversible electroporation(IRE) is a new, non-thermal local ablation method for solid tumors, which can induce cell membrane permeabilization,resulting in unrecoverable nanoscale perforation and apoptotic cell death without damaging the structural components of *** SUMMARY We report the case of a 66-year-old female patient with liver metastasis from pancreatic cancer with a pathological diagnosis of poorly differentiated adenocarcinoma. Carbohydrate antigen 19-9 was elevated to 420.3 U/m *** tomography showed a pancreas mass of 2.7 cm × 2.5 cm and single liver metastasis of 1.4 cm × 1.1 cm in the S6 area. The patient underwent IRE and arterial infusion chemotherapy and received tegafur. The therapeutic effect of the combination treatment has been evaluated as complete response. To date, the patient has survived for > 12 mo and is receiving tegafur as maintenance therapy(at the time this case report was written).CONCLUSION IRE plus arterial infusion chemotherapy and tegafur may be synergistic,providing a reference for treating liver metastasis from pancreatic cancer.

关键词： irreversible electroporation Liver metastasis from pancreatic cancer Chemotherapy Complete response Case report

A Single-institution Experience with Open irreversible electroporation for Locally Advanced Pancreatic Carcinoma

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Chinese Medical Journal 2016年第24期129卷 2920-2925页

作者： Li Yan Yong-Liang Chen Ming Su Tian Liu Kai Xu Feng Liang Wan-Qing Gu Shi-Chun Lu Department of Hepatobiliary Surgery Chinese PLA General Hospital Beijing 100853 China Department of General Surgery People's Hospital of Rizhao Rizhao Shandong 276800 China

Background： Locally advanced pancreatic carcinoma （LAPC） is characterized by poor prognosis despite recommended concurrent chemoradiotherapy. irreversible electroporation （IRE） has emerged as a potential option for the management of unresectable pancreatic cancer. This study was conducted to evaluate the safety and short-term efficacy of open IRE for the treatment of LAPC. Methods： Retrospective data of 25 consecutive patients receiving IRE for T3 lesions from July 2015 to June 2016 at a single center were analyzed. The perioperative and long-term IRE-related complications were reviewed to evaluate the safety of the procedure. The tumor reduction and biological response were analyzed through computed tomography/magnetic resonance imaging; the serum level of CA19-9 was measured as a secondary endpoint to evaluate the short-term efficacy of IRE. Results： All patients were successfully treated; the median tumor size was 4.2 cm and the median IRE time was 36 min. Four intraoperative procedure-related complications were observed （16%）： two transient hypertensive episodes, one hypotension case, and one transient supraventricular tachycardia case. Nine postoperative complications were described, including three Grade A pancreatic fistulas, three delayed gastric emptying, one acute pancreatitis, one upper gastrointestinal hemorrhage, and one portal vein thrombosis. The overall rate of stable disease was 28%, 36% achieved partial response, and lower serum CA19-9 levels were recorded in all patients at discharge. Conclusions： IRE is feasible for the treatment of LAPC and is a reasonable intervention strategy owing to its combined attributes of safety and efficacy.

关键词： CA 19-9 irreversible electroporation Locally Advanced Pancreatic Carcinoma

Comparison between high-frequency irreversible electroporation and irreversible electroporation ablation of small swine liver:follow-up of DCE-MRI and pathological observations

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Chinese Medical Journal 2021年第17期134卷 2081-2090页

作者： Jing Li Xiao-Bo Zhang Jing-Jing Wang Lu-Jia Jin Hu-Sheng Shan Xiao Zhang Li Ma Xiao-Dong Xue Xin Zhang Zhong-Liang Zhang Liang-Liang Meng Fei Yuan Yue-Yong Xiao Medical School of Chinese People’s Liberation Army Beijing 100853China Department of Radiology Characteristic Medical Center of Chinese People’s Armed Police ForceTianjin 300162China Department of Radiology The First Medical Center of the General Hospital of the People’s Liberation ArmyBeijing 100853China Department of Intensive Care Unit Tianjin First Central HospitalTianjin 300152China Department of General Surgery The First Medical Center of the General Hospital of the People’s Liberation ArmyBeijing 100853China Department of Radiotherapy Huai’an Medical AreaGeneral Hospital of the Eastern Theater CommandHuai’anJiangsu 223001China Department of Anesthesiology The First Medical Center of the General Hospital of the People’s Liberation ArmyBeijing 100853China

