title: Irreversible Electroporation for Colorectal Liver Metastases.
abstract: Image-guided tumor ablation techniques have significantly broadened the treatment possibilities for primary and secondary hepatic malignancies. A new ablation technique, irreversible electroporation (IRE), was recently added to the treatment armamentarium. As opposed to thermal ablation, cell death with IRE is primarily induced using electrical energy: electrical pulses disrupt the cellular membrane integrity, resulting in cell death while sparing the extracellular matrix of sensitive structures such as the bile ducts, blood vessels, and bowel wall. The preservation of these structures makes IRE attractive for colorectal liver metastases (CRLM) that are unsuitable for resection and thermal ablation owing to their anatomical location. This review discusses different technical and practical issues of IRE for CRLM: the indications, patient preparations, procedural steps, and different "tricks of the trade" used to improve safety and efficacy of IRE. Imaging characteristics and early efficacy results are presented. Much is still unknown about the exact mechanism of cell death and about factors playing a crucial role in the extent of cell death. At this time, IRE for CRLM should only be reserved for small tumors that are truly unsuitable for resection or thermal ablation because of abutment of the portal triad or the venous pedicles.
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Scheffer
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Marleen C A M
authors.initials: MC
authors.lastname: Melenhorst
authors.affiliation: Department of Radiology, Division of Vascular/Interventional Radiology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Echenique
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Aukje A J M
authors.initials: AA
authors.lastname: van Tilborg
authors.affiliation: Department of Urology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Willemien
authors.initials: W
authors.lastname: van den Bos
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Laurien G P H
authors.initials: LG
authors.lastname: Vroomen
authors.affiliation: Department of Surgery, VU University Medical Center, 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, Amsterdam, the Netherlands. Electronic address: mr.meijerink@vumc.nl.
authors.forename: Martijn R
authors.initials: MR
authors.lastname: Meijerink
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000295:instrumentation; D016923:Cell Death; D015179:Colorectal Neoplasms / Q000473:pathology*; D018274:Electroporation / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: ablation; colorectal cancer; image-guided; irreversible electroporation; liver metastasis; liver tumor