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Advanced Ultrasound in Diagnosis and Therapy ›› 2025, Vol. 9 ›› Issue (3): 229-244.doi: 10.26599/AUDT.2025.240052

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  • 收稿日期:2024-09-27 修回日期:2024-12-14 接受日期:2025-03-19 出版日期:2025-09-30 发布日期:2025-10-13

Research Progress on the Application of Irreversible Electroporation Ablation in Cancers

Zhang Ronga,b, Xie Litinga,c, Jin Qijinga, Zhang Chengyuea, Guo Tenga, Zhao Qiyua,*(), Jiang Tian’ana,c,*()   

  1. aDepartment of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
    bDepartment of Ultrasound Medicine, Affiliated Jinhua Hospital Zhejiang University School of Medicine, Jinhua, Zhejiang, P.R. China
    cKey Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang, P.R. China
  • Received:2024-09-27 Revised:2024-12-14 Accepted:2025-03-19 Online:2025-09-30 Published:2025-10-13
  • Contact: Department of Ultrasound Medicine, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang 310003, P.R. China. e-mail: zhaoqiyu2000@zju.edu.cn(QY Zhao); tiananjiang@zju.edu.cn (Tian’an Jiang)

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Abstract:

Irreversible electroporation (IRE) is an innovative non-thermal ablation technique increasingly utilized in cancer treatment due to its unique operational principles and clinical advantages. As a novel interventional ultrasound technology, IRE has undergone extensive research, development, and practical application over the years. IRE ablation, particularly in conjunction with immunotherapy, has emerged as a significant modality in cancer treatment and related fields. This article aims to present the advancements in irreversible electroporation ablation for cancer through an examination of both basic research and clinical applications.

Key words: Irreversible electroporation, Ultrasonography, Interventional, Cancer treatment

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Author (year,
reference No)		PatientsLesionsMean cancer size (mm)Median follow-up (months)ResultsTreatment-related complication
Thomson et al. (2011, 46)n = 25n = 75253Complete remission rate (CR):colorectal liver metastases (CLM) (RE-CIST) was 50%, hepatocellular carcinoma (HCC) was 83.3%no significant cancer response in lesions ≥ 50 mmCardiac rhythm disturbance in 2 patients, pneumothorax (1 patient), brachial plexus neuropraxia related to positioning (2 patients).
Philips et al. (2013, 47)n = 60n = 663818A total of 12 patients were felt to have been incompletely ablated. 35 (31%) patients had recurrence.
2 peri-operative deaths.		Among the high grade adverse events (AEs) were 3 cases of deep vein thrombosis (DVT)/pulmonary embolism (PE), 1 of bile leak and 2 of biliary strictures, 2 of bleeding requiring transfusions and 1portal vein thrombus. The attributable high-grade complication rate was 4%.
Hosein et al. (2014. 59)n = 29n = 5827-The 2-year progression-free survival (PFS) rate was 18%, the 2-year overall survival (OS) rate was 62%.Arrhythmias (n = 1) and post-procedure pain (n = 1).
Niessen et al. (2016, 48)n = 34n = 652413.9The local recurrence-free survival (LRFS) at 3, 6, and 12 months were 87.4%, 79.8%, and 74.8%.The overall complication rate was 27.5%, 6 cases being major complications, 8 cases being minor complications.
Bhutiani et al. (2016. 51)n = 30n = 30306The success rate for liver cancer reached 97%.Major and minor complication rates were 27% for patients undergoing IRE ablation.
Distelmaier et al. (2017,49)n = 29n = 43-2440 of the 43 (93%) target cancers were detected achieved complete ablation, only two cases of recurrence within the ablation area.The blood vessels in the surgical area were well preserved and the blood supply was normal in 29 patients, 5 cases had mild to moderate cholestasis.
Frühling et al. (2017. 58)n = 30n = 382422.3Ablation success was 78.9% at 3 months,65.8% at 6 months.6 patients (20%) have a minor complication, 1 patient (3.3%) suffered from a major complication (bile duct dilatation and stricture of the portal vein and bile duct).
Niessen et al. (2017. 57)n = 71n = 1031935.7The median OS was 26.3 months; patients with a cancer diameter >30 mm or more than 2 lesions died significantly earlier than patients with smaller or fewer cancers.5 major complications (4 liver abscess, 1 myocardial infarction) and 7 minor complications (2 pneumothorax, 2 cardiac arrhythmia, 3 hematoma).
Alnaggar et al. (2018. 53)nA (IRE) = 20
nB (IRE-NK) = 20		--7.6The median OS in the group A and group B was 8.9 and 10.1 months.No severe complications (such as ruptured or hepatic failure, myoglobinuria, or acute renal failure) were reported post-IRE.
Yang et al. (2019. 54)nA (IRE) = 22
nB (IRE-NK) = 18		-nA:47.3
nB:48.1		14PFS: IRE was 10.6 months IRE-NK was 15.1 months.
OS: IRE was 17.9 months IRE-NK was 23.2 months.		Pain, pleural effusion, ascites, fatigue, and fever. There was no difference among the two groups.
Cornelis et al. (2020. 56)n = 25n = 252125Cancer size (> 20 mm), probe spacing (> 20 mm) and the presence of Myocardial Infarction (MI) were significant predictors of time to local cancer progression (LTP).No major complications.
Meijerink et al. (2021. 55)n = 51n = 762223.9,
9.5,
6.3		1-year LTP-free survival of 68%. Local control following repeat procedures was 74% of participants (37 of 50). Median OS from first IRE was 2.7 years.Overall complication rate, 40%, 1 participant (2%) had an infected biloma after IRE, died fewer than 90 days after the procedure (grade 5 adverse event).
Frühling et al. (2023.50)n = 149n = 206-58Median Survival Time (MST): HCC was 27.0 months, colorectal cancer liver metastasis (CRCLM) was 35.0 months
LTP: HCC was 21.0 months, CRCLM was 6.0 months.		During the 30-day postoperative follow-up, 26 (17.4%) patients experienced complications.
Hassany et al. (2024.52)n = 10n = 1026.9245 patients developed recurrence away from the primary ablated site and 2 patients remained alive.Clinical decompensation occurred in 6 (60%) patients in the IRE group. The two most common causes were ascites and portal vein thrombosis

