Skip to main content
SpringerLink
Log in

Peri-tumoral Metallic Implants Reduce the Efficacy of Irreversible Electroporation for the Ablation of Colorectal Liver Metastases

  • Clinical Investigation
  • Non-Vascular Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effect of peri-tumoral metallic implants (MI) on the safety and efficacy of percutaneous irreversible electroporation (IRE) of colorectal liver metastasis (CRLM).

Materials and Methods

In this retrospective study, 25 patients (12 women, 13 men; MI: 13, no MI: 12) were treated for 29 CRLM. Patient characteristics, tumor location and size, treatment parameters and the presence of MI were evaluated as determinants of local tumor progression (LTP) with the competing risks model (univariate and multivariate analyses). Patient-specific computer models were created to examine the effect of the MI on the electric field used to induce IRE, probability of cell kill and potential thermal effects.

Results

Patients had a median follow-up of 25 months, during which no IRE-related major complications were reported. Univariate analysis showed that tumor size (> 2 cm), probe spacing (> 20 mm) and the presence of MI (p < 0.05) were significant predictors of time to LTP, but only the latter was found to be an independent predictor on multivariate analysis (sub-hazard ratio = 6.5; [95% CI 1.99, 21.4]; p = 0.002). The absence of peri-tumoral MI was associated with higher progression-free survival at 12 months (92.3% [56.6, 98.9] vs 12.5% [2.1, 32.8]). Computer simulations indicated significant distortions and reduction in electric field strength near MI, which could have contributed to under-treatment of the tumor.

Conclusions

Peri-tumoral MI increases the risk of treatment failure following IRE of CRLM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Kingham TP, Karkar AM, D’Angelica MI, et al. Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg. 2012;215(3):379–87.

    Article  Google Scholar 

  2. Cannon R, Ellis S, Hayes D, Narayanan G, Martin RCG. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol. 2013;107(5):544–9.

    Article  Google Scholar 

  3. Niessen C, Igl J, Pregler B, et al. Factors associated with short-term local recurrence of liver cancer after percutaneous ablation using irreversible electroporation: a prospective single-center study. J Vasc Interv Radiol. 2015;26(5):694–702.

    Article  Google Scholar 

  4. Scheffer HJ, Nielsen K, van Tilborg AAJM, et al. Ablation of colorectal liver metastases by irreversible electroporation: results of the COLDFIRE-I ablate-and-resect study. Eur Radiol. 2014;24(10):2467–75.

    Article  CAS  Google Scholar 

  5. Schoellhammer HF, Goldner B, Merchant SJ, Kessler J, Fong Y, Gagandeep S. Colorectal liver metastases: making the unresectable resectable using irreversible electroporation for microscopic positive margins—a case report. BMC Cancer. 2015;15(1):271.

    Article  Google Scholar 

  6. Dollinger M, Zeman F, Niessen C, et al. Bile duct injury after irreversible electroporation of hepatic malignancies: evaluation of MR imaging findings and laboratory values. J Vasc Interv Radiol. 2016;27(1):96–103.

    Article  Google Scholar 

  7. Silk MT, Wimmer T, Lee KS, et al. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol. 2014;25(1):112–8.

    Article  Google Scholar 

  8. Scheffer HJ, Vogel JA, van den Bos W, et al. The influence of a metal stent on the distribution of thermal energy during irreversible electroporation. PLoS ONE. 2016;11(2):e0148457.

    Article  Google Scholar 

  9. Ben-David E, Ahmed M, Faroja M, et al. Irreversible electroporation: treatment effect is susceptible to local environment and tissue properties. Radiology. 2013;269(3):738–47.

    Article  Google Scholar 

  10. Rems L, Miklavčič D. Tutorial: Electroporation of cells in complex materials and tissue. J Appl Phys. 2016;119(20):201101.

    Article  Google Scholar 

  11. Goldberg SN, Grassi CJ, Cardella JF, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology. 2005;235(3):728–39.

    Article  Google Scholar 

  12. Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Radiology. 2014;273(1):241–60.

    Article  Google Scholar 

  13. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. CIRSE quality assurance document and standards for classification of complications: the CIRSE classfication system. Cardiovasc Intervent Radiol. 2017;40(8):1141–6.

    Article  CAS  Google Scholar 

  14. Marčan M, Pavliha D, Kos B, Forjanič T, Miklavčič D. Web-based tool for visualization of electric field distribution in deep-seated body structures and planning of electroporation-based treatments. Biomed Eng Online. 2015;14(Suppl 3):S4.

    Article  Google Scholar 

  15. Kos B, Voigt P, Miklavcic D, Moche M. Careful treatment planning enables safe ablation of liver tumors adjacent to major blood vessels by percutaneous irreversible electroporation (IRE). Radiol Oncol. 2015;49(3):234–41.

    Article  CAS  Google Scholar 

  16. Garcia PA, Kos B, Rossmeisl JH, Pavliha D, Miklavčič D, Davalos RV. Predictive therapeutic planning for irreversible electroporation treatment of spontaneous malignant glioma. Med Phys. 2017;44(9):4968–80.

    Article  CAS  Google Scholar 

  17. Dermol J, Miklavčič D. Mathematical models describing chinese hamster ovary cell death due to electroporation in vitro. J Membr Biol. 2015;248(5):865–81.

    Article  CAS  Google Scholar 

  18. Garcia PA, Davalos RV, Miklavcic D. A numerical investigation of the electric and thermal cell kill distributions in electroporation-based therapies in tissue. PLoS ONE. 2014;9(8):e103083.

