Safety and Efficacy of an Irreversible Electroporation System with Real-Time Electrical and Thermal Monitoring for Liver Tumors: A Bicentric Retrospective Study.

PURPOSE: To assess the safety and efficacy of an irreversible electroporation (IRE) system integrating real-time electrical and thermal monitoring for liver tumor ablation. MATERIALS AND METHODS: This bicentric retrospective study included all consecutive patients treated with this device for primary or secondary liver tumors between April 2022 and August 2024. IRE was selected when surgery or thermal ablation was unsuitable. Patient, tumor and procedure characteristics-including voltage, amperage, interprobe distance, and maximal needle tip temperature-were recorded. Procedures were guided by CT, cone-beam CT or ultrasound. The protocol aimed for a "plateau-current" ≥30 A per needle pair while maintaining probe-tip temperature <50 °C near at-risk structures. Complications were classified using the CIRSE classification. Local tumor progression-free survival (LTPFS) was assessed by MRI every 3 months. RESULTS: 27 patients with 31 liver tumors (15 primary, 16 metastatic; mean diameter 17.9 mm) were treated using 3-6 electrodes. No grade ≥3 complications occurred. Median follow-up was 18.4 months; 6- and 12-month LTPFS rates were 87% and 79%. Interprobe distance >20 mm was associated with recurrence (HR=5.64, p=0.017). Mean peak temperature was 53.3 °C. In cirrhotic livers, mean current was higher (38.9 A vs 32.1 A, p=0.004) and peak temperature lower (49.4 °C vs 56.0 °C, p=0.024). CONCLUSION: This IRE system appears feasible for liver tumors ineligible for thermal ablation, with a favorable preliminary safety profile and encouraging local control. Real-time electrical and thermal monitoring might be an interesting asset to achieve standardization of IRE procedures.