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Author (year,
reference No)		PatientsLesionsMean cancer size (mm)Median follow-up (months)ResultsTreatment-related complication
Martin et al. (2013. 64)n = 54n = 543210Local progression-free survival (PFS) was 14 months, distant PFS was 15 months, overall survival (OS) was 20 monthsNo major complications.
Yan et al. (2016. 62)n = 25n = 25423The overall rate of stable disease was 28%, 36% achieved partial response, and lower serum CA19-9 levels were recorded in all patients at discharge.4 intraoperative procedure-related complications. 3 Grade A pancreatic fistulas, 3 delayed gastric emptying, 1 acute pancreatitis, 1 upper gastrointestinal hemorrhage, and 1 portal vein thrombosis
Scheffer et al. (2017. 63)n = 25n = 254012Median event-free survival (EFS) was 8 months; The median OS was 11 months from IRE.12 minor complications (grade I or II) ,11 major complications (9 grade III, 2 grade IV) in 10 patients.
Narayanan et al. (2017. 65)n = 50n = 5032-The median OS was 14.2 months after IRE. cancers ≤ 30 mm (n = 24) with > 30 mm (n = 26): 16.2 vs 9.9 months7 abdominal pain,1 pancreatitis, 1 sepsis, 1 gastric leak
Lin et al. (2017. 67)nA (IRE) = 30
nB (IRE-NK) = 37		n = 67-7.9The median PFS and OS of the IRE-NK group was higher than the IRE group.
The median PFS/OS of multiple IRE-NK group was higher than single IRE-NK group (9.9 vs 8.2 months)/ (13.7 vs12.1 months).		Cough 12.7%, nausea and emesis 6.8%, pain of puncture point 25.3%, duodenum and gastric retention 5.9%, fatigue 21.5, fever 33.5%, blood pressure intraoperative transient reduction 27.4% and white cell count reduction 22.6%
Ruarus et al. (2020. 60)n = 50n = 6140-Local recurrence developed in 23 of the 50 participants after IRE. For locally advanced pancreatic cancer (LAPC) patients median OS was 10 months from IRE. For participants with postresection local recurrence, the median OS was 9 months from IRE.14 minor and 21 major complications occurred in 29 of the 50 participants (58%). One of two participants who died may have been linked to IRE.
Li et al. (2020. 61)n = 64n = 64-29.3The median OS and PFS of the entire cohort was 24.6 months and 12.0 months.There were 7, 4, and 2 cases of pancreatic fistula, incision infection, and upper gastrointestinal bleeding.
Lin et al. (2020. 68)nA (IRE+γδ T-cell) = 30 nB (IRE) =32-nA:40
nB:39		12OS: group A vs group B:14.5 months vs. 11 months
Median PFS: group A vs group B:11 months vs. 8.5 months.		14 major and 25 minor AEs happened in 31 of the 62 patients (50%), including 16 participants in group A and 15 in group B.
O'Neill et al. (2020. 69)n = 10n = 10-12Mean time to progression was 6.3 months, median overall survival of 18.0 months.Seven patients developed grade 3/4 treatment-related adverse events.
Pan et al. (2020. 70)nA (IRE) = 46
nB (IRE-NK) = 46		n = 92nA:41
nB:44		6-29Disease-free survival (DFS) and OS between the IRE and IRE-NK group
(6.1 ± 3.9 months vs. 7.2 ± 4.3 months, and 11.8 ± 4.6
months vs. 12.4 ± 5.2 months)		No major complications.
Ma et al. (2023.71)nA (IRE) = 25
nB (IRE-NK) = 78		n = 103nA:41
nB:38		18.2Group A (IRE in combination with chemotherapy and programmed death protein-1/Programmed Death-Ligand 1 (PD-1/PD-L1) blockade) compared to group B (IRE in combination with chemotherapy): median OS: 23.6 vs 19.4 months, median PFS: 18.2 vs 14.7 months.Immune-related AEs in group A were pruritus (24%), hypothyroidism (16%), increased bilirubin (16%), ALT increase (16%). The major (grade 3 - 4) IRE-related AEs were cardiac arrhythmias (48%), hypertension (48%), pancreatitis (28%), hemorrhage (16%).

