Stereotactic Percutaneous Electrochemotherapy as Primary Approach for Unresectable Large HCC at the Hepatic Hilum

L Luerken,M Doppler,S M Brunner,H J Schlitt,W Uller

doi:10.1007/s00270-021-02841-1

Abstract

Electrochemotherapy (ECT) is a novel non-thermal ablative technique that combines chemotherapy and the application of electric pulses for reversible cell membrane electroporation. This method was recently performed in the treatment of deep-seated liver tumors during open surgery but experience about percutaneous ECT is rare and further developments like combination of percutaneous ECT with stereotactic navigated devices may be very promising. We report on a case of a 4.7 × 4.5 × 3.5 cm unresectable HCC at the hepatic hilum adjacent to the major vessels and the bile duct that was successfully treated using percutaneous ECT in combination with stereotactic navigation. Follow-up imaging 6 weeks and 6 months after ECT showed complete response.

Highlights

In recent years, local ablative procedures have become a curative treatment option even for patients with increasingly large hepatocellular carcinoma (HCC)
We report on a case of a 4.7 9 4.5 9 3.5 cm unresectable HCC at the hepatic hilum adjacent to the major vessels and the bile duct that was successfully treated using percutaneous ECT in combination with stereotactic navigation
Local ablative procedures have become a curative treatment option even for patients with increasingly large hepatocellular carcinoma (HCC). This is due to technical advances in (1) thermal ablative procedures such as multiantenna microwave ablation (MWA) [1, 2], (2) combination of radiofrequency ablation (RFA) or MWA with transarterial chemoembolization (TACE) [3] and (3) the use of stereotactic navigation devices [4,5,6]

Summary

Introduction

Local ablative procedures have become a curative treatment option even for patients with increasingly large hepatocellular carcinoma (HCC). Irreversible electroporation (IRE) is a non-thermal treatment method, which allows treatment of HCC lesions in close proximity to major blood vessels without the disadvantages of thermal ablation methods like heat sink effect and without the risk of injury of central vessels and bile ducts [7]. This renders IRE a good treatment option for tumor lesions close to the liver hilum. Contrast-enhanced MRI 6 weeks and 6 months after ECT showed complete response with no residual or recurrent HCC and without any signs of damage of the central bile ducts or affection of the liver artery (Fig. 3)

Discussion

Conclusion