    Article  Google Scholar 

  19. Donoghoe MW, Gebski V. The importance of censoring in competing risks analysis of the subdistribution hazard. BMC Med Res Methodol. 2017;17(1):52.

    Article  Google Scholar 

  20. Gallinato O, de Senneville BD, Seror O, Poignard C. Numerical workflow of irreversible electroporation for deep-seated tumor. Phys. Med. Biol. 2019;64(5):055016.

    Article  Google Scholar 

  21. Margonis GA, Sasaki K, Andreatos N, et al. KRAS mutation status dictates optimal surgical margin width in patients undergoing resection of colorectal liver metastases. Ann Surg Oncol. 2017;24(1):264–71.

    Article  Google Scholar 

  22. Akyuz M, Aucejo F, Quintini C, Miller C, Fung J, Berber E. Factors affecting surgical margin recurrence after hepatectomy for colorectal liver metastases. Gland Surg. 2016;5(3):263–9.

    Article  Google Scholar 

  23. Vroomen LGPH, Petre EN, Cornelis FH, Solomon SB, Srimathveeravalli G. Irreversible electroporation and thermal ablation of tumors in the liver, lung, kidney and bone: What are the differences? Diagn Interv Imaging. 2017;98(9):609–17.

    Article  CAS  Google Scholar 

  24. Neal RE, Smith RL, Kavnoudias H, et al. The effects of metallic implants on electroporation therapies: feasibility of irreversible electroporation for brachytherapy salvage. Cardiovasc Intervent Radiol. 2013;36(6):1638–45.

    Article  Google Scholar 

  25. Dunki-Jacobs EM, Philips P, Martin RCG. Evaluation of thermal injury to liver, pancreas and kidney during irreversible electroporation in an in vivo experimental model. Br J Surg. 2014;101(9):1113–21.

    Article  CAS  Google Scholar 

  26. Månsson C, Nilsson A, Karlson B-M. Severe complications with irreversible electroporation of the pancreas in the presence of a metallic stent: a warning of a procedure that never should be performed. Acta Radiol Short Rep. 2014. https://doi.org/10.1177/2047981614556409.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Yarmush ML, Golberg A, Serša G, Kotnik T, Miklavčič D. Electroporation-based technologies for medicine: principles, applications, and challenges. Annu Rev Biomed Eng. 2014;16:295–32020.

    Article  CAS  Google Scholar 

  28. O’Brien TJ, Bonakdar M, Bhonsle S, et al. Effects of internal electrode cooling on irreversible electroporation using a perfused organ model. Int J Hyperthermia. 2018;35:44–55.

    Article  Google Scholar 

  29. Faroja M, Ahmed M, Appelbaum L, et al. Irreversible electroporation ablation: is all the damage nonthermal? Radiology. 2013;266(2):462–70.

    Article  Google Scholar 

  30. Edhemović I, Brecelj E, Gasljevic G, et al. Intraoperative electrochemotherapy of colorectal liver metastases. J Surg Oncol. 2014;110(3):320–7.

    Article  Google Scholar 

  31. Edhemovic I, Gadzijev EM, Brecelj E, et al. Electrochemotherapy: a new technological approach in treatment of metastases in the liver. Technol Cancer Res Treat. 2011;10(5):475–85.

    Article  CAS  Google Scholar 

  32. Djokic M, Cemazar M, Popovic P, et al. Electrochemotherapy as treatment option for hepatocellular carcinoma, a prospective pilot study. Eur J Surg Oncol. 2018;44(5):651–7.

    Article  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the support of NIH Cancer Center Support Grant (P30 CA008748) for core laboratory services that were used for the presented work. The authors acknowledge the support of the National Cancer Institute of the National Institutes of Health under Award Numbers U54CA137788/U54CA132378, and the Slovenian Research Agency (ARRS), Slovenia Program P2-0249, Grant Z3-7126 and Bilateral Slovenian-USA project BI-US/18-19-002. SBS is a consultant to BTG, Johnson & Johnson, XACT, Adegro and Medtronic. SBS is a consultant to BTG, Johnson & Johnson, XACT, Adgero, Innobaltive, and Medtronic. SBS has funding support from GE Healthcare, Ethicon, Elesta and Angiodynamics, and holds stock in Aperture Medical.

Author information

Authors and Affiliations

  1. Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Francois H. Cornelis, Masashi Fujimori, Elena N. Petre & Stephen B. Solomon

  2. Tenon Hospital, ISCD, Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France

    Francois H. Cornelis

  3. Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, 1000, Ljubljana, Slovenia

    Helena Cindrič, Bor Kos & Damijan Miklavčič

  4. Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, 01003, USA

    Govindarajan Srimathveeravalli

  5. Institute for Applied Life Sciences, University of Massachusetts, Amherst, MA, 01003, USA

    Govindarajan Srimathveeravalli

Authors
  1. Francois H. Cornelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helena Cindrič
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bor Kos
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masashi Fujimori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elena N. Petre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Damijan Miklavčič
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stephen B. Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Govindarajan Srimathveeravalli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Govindarajan Srimathveeravalli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical Approval

All procedures were performed in accordance with the ethical standards of the institutional or national research committee, and with the Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, informed consent is not required.

Consent for Publication

For this type of study, consent for publication is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cornelis, F.H., Cindrič, H., Kos, B. et al. Peri-tumoral Metallic Implants Reduce the Efficacy of Irreversible Electroporation for the Ablation of Colorectal Liver Metastases. Cardiovasc Intervent Radiol 43, 84–93 (2020). https://doi.org/10.1007/s00270-019-02300-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-019-02300-y

Keywords

Search

Navigation