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Author (year,
reference No)		PatientsLesionsMean cancer sizeMedian follow-upResultsTreatment-related complication
Prostate cancers
Onik et al. (2010. 72)n = 16n = 16-3 weeksAll patients were continent immediately, 15 patients had no evidence for cancer in the ablation area. 1 patient has microfocus of Gleason 6 lesion outside ablation area.No major complications.
Fenner et al. (2014. 77)n = 34n = 34-6 months19 patients retain erectile function. The patients who can control urination independently before retain this ability after surgery.2 cases of urinary retention, 6 cases of hematuria, 5 cases of dysuria, and 5 cases of urinary tract infection.
Ting et al. (2016. 73)n = 25n = 25-8 monthsNo suspicious findings on mp-MRI (n = 24) or biopsy (n = 21) in all patients. 4 significant finding on biopsy adjacent to the treatment zone, and 1 in outfield.1 Clavien Grade 3 complication and five Grade 1 complications. Functional follow-up confirmed no significant change in sexual or bowel function.
Dong et al. (2018. 76)n = 50n = 50-6 monthsThe ablation margin is obvious, the prostate capsule and urethra were intact.No major complications.
Wang et al. (2022. 74)n = 109n = 10938.1 mL6 monthsMedian (IQR) international prostate symptom score was 4.5 (2.0 - 9.5), and median (IQR) international index of erectile function 5 score was 2.0 (0.5 - 12.5).The overall complication rate was 37.6%, like elevated white blood cell level in urine, followed by epididymiti, prolonged gross hematuria, urinary retention, urinary tract infection and bladder stones.
Scheltema et al. (2023. 75)n = 229n = 229-60 monthsFailure-free survival
(FFS) rates were 91% at 3 years, 84% at 5 years and 69% at 8 years. Metastasis-free survival was 99.6%, prostate cancer (PC) a-specific and overall survival were 100%.		Short-term urinary continence was preserved (98%, 3 of 144 at baseline, 99%, 1 of 131 at 12 months) and erections sufficient for intercourse decreased by 13% compared to baseline (71% to 58%).
Kidney cancers
Buijs et al. (2019. 80)n = 10n = 1023 mm6 monthsTechnical success was achieved in 9 cases.1 patient had a grade 3 Clavien-Dindo complication.
Wah et al. (2021. 78)n = 26n = 3025 mm37 months22 renal cell carcinomas
(RCCs) were completely IRE ablated. The overall 2- and 3-year cancer-specific (CS), local recurrence-free (LRF) and metastasis-free (MF) survival rates are 89%, 96%, 91% and 87%.		1 patient had CD-III complication with a proximal ureteric injury.5 patients developed > 25% reduction of estimated glomerular filtration rate (eGFR). No patient need requirement for renal dialysis.
Wang et al. (2021.79)n = 15n = 1924 mm6 monthsThe success rate of the procedure was 100%.2 patients had transient gross hematuria. Self-limiting perinephric hematomas occurred in 1 patient.

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