Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience

PurposeTo evaluate the efficacy and safety of irreversible electroporation (IRE) in the treatment of unresectable hepatocellular carcinoma (HCC).Materials and MethodsA retrospective study was conducted from September 2014 to June 2017. A total of 21 HCCs in 21 patients with cirrhosis were treated with IRE. There were eight subcapsular or exophytic, ten perivascular and three peribiliary tumors. The median tumor size was 26mm (range 14-40mm). The technical success of the procedure was recorded. Median follow-up, median time to local recurrence, median local tumor progression-free survival (PFS) and complications were recorded.ResultsTechnical success was achieved in all the patients. The median follow-up was 10months (range 2-30months). The median time to local recurrence and local tumor PFS were 4months (range 3-4months) and 7months (range 3-30months), respectively. The tumor-related factor that was significantly associated with local PFS was the size. Maximum tumor diameter <25mm was significantly associated with local tumor PFS (p=0.045). Other parameters including tumor location, segmental portal vein thrombosis, baseline alpha-fetoprotein level and underlying etiology did not affect local tumor PFS. Complications were noted in nine patients and were classified as grades 1 and 2. No procedure-related mortality was encountered.ConclusionIRE is an effective treatment for ablation of small HCCs. Larger prospective studies with strict selection criteria will establish the safety and efficacy of IRE in the treatment of unresectable HCC in patients who cannot undergo thermal ablation.