The Other Regime: Irreversible Electroporation
The subject of this portal is electrochemotherapy, which rests on reversible electroporation. Irreversible electroporation (IRE-ECT) is a different regime of the same biophysical phenomenon and appears in the corpus as comparative context. This page shows where the two regimes diverge; it does not recommend a choice.
Comparison Table
| Reversible electroporation (RE-ECT) | Irreversible electroporation (IRE-ECT) | |
|---|---|---|
| Core aim | Make the membrane transiently permeable and deliver a cytotoxic drug into the cell | Kill cells directly with the electric field (ablation) |
| Drug use | Required (bleomycin or cisplatin) | None |
| Source of cell death | Intracellular drug action (DNA damage) | Permanent loss of membrane integrity and collapse of homeostasis |
| Typical field strength | ≈1,000–1,300 V/cm | ≈1,500–3,000 V/cm |
| Typical pulse count | 8 | 70–100 |
| Thermal effect | Negligible | Non-thermal, though heating at the electrode tip may be reported |
| Extracellular matrix | Preserved | Preserved |
| Large vessels and nerves | Generally preserved | Preserved; studied in lesions adjacent to vascular and ductal structures |
| Anaesthesia | Local to general, depending on lesion number and depth | General anaesthesia with deep neuromuscular blockade is required |
| Cardiac synchronisation | Recommended for applications near the heart | Required as standard |
| Guideline-level coverage | ESOPE standard operating procedures (2006, updated 2018) and NICE IPG446/IPG478 | No comparable European practice standard exists |
| Care setting | Can be delivered as an outpatient or at the bedside for a limited number of superficial lesions; sessions are repeatable | An image-guided interventional procedure requiring operating-theatre conditions |
| Leading indications | Cutaneous and subcutaneous metastases, malignant melanoma, head and neck, chest wall, Kaposi sarcoma | Locally advanced pancreatic cancer, perivascular liver tumours, prostate |
| Publications in the corpus | 1639 | 1035 |
Where Each Regime Is Used
Electrochemotherapy
Numerous, scattered lesions in the skin and subcutis. A single systemic bleomycin dose can treat dozens of nodules in one session; for a limited number of superficial lesions the procedure can be done as an outpatient or at the bedside, and sessions are repeatable.
In bleeding, ulcerated superficial lesions the haemostatic contribution of the vascular lock is a separate gain. The method is standardised by ESOPE, defined as an interventional procedure in NICE guidance, and accounts for the large majority of clinical publications in the corpus.
Irreversible electroporation
Studied in deep-seated lesions adjacent to large vessels, bile ducts or nerves, locations where thermal ablation is considered unsuitable because of heat spread.
Delivery takes place under interventional radiology conditions with general anaesthesia, deep neuromuscular blockade and ECG synchronisation. The evidence base rests largely on single-arm series; no European practice standard comparable to ESOPE exists.
The two regimes answer different clinical questions, and the distribution of areas in the corpus reflects that.
Regime Split in the Corpus
Shows how much of each area’s literature belongs to the reversible regime and how much to the irreversible one.
| Application area | Reversible (RE-ECT) | Irreversible (IRE-ECT) | Split |
|---|---|---|---|
| General Principles & Biophysics | 556 | 218 | 72%28% |
| Liver Tumours | 75 | 206 | 27%73% |
| Skin & Cutaneous Tumours | 248 | 27 | 90%10% |
| Pancreatic Cancer | 40 | 227 | 15%85% |
| Malignant Melanoma | 168 | 7 | 96%4% |
| Cardiac Pulsed-Field Ablation | 0 | 135 | 0%100% |
| Prostate & Urological Tumours | 24 | 96 | 20%80% |
| Veterinary Oncology | 119 | 0 | 100%0% |
| Breast Cancer | 98 | 9 | 92%8% |
| Head & Neck Tumours | 66 | 8 | 89%11% |
| Bone & Soft Tissue Sarcomas | 49 | 10 | 83%17% |
| Colorectal Cancer | 44 | 8 | 85%15% |
| Brain Tumours | 16 | 25 | 39%61% |
| Vascular Malformations | 32 | 0 | 100%0% |
| Vulvar Cancer | 29 | 1 | 97%3% |
| Cholangiocarcinoma | 6 | 21 | 22%78% |
| Electrochemotherapy in Metastatic Disease | 22 | 5 | 81%19% |
| Kaposi Sarcoma | 25 | 0 | 100%0% |
| Lung & Peribronchial Tumours | 6 | 11 | 35%65% |
| Ovarian Tumours | 11 | 4 | 73%27% |
| Non-Oncological IRE Applications | 0 | 10 | 0%100% |
| Devices & Clinical Trials | 5 | 3 | 62%38% |
| Endometrial Cancer | 0 | 4 | 0%100% |