Irreversible electroporation: state of the art

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: IRE; ablation; cancer; focal therapy; irreversible electroporation; tumor.

Figure 1

IRE equipment. Notes: (A) The NanoKnife™ IRE console. (B) User-friendly treatment planning software generates a 2D representation of the ablation zone, perpendicular to the direction of the inserted needle electrodes. (C) Monopolar needle electrodes (16 G), covered in a retractable insulation sheath, allowing for adjustment of the active tip length. The blue spacer allows for parallel external fixation of the IRE needles. (D) AccuSync ECG synchronizer, allowing for synchronization of the IRE pulses with the cardiac rhythm. Abbreviations: ECG, electrocardiogram; IRE, irreversible electroporation; 2D, two-dimensional.