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Irreversible electroporation: Just another form of thermal therapy?
Author(s) -
van Gemert Martin J. C.,
Wagstaff Peter G. K.,
de Bruin Daniel M.,
van Leeuwen Ton G.,
van der Wal Allard C.,
Heger Michal,
van der Geld Cees W. M.
Publication year - 2015
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.22913
Subject(s) - irreversible electroporation , medicine , joule heating , electroporation , coagulative necrosis , blood flow , biomedical engineering , prostate , pulse (music) , pathology , radiology , materials science , chemistry , optics , physics , cancer , biochemistry , detector , composite material , gene
BACKGROUND Irreversible electroporation (IRE) is (virtually) always called non‐thermal despite many reports showing that significant Joule heating occurs. Our first aim is to validate with mathematical simulations that IRE as currently practiced has a non‐negligible thermal response. Our second aim is to present a method that allows simple temperature estimation to aid IRE treatment planning. METHODS We derived an approximate analytical solution of the bio‐heat equation for multiple 2‐needle IRE pulses in an electrically conducting medium, with and without a blood vessel, and incorporated published observations that an electric pulse increases the medium's electric conductance. RESULTS IRE simulation in prostate‐resembling tissue shows thermal lesions with 67–92°C temperatures, which match the positions of the coagulative necrotic lesions seen in an experimental study. Simulation of IRE around a blood vessel when blood flow removes the heated blood between pulses confirms clinical observations that the perivascular tissue is thermally injured without affecting vascular patency. CONCLUSIONS The demonstration that significant Joule heating surrounds current multiple‐pulsed IRE practice may contribute to future in‐depth discussions on this thermal issue. This is an important subject because it has long been under‐exposed in literature. Its awareness pleads for preventing IRE from calling “non‐thermal” in future publications, in order to provide IRE‐users with the most accurate information possible. The prospect of thermal treatment planning as outlined in this paper likely aids to the important further successful dissemination of IRE in interventional medicine. Prostate 75:332–335, 2015 . © 2014 The Authors. The Prostate Published by Wiley Periodicals, Inc.