CIO 2022-6 Irreversible Electroporation versus Radiofrequency Ablation as a Treatment Option in Hepatocellular Carcinoma

Purpose: In the United States, hepatocellular carcinoma (HCC) has an incidence of 7.7 per 100,000, which has steadily increased from 1992, when there was an incidence of 4.1 per 100,000. HCC is the most prevalent primary liver cancer and ranks fourth among cancer-related deaths. The gold-standard treatment for patients with early-stage HCC is surgical resection; however, when patients are not candidates for surgery, the treatment of choice is percutaneous ablation, with radiofrequency ablation (RFA) being the gold standard. Irreversible electroporation (IRE) is a newer ablation technology that uses a form of low-energy DC at a high voltage to disrupt the cell membrane of the HCC lesion by creating nanopores. This process disrupts the homeostasis of the lesion, leading to apoptosis and eventual cell death. The purpose of this research is to compare the 12-month local recurrence–free survival (LRFS), technical success rate (TSR), and major adverse event rate (MAE) of IRE and RFA to determine if IRE could replace RFA as the gold-standard ablation technique for patients with HCC.

Materials and Methods: A literature review was done using the PubMed database to compare the 12-month LRFS, TSR, and MAE of IRE with RFA. MAE was defined as complications that were life threatening or resulted in hospitalization. TSR was defined by complete ablation of the treated HCC lesion. Three studies were used in this review, with their results were compiled and reviewed. Among the three studies, a total of 201 cases were compared and reviewed. Of these cases, 105 received IRE, and 96 received RFA.

Results: A total of 76.9% of lesions receiving IRE achieved 12-month LRFS compared with 84.3% of RFA lesions. This result showed no significance on a 95% confidence interval (CI) (P = 0.1936). IRE had an MAE percentage of 1.9% compared with 0% of RFA-treated lesions. This result showed no significance on a 95% CI (P = 0.17384). The TSR of IRE-treated lesions was 92.04% compared with 98.11% for RFA-treated lesions. This result showed no significance on a 95% CI (P = 0.07186).

Conclusions: This review indicates that IRE could be a suitable replacement for RFA in the treatment of patients with HCC. Although currently regarded as an option only when RFA is not recommended, IRE shows no significant difference in short-term effectiveness or safety. Because IRE is a relatively new technology, more research needs to be done to determine its long-term effectiveness and safety.