Midterm Safety and Efficacy of Irreversible Electroporation of Malignant Liver Tumors Located Close to Major Portal or Hepatic Veins
Midterm Safety and Efficacy of Irreversible Electroporation of Malignant Liver Tumors Located Close to Major Portal or Hepatic Veins
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DOI：
10.1148/radiol.2017161561
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发表时间：
2017-12-01
期刊：
影响因子：
19.7
通讯作者：
Bruners, Philipp
中科院分区：
文献类型：
--
作者：
Distelmaier, Martina;Barabasch, Alexandra;Bruners, Philipp
目的：探讨不可逆电穿孔（IRE）治疗不适合热消融（射频消融[RFA]或微波消融）的肝脏肿瘤的疗效和安全性。材料和方法：这是一项机构审查委员会批准的前瞻性研究，纳入29例患者（15名男性，14名女性，平均年龄63岁，12岁[标准差]），其中43例原发性（n = 8）或继发性（n = 35）肝恶性肿瘤，接受了计算机断层扫描（CT）引导的IRE。所有目标肿瘤均位于紧邻肝大静脉、门静脉或两者的位置；因此，它们不适合射频消融或微波消融。患者接受介入后CT和磁共振（MR）成像。系统随访磁共振成像平均24个月，以评估完全消融，肝内肿瘤复发和并发症。确定胆管狭窄、不完全消融和肿瘤复发率的95%置信区间（ci）。结果：43个靶肿瘤中有40个（93%;95% CI: 85,100）实现了完全消融，安全范围为5-10 mm，并在介入后立即进行了CT和MR成像。在40例完全消融的肿瘤中，有13例（33%;95% CI: 18,47）在2-18个月观察到肝内肿瘤复发。然而，这13个肿瘤中只有2个（15%;95% CI: 0.35）在消融区被观察到。在其余11例（85%;95% CI: 65, 100）中，肿瘤沿针道生长。两种真正的局部复发均未发生在血管部位。随访时邻近血管仍保持灌注。21例门静脉附近肿瘤患者中有5例（24%;95% CI: 5,39）在IRE后2-6周出现轻度至中度胆汁淤积。结论：IRE可避免热沉效应引起的不完全消融和大血管损伤；然而，26%的治疗肿瘤中观察到针道播种，24%的消融中IRE诱导胆管足够的局部加热。
Purpose: To investigate the efficacy and safety of irreversible electroporation (IRE) in the treatment of hepatic tumors not suitable for thermal ablation (radiofrequency ablation [RFA] or microwave ablation).Materials and Methods: This was an institutional review board-approved prospective study in 29 patients (15 men, 14 women; mean age, 63 years 6 12 [standard deviation]) with 43 primary (n = 8) or secondary (n = 35) malignant liver tumors who underwent computed tomography (CT)-guided IRE. All target tumors were located immediately adjacent to major hepatic veins, portal veins, or both; thus, they were not considered suitable for RFA or microwave ablation. Patients underwent postinterventional CT and magnetic resonance (MR) imaging. Systematic follow-up MR imaging was performed for 24 months on average to assess complete ablation, intrahepatic tumor recurrence, and complications. The 95% confidence intervals (CIs) were determined for the rate of bile duct strictures, incomplete ablation, and tumor recurrence.Results: Complete ablation was achieved in 40 (93%; 95% CI: 85, 100) of 43 target tumors, with a safety margin of 5-10 mm, and was confirmed at immediate postinterventional CT and MR imaging. In 13 (33%; 95% CI: 18, 47) of 40 completely ablated tumors, intrahepatic tumor recurrence was observed at 2-18 months. However, only two (15%; 95% CI: 0, 35) of these 13 tumors were observed within the ablation zone. In the remaining 11 (85%; 95% CI: 65, 100), tumor growth was observed alongside the needle tract. None of the two true local recurrences occurred at the site of the vessel. All adjacent vessels remained perfused at follow-up. Five (24%; 95% CI: 5, 39) of 21 patients with target tumors adjacent to portal veins developed mild to moderate cholestasis 2-6 weeks after IRE.Conclusion: IRE is useful to avoid incomplete ablation secondary to heat-sink effects and damage to major blood vessels; however, needle tract seeding is observed in 26% of treated tumors, and IRE induces sufficient local heating to bile ducts in 24% of ablations.