Evaluation of the Ablation of Hepatic Lesions by Electroporation — EVALHEP  

Liver Cancer Clinical Trial

Official title: Evaluation of the Ablation of Hepatic Lesions by Electroporation

Status Recruiting

Clinical Trial Summary

Irreversible electroporation is a curative treatment for cancerous liver lesions, performed on deep-seated tumors that are not eligible for surgical resection or percutaneous thermal ablation.

The EVALHEP project aims to develop criteria for evaluating the effectiveness of the treatment based on imaging, mathematical models, and numerical simulations to assist radiologists who perform these complex procedures.

Clinical Trial Description

Percutaneous destruction of malignant liver tumors has been developing in routine clinical practice for around twenty years, and is performed by interventional radiologists under imaging guidance (ultrasound, computed tomography (CT), Cone-Beam CT...).

Irreversible electroporation (IRE) is a percutaneous tumor destruction technique distinguished from other ablation methods by its non-thermal mechanism of action. The rationale behind IRE is that cells subjected to a powerful pulsed electric field will have their membrane irreversibly damaged and destroyed, while the surrounding extracellular matrix will be respected. This technology offers the opportunity to effectively destroy lesions that would be impossible to treat by any other method, due to their critical tumor location, close to vital structures at risk.

Although it has demonstrated its clinical efficacy over the years, with the potential to provide safe, curative treatment for patients with deep, poorly located tumors, IRE is considered a complex procedure, subject to numerous variability factors, and remains under-utilized to this day. Precise insertion of several needles (up to 6) at tumor level is required to obtain a homogeneous electric field of sufficient intensity. To date, there is no way of assessing the effectiveness of the procedure in real time, and inaccuracies in needle positioning or in treatment parameters will generate changes in the distribution of the electric field that may adversely affect treatment efficacy. What's more, it remains difficult to assess treatment efficacy on post-therapy images, the interpretation of which is subject to controversy.

The Interventional Radiology (IR) unit of the University Hospitals of Paris Seine Saint Denis (HUPSSD) has been using IRE for over 10 years as part of its clinical routine, mainly for the ablation of liver tumors, and in particular hepatocellular carcinoma (HCC) which is inoperable and ineligible for conventional thermo-ablation. Over the past ten years, more than 350 patients have benefited from one or more IREs for the treatment of liver tumors at HUPSSD, making the department a reference center in the field.

Thanks to the contributions of mathematics applied to oncology, numerical tools and the clinical experience of the HUPSSD IR department, the aim of this project is to develop evaluation criteria for IRE ablations of liver tumors based on clinical imaging and numerical simulations of the electric field. ;

Related Conditions & MeSH terms

• Liver Cancer
• Liver Neoplasms

• NCT number: NCT06289712
• Study type: Observational
• Source: Assistance Publique - Hôpitaux de Paris
• Contact: Olivier SUTTER, Pr,MD, PhD
• Phone: 01 72 40 00 12
• Email: olivier.sutter@aphp.fr
• Status: Recruiting
• Start date: November 23, 2023
• Completion date: May 23, 2025