Future perspectives of IRE

Modern medicine is constantly developing less invasive methods for treatment of disease. While some of the research regarding tissue ablation was documented over 100 years ago, the majority of the investigative efforts have taken place within the past 20 years. Since its first introduction in 1990, the efficacy of thermal ablation techniques, such as radiofrequency ablation (RFA) and microwave ablation (MWA), has greatly improved due to technological advancements in image guidance, resulting in real-time tumor localization and accurate needle targeting. Technical advances of the thermal devices such as the development of more powerful generators and better-quality probe designs have further improved the efficacy, creating larger, more spherical, and more predictable ablation zones. In the rapidly changing climate of tumor ablation, irreversible electroporation (IRE) is the newest kid on the block. Over the past years, IRE has been increasingly used in clinical practice because the hypothetical advantages over thermal ablation seem intuitive and self-evident. However, hard evidence regarding the actual working mechanism and - more importantly - regarding the established safety and efficacy is lacking and conclusions drawn from the available data may very well be prejudiced.