Computed tomography-guided irreversible electroporation for a pubic bone metastasis - a technical note and early experience

Sep 29, 2026

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Bone metastases are common in advanced solid tumors and often require local control in addition to systemic therapy. Thermal ablation can be limited in anatomically complex, heat-sensitive sites, and irreversible electroporation (IRE) is non-thermal and has not been reported for bone metastases. This technical note describes computed tomography-guided IRE early experience for a pubic bone lesion near critical structures, highlighting feasibility, safety, and early oncologic efficacy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Abstract

Keywords

Technique

Clinical case background

Imaging assessment

Rationale for IRE over thermal ablation

Main points

Copyright @ 2026 Author(s) -[Available online at dirjournal.org](Available online at dirjournal.org). Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. TECHNICAL NOTE Computed tomography-guided irreversible electroporation for a pubic bone metastasis: a technical note and early experience Claudio Pusceddu1 Eliodoro Faiella2 Claudio Cau 1 Pierluigi Rinaldi1 Paolo Cossu3 Salvatore Marsico4 1Mater Olbia Hospital, Clinic of Radiology, Olbia, Italy 2Campus Bio Medico, Department of Radiology, Rome, Italy 3Mater Olbia Hospital, Clinic of Anesthesiology, Olbia, Italy 4Hospital del Mar, Clinic of Radiology, Barcelona, Spain Corresponding author: Salvatore Marsico E-mail: [salvatore.marsico@hotmail.it](salvatore.marsico@hotmail.it) Received 14 April 2025; revision requested 21 April 2025; last revision received 24 May 2025; accepted 22 June 2025. Epub: 21.07.2025 Publication date: 02.01.2026 DOI: 10.4274/dir.2025.253402 ABSTRACT Bone metastases are common in advanced solid tumors and often require local control strategies in addition to systemic therapy. Although thermal ablation is an established method for selected lesions, its use may be limited in anatomically complex or heat-sensitive locations. Irreversible electroporation, a non-thermal ablative technique widely used in visceral oncology, has not yet been reported for the treatment of bone metastases. KEYWORDS Ablation, bone, interventional, metastases, oncology B one metastases are a frequent and challenging complication of advanced malignancies, particularly in patients with breast, prostate, or lung cancer. These lesions often cause severe pain, impaired mobility, and pathological fractures, considerably reducing pa- tients’ quality of life and functional autonomy. In the multidisciplinary management of such patients, local tumor control remains a key objective, especially for symptomatic, progressive, or weight-bearing lesions. Traditional local therapies include external beam radiotherapy, surgical stabilization, and image-guided percutaneous ablation. Among these, thermal ablation methods–radiofrequencyablation (RFA), microwave ablation (MWA), and cryoablation–have been widely adopted due to their efficacy, minimal invasiveness, and rapid recovery profiles. These techniques are recommended by current practice guidelines for treating painful or oligometastatic bone lesions and are particularly useful when systemic options are exhausted or contraindicated. 1,2 However, thermal ablation has important limitations. It is contraindicated in anatomical regions where adjacent critical structures–such as nerves, vessels, hollow organs, or joint capsules–are susceptible to thermal injury. The anterior pelvic ring, sacrum, spine, and skull base are examples of areas where thermal techniques pose a substantial risk of collateral damage. Moreover, thermal spread can be difficult to control, especially in heterogeneous or poorly vascularized tissues such as bone. In this context, irreversible electroporation (IRE) represents a promising alternative. It is a non-thermal technique that induces apoptosis by delivering high-voltage electric pulses across cell membranes, creating permanent nanopores that disrupt cellular homeostasis.3,4 Its primary advantage lies in the preservation of the extracellular matrix and surrounding connective tissues. Unlike thermal energy, electrical fields do not denature collagen, elastin, or basement membranes, enabling tumor ablation near neurovascular bundles or urogenital organs with a reduced risk of collateral injury.5 IRE has already been validated in visceral oncology, particularly for pancreatic, hepatic, and renal tumors located in anatomically complex regions. Despite these promising applications, its use in the treatment of bone metastases has not been previously reported. You may cite this article as: Pusceddu C, Faiella

FAQs

Why was thermal ablation unsuitable for the pubic bone metastasis in this case?

The lesion was in immediate proximity to the distal urethra and the anterior capsule of the pubic symphysis, making additional thermal ablation contraindicated due to risk to adjacent critical structures.

How does irreversible electroporation (IRE) differ from thermal ablation?

IRE is a non-thermal technique that delivers high-voltage electric pulses to induce apoptosis through permanent nanopores, preserving the extracellular matrix and reducing collateral injury compared with heat-based methods.

What did the authors report regarding feasibility and safety of CT-guided IRE?

The procedure demonstrated technical feasibility and early oncologic efficacy, was technically successful and well-tolerated, with no peri-procedural complications and a complete metabolic response.

Sep 29, 2026

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