# Cancer Treatment: An Overview of Pulsed Electric Field Utilization and Generation
###### Abstract  
Patients diagnosed with cancer receive different types of treatments based on the type and the level of the tumour. An emerging treatment that differs from well-developed systematic therapies (i.e., Chemotherapy, Radiotherapy, and Immunotherapy) is Tumour Treating Field (TTF) treatment. Tumour behaviour under TTF treatment varies based on the electric field intensity; the process of exposing the tumour cells to an electric field is called electroporation. From the electrical perspective, the most efficient method for electroporation is to use a voltage pulse generator. Several pulse generator topologies have been introduced to overcome existing limitations, mitigate the drawbacks of classical generators, and provide more controllable, flexible, and portable solid-state voltage pulse generators. This paper provides a review of cancer treatment using TTF and highlights the key specifications required for efficient treatment. Additionally, potential voltage pulse generators are reviewed and compared in terms of their treatment efficacy and efficient use of electrical power. cancer treatment; electroporation; electroporator; high-voltage pulse generator; pulsed electric field (PEF); tumour treating field (TTF) +
Footnote †: journal: Medical  
cancer cell progression and prevents proliferation [8; 9]. TTF is delivered in a range of frequencies from 100 kHz to 500 kHz based on the cancer cell type, allowing for optimal treatment of different cancers [10; 11]. TTF targets cancer cell features through many different mechanisms, including anti-mitotic action, enhanced autophagy, suppression of migration, and increased permeability; as cancer cells have features that are different from healthy cells, the treatment is able to be highly selective, leaving healthy neighbouring tissues unaffected [12; 13]. Commercial products that are used clinically for electrochemotherapy-based cancer treatment and certified by the US Food and Drug Administraion (FDA) include Optune(r) ([[https://www.optune.com/](https://www.optune.com/)]([https://www.optune.com/](https://www.optune.com/)) (accessed on 20 June 2023)) and Optune Lua(r) ([[https://www.optunehua.com/](https://www.optunehua.com/)]([https://www.optunehua.com/](https://www.optunehua.com/)) (accessed on 20 June 2023)) from the NovoCureTM company. These two products are wearable and portable devices that can be used for treatment in adult patients (aged 22 years or older) who have been diagnosed with a brain cancer called glioblastoma multiforme (GBM) [14; 15]. These devices can be used on patients in two contexts. If the patient has been newly diagnosed with GBM, Optune is used with chemotherapy if the cancer is confirmed by a doctor or physician and the patient has had surgery to remove much of the tumour. Alternatively, the device can be used to treat patients with GBM recurrence alone as an alternative to other standard medical treatments if surgery, radiation, and chemotherapy have failed to treat the patient and had no effect on cancer. This suggests that they are primarily used as a salvage treatment option for relapsed GBM when surgery, radiation, and chemotherapy have been unsuccessful. This is very important in GBM, as the majority of GBM patients exhibit relapse (75-80%), which is correlated with shorter survival [16]. The device comprises a power source, a field generator, and four transducer arrays. Transducers are attached to the patient's scalp after it has been completely shaved. Each transducer is composed of ceramic discs with a hydrogel coating to enhance pulse delivery to the scalp. The field generator is the part responsible for generating an alternating electric field that is used to shape the waveform utilizing the energy stored in the power source [17; 18]. Through trials and clinical treatment, the only side effect related to using this device is inflammation and irritation of the scalp skin, which can be treated with topical corticosteroids [19].