Percutaneous Ablation of Hepatic Tumors Using Irreversible Electroporation: A Prospective Safety and Midterm Efficacy Study in 34 Patients
Percutaneous Ablation of Hepatic Tumors Using Irreversible Electroporation: A Prospective Safety and Midterm Efficacy Study in 34 Patients
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DOI：
10.1016/j.jvir.2015.12.025
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发表时间：
2016-04-01
影响因子：
2.9
通讯作者：
Wiggermann, Philipp
中科院分区：
文献类型：
--
作者：
Niessen, Christoph;Beyer, Lukas P.;Wiggermann, Philipp
目的：目的探讨经皮不可逆电穿孔（IRE）治疗不宜切除或热消融的原发性和继发性肝癌的安全性和有效性。材料与方法：在这项前瞻性、单中心研究中，对65例肝恶性肿瘤行IRE治疗。（肝细胞癌; n = 33;胆管细胞癌，n = 5;结直肠癌转移，n = 22;神经内分泌癌转移，n = 3;睾丸癌转移，n = 2）的34名患者（27名男性，7名女性;平均年龄，59.4岁± 11.2岁）进行了治疗。局部无复发生存率（LRFS）根据Kaplan-Meier方法进行了评估后，平均随访13.9 months.Results：中位肿瘤直径为2.4 cm +/- 1.4（范围，0.2-7.1 cm）。在65例肿瘤中，12例（18.5%）因消融不完全（n = 3）或早期局部复发（n = 9）而需要再次治疗。3、6和12个月时的LRFS分别为87.4%、79.8%和74.8%。根据改良的实体瘤疗效评价标准，至疾病进展的中位时间为15.6个月。总体并发症发生率为27.5%，有6例严重并发症和8例轻微并发症。主要并发症包括弥漫性腹膜内出血（n = 1）、门静脉部分血栓形成（n = 1）和肝脓肿（n = 4）。轻微的并发症是肝血肿（n = 6）和临床上不明显的气胸（n = 2）。结论：IRE显示了有希望的结果，经皮治疗肝肿瘤的治疗效果，但是，重大的关注仍然存在于其安全性。
Purpose: To evaluate the safety and efficacy of percutaneous irreversible electroporation (IRE) of primary and secondary liver cancer unsuitable for resection or thermal ablation.Materials and Methods: In this prospective, single-center study, 65 malignant liver tumors (hepatocellular carcinoma; n = 33; cholangiocellular carcinoma, n = 5; colorectal cancer metastasis, n = 22; neuroendocrine cancer metastasis, n = 3; testicular cancer metastasis, n = 2) in 34 patients (27 men, 7 women; mean age, 59.4 y +/- 11.2) were treated. Local recurrence-free survival (LRFS) according to the Kaplan-Meier method was evaluated after a median follow-up of 13.9 months.Results: Median tumor diameter was 2.4 cm +/- 1.4 (range, 0.2-7.1 cm). Of 65 tumors, 12 (18.5%) required retreatment because of incomplete ablation (n = 3) or early local recurrence (n = 9). LRFS at 3, 6, and 12 months was 87.4%, 79.8%, and 74.8%. The median time to progressive disease according to modified Response Evaluation Criteria In Solid Tumors was 15.6 months. Overall complication rate was 27.5% with six major complications and eight minor complications. Major complications included diffuse intraperitonal bleeding (n = 1), partial thrombosis of the portal vein (n = 1), and liver abscesses (n = 4). Minor complications were liver hematomas (n = 6) and clinically inapparent pneumothoraces (n = 2).Conclusions: IRE showed promising results regarding therapeutic efficacy for the percutaneous treatment of liver tumors; however, significant concerns remain regarding its safety.