Electrochemical Effects after Transarterial Chemoembolization in Combination with Percutaneous Irreversible Electroporation: Observations in an Acute Porcine Liver Model.
OBJECTIVE
To evaluate the effects of combined use of transarterial chemoembolization and irreversible electroporation (IRE) for focal tissue ablation in an acute porcine liver model.


METHODS
Two established interventional techniques were combined: IRE with zones of irreversible and reversible electroporation and chemoembolization with microspheres, iodized oil, and doxorubicin. IRE was performed before chemoembolization in two pigs (pigs 1 and 2; IRE/chemoembolization group), chemoembolization was performed before IRE in two pigs (pigs 3 and 4; chemoembolization/IRE group), and only IRE was performed in two pigs (pigs 5 and 6). Five study groups were defined: IRE/chemoembolization (pigs 1 and 2), chemoembolization/IRE (pigs 3 and 4), IRE only (pigs 5 and 6), chemoembolization only (tissue outside the IRE zones in pigs 1-4), and control (untreated liver tissue outside the IRE zones in pigs 5 and 6). Animals were euthanized 2 hours after intervention. Size and shape of IRE zones on contrast-enhanced computed tomography, cell death on light microscopy, and doxorubicin tissue concentrations on chromatography and fluorescence microscopy were analyzed.


RESULTS
Size and shape of IRE zones were not significantly different (eg, P = .067 for volume). A histologic marker for irreversible cell death was positive in IRE/chemoembolization, chemoembolization/IRE, and IRE groups only in the macroscopically visible IRE zones. Doxorubicin tissue concentrations were not significantly different (P = .873). However, in the reversible electroporation (RE) zones, broad areas with intense intranuclear doxorubicin accumulation were observed in IRE/chemoembolization but not in chemoembolization/IRE and chemoembolization groups.


CONCLUSIONS
IRE before chemoembolization enhances the intranuclear accumulation of doxorubicin in the RE zone.
Clinic for Diagnostic and Interventional Radiology, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany; Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Cancer Center Heilbronn-Franken, SLK Kliniken Heilbronn, Heilbronn, Germany.
Dominik
D
Vollherbst
Clinic for Diagnostic and Interventional Radiology, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
Robert C
RC
Bertheau
Department of General Visceral and Transplantation Surgery, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
Stefan
S
Fritz
Department of General Pathology, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
Carolin
C
Mogler
Clinic for Diagnostic and Interventional Radiology, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
Hans-Ulrich
HU
Kauczor
Department of General Visceral and Transplantation Surgery, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
Eduard
E
Ryschich
Clinic for Diagnostic and Interventional Radiology, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany.
Boris A
BA
Radeleff
Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Cancer Center Heilbronn-Franken, SLK Kliniken Heilbronn, Heilbronn, Germany.
Philippe L
PL
Pereira
Clinic for Diagnostic and Interventional Radiology, Liver Cancer Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany; Clinic for Diagnostic and Interventional Radiology, Stuttgart Cancer Center, European Siemens Reference Site for Interventional Oncology and Radiology, Klinikum Stuttgart, Stuttgart, Germany. Electronic address: christof.sommer@med.uni-heidelberg.de.
Christof M
CM
Sommer
D000818:Animals; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000378:metabolism; D001706:Biopsy; D016923:Cell Death / Q000187:drug effects; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004317:Doxorubicin / Q000008:administration & dosage* / Q000378:metabolism; D053672:Electrochemotherapy; D007459:Iodized Oil / Q000008:administration & dosage; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D023421:Models, Animal; D013552:Swine; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000903:Antibiotics, Antineoplastic; D007459:Iodized Oil; D004317:Doxorubicin