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Comparison of selective intra-arterial to standard intravenous administration in percutaneous electrochemotherapy (pECT) for liver tumors

Tim Wilke

Tim Wilke

Departement of Gastroenterology, Sinzig Medical Care CenterLinz/Rhein, Germany
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Wilke, Tim
, 
Erschad Hussain

Erschad Hussain

Campus Lübeck, University Schleswig-HolsteinLübeck, Germany
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Hussain, Erschad
, 
Hannah Spallek

Hannah Spallek

Clinic for Gynaecology and Obstetrics, University Hospital MannheimMannheim, Germany
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Spallek, Hannah
, 
Francesca de Terlizzi

Francesca de Terlizzi

IGEA Clinical Biophysics, Laboratory CarpiModena, Italy
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Terlizzi, Francesca de
, 
Lluis M Mir

Lluis M Mir

METSY UMR 9018, Université Paris-Saclay, CNRS, Gustave RoussyVillejuif, France
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Mir, Lluis M
, 
Peter Bischoff

Peter Bischoff

Clinic for Diagnostic and Interventional Radiology and Neuroradiology, WEGE KlinikBonn, Germany
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Bischoff, Peter
, 
Andreas Schäfer

Andreas Schäfer

Clinic for Diagnostic and Interventional Radiology and Neuroradiology, WEGE KlinikBonn, Germany
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Schäfer, Andreas
, 
Elke Bartmuß

Elke Bartmuß

Clinic for Diagnostic and Interventional Radiology and Neuroradiology, WEGE KlinikBonn, Germany
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Bartmuß, Elke
, 
Matteo Cadossi

Matteo Cadossi

IGEA Clinical Biophysics, Laboratory CarpiModena, Italy
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Cadossi, Matteo
, 
Alessandro Zanasi

Alessandro Zanasi

IGEA Clinical Biophysics, Laboratory CarpiModena, Italy
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Zanasi, Alessandro
, 
Michael Pinkawa

Michael Pinkawa

Clinic for Radiotherapy and Radiation Oncology, WEGE KlinikBonn, Germany
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Pinkawa, Michael
 and 
Attila Kovács

Attila Kovács

Clinic for Diagnostic and Interventional Radiology and Neuroradiology, WEGE KlinikBonn, Germany
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Kovács, Attila
  
Feb 27, 2025
Comparison of selective intra-arterial to standard intravenous administration in percutaneous electrochemotherapy (pECT) for liver tumors's Cover Image
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Article Category: research article
Published Online: Feb 27, 2025
Page range: 100 - 109
Received: Jan 23, 2025
Accepted: Feb 04, 2025
DOI: https://doi.org/10.2478/raon-2025-0017
Keywords
© 2025 Tim Wilke et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

(A) Transverse contrast-enhanced T1w MR image of a pancreatic carcinoma metastasis with a maximum diameter of 7 cm in segments V/VI and VII, which no longer responds to systemic chemotherapy and is growing rapidly and progressively. (B) Corresponding slice to A in diffusion imaging. (C) Complete contrast of the metastasis in 2D angiography. (D) Documentation of complete contrast coverage of the metastasis in cone beam CT. (E). Stereotactic navigation (CAS-One® IR) of the electrodes for electroporation. (F). Parallel planning of the electrodes in the tumor to achieve homogeneous electroporation. (G). The transverse contrast-enhanced T1w MR image of the metastasis one month after the electrochemotherapy (ECT) procedure demonstrates the complete loss of perfusion in the entire metastasis. (H) Corresponding slice to G in diffusion imaging.
(A) Transverse contrast-enhanced T1w MR image of a pancreatic carcinoma metastasis with a maximum diameter of 7 cm in segments V/VI and VII, which no longer responds to systemic chemotherapy and is growing rapidly and progressively. (B) Corresponding slice to A in diffusion imaging. (C) Complete contrast of the metastasis in 2D angiography. (D) Documentation of complete contrast coverage of the metastasis in cone beam CT. (E). Stereotactic navigation (CAS-One® IR) of the electrodes for electroporation. (F). Parallel planning of the electrodes in the tumor to achieve homogeneous electroporation. (G). The transverse contrast-enhanced T1w MR image of the metastasis one month after the electrochemotherapy (ECT) procedure demonstrates the complete loss of perfusion in the entire metastasis. (H) Corresponding slice to G in diffusion imaging.

FIGURE 2.

Progression free survival in the 2 groups during the 18-month follow-up period.
Progression free survival in the 2 groups during the 18-month follow-up period.

Response to percutaneous electrochemotherapy (pECT) treatment in the 2 groups

RESPONSE i.v. pECT (N = 21) i.a. pECT (N = 31) P value P value
N % N % Overall distribution CR vs. non CR
CR 13 61.9% 25 80.6% 0.3454 0.1349
PR 5 23.8% 4 12.9%
SD 1 4.8% 0 0.0%
PD 0 0.0% 1 3.2%
Lost to follow up 2 9.5% 1 3.2%

Descriptive characteristics of the patients in the 2 groups

PATIENTS i.v. pECT (N = 18) i.a. pECT (n = 26) P value
N % N %
Gender
  Males 8 44% 15 58% 0.5406
  Females 10 56% 11 42%
Diagnosis
  Colorectal cancer 7 39% 10 38% 0.4620
  Breast cancer 4 22% 4 15%
  Hepato cellular carcinoma 2 11% 2 8%
  Cholangio cellular carcinoma 0 0% 3 12%
  Ovarian cancer 2 11% 0 0%
  Non-small cell lung cancer (NSCLC) 1 6% 2 8%
  Anal cancer 1 6% 0 0%
  Pancreatic cancer 0 0% 1 4%
  Parotis carcinoma 0 0% 1 4%
  Neuroendocrine carcinoma 0 0% 1 4%
  Uterus carcinoma 0 0% 1 4%
  Esophageal carcinoma 0 0% 1 4%
  Cancer of unknown primary origin (CUP) 1 6% 0 0%
Liver metastases
  Synchronous 8 44% 16 62% 0.5343
  Metachronous 8 44% 8 31%
  No 2 11% 2 7%
Metastases location other than liver
  None 9 50% 17 65% 0.3613
  Yes 9 50% 9 35%
Other metastasis’ location
  Lung 3 17% 3 12% 0.6025
  Bone 1 6% 2 8%
  Kidney 1 6% 1 4%
  Lung + bone + brain 1 6% 0 0%
  Bone + peritoneum 1 6% 0 0%
  Pleural + bone 1 6% 0 0%
  Retroperineal 1 6% 0 0%
  Adrenal gland 0 0% 1 4%
  Lymphnode 0 0% 1 4%
  Bone + lymphnode 0 0% 1 4%
Previous treatments
  Systemic therapy 16 89% 26 100% 0.1617
  Liver surgery 4 22% 12 46% 0.1251
  Local treatments 11 61% 8 31% 0.0657
Type of local treatments
  TACE 8 43% 4 15% 0.1529
  TACE+RFA 1 6% 0 0%
  TACE+CP 1 6% 0 0%
  TACE/MWA/CRYOTH 0 0% 2 8%
  CRYOTH 1 6% 0 0%
  IBT 0 0% 2 8%
Comorbidities
  Cardiac diseases 6 33% 7 27% 0.7422
  Pulmonary diseases 3 17% 7 27% 0.4889
  Liver diseases 9 50% 0 0% <0.0001
Number of target lesions per patient
  1 15 83% 21 81% 1.000
  2 3 17% 5 19%

Characteristics of target lesions in the 2 groups

LESIONS i.v. pECT (N = 21) i.a. pEC (N = 31) P value
N % N %
Type
  Hypervascular 2 9.5% 5 16.1% 0.7664
  Intermediate 14 66.7% 20 64.5%
  Hypovascular 5 23.8% 6 19.4%
Challenging location*
  Yes 19 90.5% 21 67.7% 0.0927
  No 2 9.5% 10 32.3%
Vessels or bile ducts surrounding the metastases
  Distant (> 10 mm) 4 19.0% 8 25.8% 0.5389
  Close (1 mm to 10 mm) 6 28.6% 5 16.1%
  Adjacent (< 1 mm) 11 52.4% 18 58.1%
Previous local treatments on the lesion
  Yes 7 33.3% 8 25.8% 0.7559
  No 14 66.7% 23 74.2%
Type of local treatments on the lesion
  TACE (transarterial chemoembolization) 6 28.6% 4 12.9% 0.1474
  CP (chemoperfusion) 1 4.8% 0 0.0%
  IBT (interstitial brachytherapy) 0 0.0% 2 6.5%
  TACE/MWA/CRYOTH 0 0.0% 2 6.5%
Technical success
  Yes 20 95.2% 31 100.0% 0.2199
  No 1 4.8% 0 0.0%
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Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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