Background:High-frequency irreversible electroporation(H-FIRE)is a novel,next-generation nanoknife technology with the advantage of relieving irreversible electroporation(IRE)-induced muscle ***,the difference between IRE and H-FIRE with distinct ablation parameters was not clearly *** study aimed to compare the efficacy of the two treatments in ***:Ten Bamaminiature swinewere divided into two group:five in the 1-day group and five in the 7-day *** efficacy of IRE and H-FIRE ablation was compared by volume transfer constant(Krans),rate constant(Kep)and extravascular extracellular volume fraction(Ve)value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),size of the ablation zone,and histologic *** animal underwent the IRE *** of the electrodesweremeasured during ***-MRI images were obtained 1,4,and 7 days after ablation in the 7-day *** animals in the two groups were euthanized 1 day or 7 days after ablation,and subsequently,IRE and H-FIRE treated liver tissues were collected for histological ***’s t test or Mann-Whitney U test was applied for comparing any two ***-way analysis of variance(ANOVA)test and Welch’s ANOVA test followed byHolm-Sidak’smultiple comparisons test,one-wayANOVAwith repeatedmeasures followed by Bonferroni test,or Kruskal-Wallis H test followed by Dunn’s multiple comparison test was used for multiple group comparisons and post hoc *** correlation coefficient test was conducted to analyze the relationship between two ***:Higher Ve was seen in IRE zone than in H-FIRE zone(0.14±0.02 vs.0.08±0.05,t=2.408,P=0.043)on day 4,but no significant difference was seen in Ktrans or Kep between IRE and H-FIRE zones at all time points(all P>0.05).For IRE zone,the greatest Ktrans was seen on day 7,which was significantly higher than that on day 1(P=0.033).The ablation zone size of H-FIRE was significantly larger th

关键词： irreversible electroporation High-frequency irreversible electroporation Dynamic contrast enhanced-magnetic resonance imaging Thermal damage

Gemcitabine plus concurrent irreversible electroporation vs gemcitabine alone for locally advanced pancreatic cancer

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World Journal of Clinical Cases 2020年第22期8卷 5564-5575页

作者： Yang-Yang Ma Yin Leng Yan-Li Xing Hong-Mei Li Ji-Bing Chen Li-Zhi Niu Central Laboratory Affiliated Fuda Cancer HospitalJinan UniversityGuangzhou 510665Guangdong ProvinceChina Department of Oncology Affiliated Fuda Cancer HospitalJinan UniversityGuangzhou 510665Guangdong ProvinceChina Department of Interventional Radiology Affiliated Fuda Cancer HospitalJinan UniversityGuangzhou 510665Guangdong ProvinceChina

BACKGROUND Locally advanced pancreatic cancer(LAPC)is a common malignant digestive system tumor that ranks as the fourth leading cause of cancer-related death in the *** prognosis of LAPC is poor even after standard *** electroporation(IRE)is a novel ablative strategy for *** studies have confirmed the safety of *** date,no prospective studies have been performed to investigate the therapeutic efficacy of conventional gemcitabine(GEM)plus concurrent *** To compare the therapeutic efficacy between conventional GEM plus concurrent IRE and GEM alone for *** From February 2016 to September 2017,a total of 68 LAPC patients were treated with GEM plus concurrent IRE(n=33)or GEM alone(n=35).Overall survival(OS),progression free survival(PFS),and procedure-related complications were compared between the two *** analyses were performed to identify any prognostic *** There were no treatment-related *** technical success rate of IRE ablation was 100%.The GEM+IRE group had a significantly longer OS from the time of diagnosis of LAPC(19.8 mo vs 9.3 mo,P<0.0001)than the GEM alone *** GEM+IRE group had a significantly longer PFS(8.3 mo vs 4.7 mo,P<0.0001)than the GEM alone *** volume less than 37 cm3 and GEM plus concurrent IRE were identified as significant favorable factors for both the OS and *** Gemcitabine plus concurrent IRE is an effective treatment for patients with LAPC.

关键词： irreversible electroporation Gemcitabine Locally advanced pancreatic cancer Overall survival Progression free survival Prognostic factors

Arterial complication of irreversible electroporation procedure for locally advanced pancreatic cancer

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World Journal of Gastrointestinal Oncology 2016年第10期8卷 751-756页

作者： Yahya Ekici Tugan Tezcaner Hüseyin Onur Aydin Fatih Boyvat G?khan Moray Department of General Surgery Medical Faculty of Baskent University Department of Radiology Medical Faculty of Baskent University

irreversible electroporation(IRE) is a non-thermal ablation technique used especially in locally advanced pancreatic carcinomas that are considered surgically *** present the first case of acute superior mesenteric artery(SMA) occlusion secondary to pancreatic IRE procedure that has not been reported before in the literature.A 66-year-old man underwent neoadjuvant chemoradiotherapy for locally advanced pancreatic ductal *** procedure was applied to the patient during laparotomy under general *** finishing the procedure,an acute intestinal ischemia was detected.A conventional vascular angiography was performed and a metallic stent was successfully placed to the SMA and blood flow was *** is important to be careful in such cases of tumor involvement of SMA when evaluating for IRE procedure of pancreatic tumor.

关键词： irreversible electroporation Mesenteric artery occlusion Locally advanced pancreatic cancer Superior mesenteric artery