Irreversible Electroporation (IRE): Comparative Context
The subject of this portal is electrochemotherapy (ECT), which rests on reversible electroporation. Irreversible electroporation (IRE) 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 and does not treat the two as equivalent.
Comparison Table
| Electrochemotherapy (ECT) | Irreversible electroporation (IRE) | |
|---|---|---|
| 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 |
| Pulse parameters | A single published framework: 8 or 96 pulses depending on electrode type, 100 µs, 1,000–1,300 V/cm amplitude-to-distance ratio | No single published standard; protocols vary between studies (for example 80 pulses, 100 µs, 2,500 V/cm in one preclinical study) |
| Thermal effect | The cell death mechanism is principally non-thermal; Joule heating can occur | Non-thermal, though heating at the electrode tip may be reported |
| Extracellular matrix | Largely preserved | Largely preserved; the preservation is not absolute |
| Large vessels and nerves | Generally preserved | Generally preserved, though not absolutely; studied in lesions adjacent to vascular and ductal structures |
| Anaesthesia | Local to general, depending on lesion number and depth | Delivered under general anaesthesia with complete muscle relaxation; a deeper neuromuscular blockade is reported to be needed for retroperitoneal sites , |
| Cardiac synchronisation | Used for applications near the heart , | Used as standard for applications near the heart |
| Guideline-level coverage | ESOPE standard operating procedures (2006; the 2018 update covers cutaneous tumours and skin metastases) , and NICE HealthTech guidance NICE HTG305, NICE HTG333 | This portal’s survey found no comparable European practice standard |
| Care setting | Can be delivered as an outpatient procedure for a limited number of superficial lesions; sessions are repeatable | An interventional procedure delivered percutaneously under imaging guidance or during open surgery , |
| Leading indications | Cutaneous and subcutaneous metastases, malignant melanoma, head and neck, chest wall, Kaposi sarcoma | Locally advanced pancreatic cancer, perivascular liver tumours, prostate |
| Publications of this method in the extended corpus | 1,073 | 928 |
| Other methods sharing the same regime The method label is single per record; these publications sit beside the numbers above, not inside them. | other electroporation applications 657 calcium electroporation 75 gene electrotransfer 146 electrosclerotherapy 28 | pulsed-field ablation 128 |
| Regime total | reversible 1,979 | irreversible 1,056 |
The counts are from the extended electroporation corpus and show publication volume; they are not an indicator of clinical effectiveness or adoption. The NICE guidance was published in 2013 and 2014 as IPG446 and IPG478 and was later moved, with content unchanged, to the HealthTech guidance numbering (HTG305 and HTG333).
Where Each Regime Is Used
Electrochemotherapy (ECT)
Numerous, scattered lesions in the skin and subcutis. A single systemic bleomycin dose can treat many nodules in one session; for a limited number of superficial lesions the procedure can be done as an outpatient, and sessions are repeatable.
The method is standardised by the ESOPE procedures , and is addressed as a defined interventional procedure in NICE HealthTech guidance in the United Kingdom. NICE HTG305, NICE HTG333
Irreversible electroporation (IRE)
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 is percutaneous under imaging guidance or during open surgery, under general anaesthesia with complete muscle relaxation. , For sites close to the heart the pulses are synchronised to the electrocardiogram.
ECT and IRE Split by Area
Within each area only the publications labelled ECT and IRE are set against one another. Other electroporation methods in the same area (other applications, gene electrotransfer, calcium electroporation, PFA) are not in the denominator, so the percentages show the share between these two methods rather than the area as a whole. In General Principles & Biophysics, for instance, 456 of the area's 968 records are compared in that row. Scope: the extended electroporation corpus.
| Application area | ECT | IRE | Split |
|---|---|---|---|
| General Principles & Biophysics | 245 | 211 | 54%46% |
| Pancreatic Cancer | 34 | 229 | 13%87% |
| Liver Tumours | 47 | 203 | 19%81% |
| Skin & Cutaneous Tumours | 173 | 5 | 97%3% |
| Malignant Melanoma | 124 | 6 | 95%5% |
| Prostate & Urological Tumours | 11 | 117 | 9%91% |
| Veterinary Oncology | 122 | 4 | 97%3% |
| Breast Cancer | 87 | 8 | 92%8% |
| Head & Neck Tumours | 63 | 6 | 91%9% |
| Bone & Soft Tissue Sarcomas | 39 | 13 | 75%25% |
| Brain Tumours | 7 | 30 | 19%81% |
| Colorectal Cancer | 24 | 8 | 75%25% |
| Vulvar Cancer | 29 | 1 | 97%3% |
| Kaposi Sarcoma | 22 | 0 | 100%0% |
| Cholangiocarcinoma | 4 | 17 | 19%81% |
| Electrochemotherapy in Metastatic Disease | 13 | 7 | 65%35% |
| Non-Oncological Electroporation | 0 | 20 | 0%100% |
| Cardiac Pulsed-Field Ablation | 1 | 15 | 6%94% |
| Lung & Peribronchial Tumours | 4 | 11 | 27%73% |
| Nanosecond Pulsed Electric Field (nsPEF) | 4 | 7 | 36%64% |
| Devices & Clinical Trials | 4 | 5 | 44%56% |
| Ovarian Tumours | 7 | 2 | 78%22% |
| Vascular Malformations | 7 | 0 | 100%0% |
| Oesophageal & Upper Gastrointestinal Tumours | 2 | 1 | 67%33% |
| Endometrial Cancer | 0 | 2 | 0%100% |