TY - JOUR
T1 - Application of Irreversible Electroporation Ablation as Adjunctive Treatment for Margin Enhancement
T2 - Safety and Efficacy
AU - Simmerman, Erika
AU - Chung, Jane
AU - Lawson, Andrew
AU - Kruse, Edward James
N1 - Funding Information:
This study did not require any institutional funds. The authors are grateful to the Department of General Surgery at Augusta University Medical Center (AUMC), United States and the Division of Surgical Oncology for administrative support. Author contributions: E.K. contributed to the study concept and design, experiment execution, data analysis, writing of the manuscript, and editing/approval of the final draft. As senior author he had full access to all of the data in the study and had the final responsibility for the decision to submit for publication. E.S. contributed to study concept and design, experiment execution, data analysis, writing of the manuscript, and editing/approval of the final draft. J.C. contributed to the study concept and design, writing of the manuscript, and editing/approval of the final draft. A.L. contributed to the execution of the experiment, data analysis, and writing of the manuscript.
Publisher Copyright:
© 2019
PY - 2020/2
Y1 - 2020/2
N2 - Background: Irreversible electroporation (IRE) is a relatively new ablation technique utilized as focal therapy to target areas of significant tumor burden to ablate tumors in situ or improve margins of resection. Its application has largely been reported in the pancreas, liver, kidney, and prostate. Because locoregional therapy is becoming more common, IRE may be a reasonable alternative in additional situations if shown to be safe and efficacious. We have utilized IRE intraoperatively in highly selected patients for adjunctive treatment of primary and metastatic tumors at the time of surgical resection to achieve local control where an R1 resection is clinically felt to be likely. We hypothesize that IRE is a safe and effective adjuvant therapy. Our primary objective was to evaluate the safety of IRE with regard to the effects of other structures within the ablated zone. A secondary objective was to estimate local control rates of locally advanced tumors when IRE was used as an adjunct for margin enhancement. Methods: This is a retrospective chart review of a prospective database at a single tertiary institution. The study included patients receiving IRE from November 2013 through May 2016 at the time of resection of tumor resection for margin enhancement. Primary tumors included liver, pancreatic, retroperitoneal, extremity, and pelvic tumors. Patients undergoing treatment for palliation or in situ ablation were excluded. Results: Forty patients received IRE for margin enhancement. Median follow-up was 14 mo. Three patients (7.5%) had a local recurrence, and 12 (30%) had a distant recurrence. Adverse events possibly related to IRE are described. Conclusions: Our institution demonstrated a low local recurrence rate of only 7.5% in patients treated with intraoperative IRE for margin enhancement. This may be a useful adjunct at the time of surgical resection to help achieve local control in difficult areas where an R1 resection is likely. This topic will require further investigation with prospective trials and longer follow-up.
AB - Background: Irreversible electroporation (IRE) is a relatively new ablation technique utilized as focal therapy to target areas of significant tumor burden to ablate tumors in situ or improve margins of resection. Its application has largely been reported in the pancreas, liver, kidney, and prostate. Because locoregional therapy is becoming more common, IRE may be a reasonable alternative in additional situations if shown to be safe and efficacious. We have utilized IRE intraoperatively in highly selected patients for adjunctive treatment of primary and metastatic tumors at the time of surgical resection to achieve local control where an R1 resection is clinically felt to be likely. We hypothesize that IRE is a safe and effective adjuvant therapy. Our primary objective was to evaluate the safety of IRE with regard to the effects of other structures within the ablated zone. A secondary objective was to estimate local control rates of locally advanced tumors when IRE was used as an adjunct for margin enhancement. Methods: This is a retrospective chart review of a prospective database at a single tertiary institution. The study included patients receiving IRE from November 2013 through May 2016 at the time of resection of tumor resection for margin enhancement. Primary tumors included liver, pancreatic, retroperitoneal, extremity, and pelvic tumors. Patients undergoing treatment for palliation or in situ ablation were excluded. Results: Forty patients received IRE for margin enhancement. Median follow-up was 14 mo. Three patients (7.5%) had a local recurrence, and 12 (30%) had a distant recurrence. Adverse events possibly related to IRE are described. Conclusions: Our institution demonstrated a low local recurrence rate of only 7.5% in patients treated with intraoperative IRE for margin enhancement. This may be a useful adjunct at the time of surgical resection to help achieve local control in difficult areas where an R1 resection is likely. This topic will require further investigation with prospective trials and longer follow-up.
KW - Focal adjunctive cancer therapy
KW - Hepatobiliary cancer
KW - Irreversible electroporation ablation
KW - Margin enhancement in cancer
KW - Pancreatic cancer
KW - Sarcoma
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U2 - 10.1016/j.jss.2019.06.010
DO - 10.1016/j.jss.2019.06.010
M3 - Article
C2 - 31610354
AN - SCOPUS:85073077087
SN - 0022-4804
VL - 246
SP - 260
EP - 268
JO - Journal of Surgical Research
JF - Journal of Surgical Research
ER -
