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Published on: June 8, 2018
Irreversible electroporation of small renal masses: suboptimal oncologic efficacy in an early series
Noah E Canvasser1, Igor Sorokin1, Aaron H Lay1
1Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
Purpose:
To report on the first short-term oncologic outcomes of percutaneous irreversible electroporation for small renal masses.
Methods:
Patients with cT1a renal masses treated with irreversible electroporation from April 2013 through December 2016 were reviewed. Small, low complexity tumors were generally selected for irreversible electroporation using the NanoKnife® System (Angiodynamics, Latham, NY, USA). Surveillance imaging was performed post-operatively, and survival analysis was completed using the Kaplan-Meier method.
Results:
A total of 42 tumors in 41 patients underwent irreversible electroporation. Mean tumor size was 2.0 cm with a median R.E.N.A.L nephrometry score of 5. Twenty-nine patients (71%) were discharged the same day of the procedure and no major (Clavien grade II or higher) intraoperative or post-operative complications occurred. Initial treatment success rate was 93%; our three failures (7%) underwent salvage radiofrequency ablation. With a mean follow-up of 22 months, 2-year local recurrence-free survival was 83% for patients with biopsy confirmed renal cell carcinoma, 87% with biopsy confirmed or a history of renal cell carcinoma, and 92% for the intent-to-treat cohort.
Conclusions:
Although with low morbidity, in comparison to extirpation and conventional thermal ablation technologies, irreversible electroporation has suboptimal short-term local disease control results in this series of small, low complexity tumors. Larger series and longer follow-up will determine the durability of this modality.
Insights
Percutaneous irreversible electroporation for small renal masses showed a 93% initial success rate but suboptimal local disease control compared to other methods. Further studies are needed to confirm its long-term effectiveness.
Area of Science:
- Urology
- Oncology
- Minimally Invasive Surgery
Background:
- Small renal masses are increasingly detected, necessitating effective and minimally invasive treatment options.
- Percutaneous irreversible electroporation (IRE) is an emerging ablation technique for solid tumors.
Purpose of the Study:
- To evaluate the short-term oncologic outcomes of percutaneous irreversible electroporation (IRE) for small renal masses.
- To assess the safety and efficacy of IRE in a cohort of patients with cT1a renal tumors.
Main Methods:
- Retrospective review of patients with cT1a renal masses treated with IRE using the NanoKnife® System.
- Analysis of procedural success, complication rates, and oncologic outcomes including local recurrence-free survival.
- Kaplan-Meier survival analysis for different patient cohorts.
Main Results:
- 42 tumors in 41 patients were treated with IRE, with a mean tumor size of 2.0 cm.
- High initial treatment success rate (93%) with no major complications; 71% of patients discharged same day.
- 2-year local recurrence-free survival ranged from 83% to 92% depending on the cohort.
Conclusions:
- Percutaneous IRE demonstrated low morbidity for small renal masses but suboptimal short-term local disease control compared to established therapies.
- Further research with larger patient series and longer follow-up is required to determine the durability of IRE.
- IRE may be a viable option for select small, low-complexity renal tumors, but its long-term oncologic control needs further validation.
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