Irreversible Electroporation for Hepatic Tumors: Protocol Standardization Using the Modified Delphi Technique.

Area of Science:

• Oncology
• Interventional Radiology
• Medical Devices

Background:

• Hepatic malignancies present treatment challenges, necessitating advanced ablation techniques.
• Irreversible electroporation (IRE) offers a non-thermal option for liver tumors, particularly those near critical structures.
• Standardized protocols are crucial for optimizing IRE efficacy and safety in clinical practice.

Purpose of the Study:

• To develop a uniform protocol for irreversible electroporation (IRE) in treating hepatic malignancies.
• To provide consensus-based guidelines on indications, procedural parameters, perioperative care, and follow-up for IRE.
• To establish expert recommendations for patient selection and management in IRE therapy for liver tumors.

Main Methods:

• Modified Delphi technique involving 8 interventional radiology panelists with expertise in hepatobiliary IRE.
• Three iterative rounds of anonymous questionnaires to gather consensus on IRE protocols.
• Consensus defined as 80% or greater agreement among panelists on specific items.

Main Results:

• Consensus reached on 91% of 136 items, yielding 124 agreed-upon recommendations.
• IRE is recommended for unresectable liver tumors unsuitable for thermal ablation due to proximity to critical structures.
• Specific contraindications include ventricular arrhythmias and advanced heart failure; metal stents outside the ablation zone are not contraindications.

Conclusions:

• The study provides expert consensus recommendations for irreversible electroporation (IRE) in hepatic malignancies.
• Guidelines cover patient selection, workup, procedural details, and post-treatment follow-up.
• These recommendations aim to standardize and improve the application of IRE for liver cancer treatment.