title: Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy.
abstract: OBJECTIVE
  To provide an overview of current clinical results of irreversible electroporation (IRE), a novel, nonthermal tumor ablation technique that uses electric pulses to induce cell death, while preserving structural integrity of bile ducts and vessels.
  
  
  METHODS
  All in-human literature on IRE reporting safety or efficacy or both was included. All adverse events were recorded. Tumor response on follow-up imaging from 3 months onward was evaluated.
  
  
  RESULTS
  In 16 studies, 221 patients had 325 tumors treated in liver (n = 129), pancreas (n = 69), kidney (n = 14), lung (n = 6), lesser pelvis (n = 1), and lymph node (n = 2). No major adverse events during IRE were reported. IRE caused only minor complications in the liver; however, three major complications were reported in the pancreas (bile leak [n = 2], portal vein thrombosis [n = 1]). Complete response at 3 months was 67%-100% for hepatic tumors (93%-100% for tumors o 3 cm). Pancreatic IRE combined with surgery led to prolonged survival compared with control patients (20 mo vs 13 mo) and significant pain reduction.
  
  
  CONCLUSIONS
  In cases where other techniques are unsuitable, IRE is a promising modality for the ablation of tumors near bile ducts and blood vessels. This articles gives an extensive overview of the available evidence, which is limited in terms of quality and quantity. With the limitations of the evidence in mind, IRE of central liver tumors seems relatively safe without major complications, whereas complications after pancreatic IRE appear more severe. The available limited results for tumor control are generally good. Overall, the future of IRE for difficult-to-reach tumors appears promising.
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands. Electronic address: hj.scheffer@vumc.nl.
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Scheffer
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: de Jong
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Aukje A J M
authors.initials: AA
authors.lastname: van Tilborg
authors.affiliation: Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Vieveen
authors.affiliation: Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Arthur R A
authors.initials: AR
authors.lastname: Bouwman
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Sybren
authors.initials: S
authors.lastname: Meijer
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Cornelis
authors.initials: C
authors.lastname: van Kuijk
authors.affiliation: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Petrousjka M P
authors.initials: PM
authors.lastname: van den Tol
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
authors.forename: Martijn R
authors.initials: MR
authors.lastname: Meijerink
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D038524:Diffusion Magnetic Resonance Imaging; D053672:Electrochemotherapy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D064847:Multimodal Imaging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome