Abstract : Irreversible electroporation (IRE) is the sole physical ablative technology inducing tumorous cell death by process unrelated to thermal effect. This characteristic makes the technique suitable for the treatment of subtypes of liver tumors especially hepatocellular carcinoma (HCC) located next to critical structures leading to contraindications to thermal ablation like radiofrequency, microwave or cryotherapy. However, while IRE appears safe in such assumed challenging cases for thermal techniques, several issues remain to be addressed to make its use easier and more effective in clinical practice. First of all, tissue changes induced by IRE must be assessed keeping in mind that conversely to thermal techniques its efficacy is not limited to observable coagulative necrotic component of treatment zone. In addition, IRE which is multibipolar ablative technology requires meticulous demanding electrodes positioning to ensure proper magnitude of electric fields between each dipole. Finally, numerical simulations of IRE are mandatory to ease the setting of electrical pulses parameters to improve predictability of treatment in each individual case. In this setting of continue efforts to improve practicability of IRE the technique is routinely used in our institution since several years for the treatment of patients bearing early and locally advanced HCC not amenable to resection or thermal ablation. All along our experience with IRE, imaging appeared as a key point for addressing the specific issues listed above. For the 58 first patients 92% of complete ablation were achieved while the one-year local tumor progression free survival was 70% (95% CI: 56%, 81%). Indeed, despite the need of improvements IRE appears right now as a unique opportunity to achieve complete sustained local tumor control for patient bearing early or locally advanced HCC not amenable to other curative treatments.

Keywords : cell membrane; irreversible electroporation; tissue ablation; hepatocellular carcinoma