Advertisement

World Journal of Urology

, Volume 35, Issue 10, pp 1549–1555 | Cite as

Irreversible electroporation of small renal masses: suboptimal oncologic efficacy in an early series

  • Noah E. Canvasser
  • Igor Sorokin
  • Aaron H. Lay
  • Monica S. C. Morgan
  • Asim Ozayar
  • Clayton Trimmer
  • Jeffrey A. Cadeddu
Original Article

Abstract

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.

Keywords

Kidney neoplasms Carcinoma Renal cell Electroporation Survival rate Complications 

Notes

Compliance with ethical standards

Author contributions

NEC: Data collection, Data analysis, Manuscript writing and editing. IS: Data collection, Data analysis, Manuscript writing and editing. AHL: Data collection. MSCM: Data collection, Manuscript writing. AO: Data collection. CT: Protocol/project development. JAC: Protocol/project development, Data analysis, Manuscript editing.

Conflict of interest

The authors declare that they have no conflict of interest.

Extra-institutional funding

None.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki declaration and its later amendments.

References

  1. 1.
    Tracy CR, Raman JD, Donnally C, Trimmer CK, Cadeddu JA (2010) Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer 116(13):3135–3142CrossRefPubMedGoogle Scholar
  2. 2.
    Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA (2013) Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 63(3):486–492CrossRefPubMedGoogle Scholar
  3. 3.
    Olweny EO, Park SK, Tan YK, Best SL, Trimmer C, Cadeddu JA (2012) Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol 61(6):1156–1161CrossRefPubMedGoogle Scholar
  4. 4.
    Kim EH, Tanagho YS, Saad NE, Bhayani SB, Figenshau RS (2014) Comparison of laparoscopic and percutaneous cryoablation for treatment of renal masses. Urology 83(5):1081–1087CrossRefPubMedGoogle Scholar
  5. 5.
    Caputo PA, Ramirez D, Zargar H, Akca O, Andrade HS, O’Malley C, Remer EM, Kaouk JH (2015) Laparoscopic cryoablation for renal cell carcinoma: 100-month oncologic outcomes. J Urol 194(4):892–896CrossRefPubMedGoogle Scholar
  6. 6.
    Atwell TD, Carter RE, Schmit GD, Carr CM, Boorjian SA, Curry TB, Thompson RH, Kurup AN, Weisbrod AJ, Chow GK, Leibovich BC, Callstrom MR, Patterson DE (2012) Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol 23(1):48–54CrossRefPubMedGoogle Scholar
  7. 7.
    Best SL, Park SK, Youssef RF, Yaacoub RF, Olweny EO, Tan YK, Trimmer C, Cadeddu JA (2012) Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters. J Urol 187(4):1183–1189CrossRefPubMedGoogle Scholar
  8. 8.
    Park BK, Kim CK (2009 Sep) Complications of image-guided radiofrequency ablation of renal cell carcinoma: causes, imaging features and prevention methods. Eur Radiol 19(9):2180–2190CrossRefPubMedGoogle Scholar
  9. 9.
    Lay AH, Faddegon S, Olweny EO, Morgan M, Lorber G, Trimmer C, Leveillee R, Cadeddu JA, Gahan JC (2015) Oncologic efficacy of radio frequency ablation for small renal masses: clear cell vs papillary subtype. J Urol 194(3):653–657CrossRefPubMedGoogle Scholar
  10. 10.
    Davalos RV, Mir ILM, Rubinsky B (2005 Feb) Tissue ablation with irreversible electroporation. Ann Biomed Eng 33(2):223–231CrossRefPubMedGoogle Scholar
  11. 11.
    Gehl J (2003 Apr) Electroporation: theory and methods, perspectives for drug delivery, gene therapy and research. Acta Physiol Scand 177(4):437–447CrossRefPubMedGoogle Scholar
  12. 12.
    Edd JF, Horowitz L, Davalos RV, Mir LM, Rubinsky B (2006) In vivo results of a new focal tissue ablation technique: irreversible electroporation. IEEE T Bio-Med Eng 53(7):1409–1415CrossRefGoogle Scholar
  13. 13.
    Kingham TP, Karkar AM, D’Angelica MI, Allen PJ, Dematteo RP, Getrajdman GI, Sofocleous CT, Solomon SB, Jarnagin WR, Fong Y (2012) Ablation of perivascular hepatic malignant tumors with irreversible electroporation. J Am Coll Surg 215(3):379–387CrossRefPubMedGoogle Scholar
  14. 14.
    Martin RCG, Kwon D, Chalikonda S, Sellers M, Kotz E, Scoggins C, McMasters KM, Watkins K (2015 Sep) Treatment of 200 locally advanced (stage III) pancreatic adenocarcinoma patients with irreversible electroporation: safety and efficacy. Ann Surg 262(3):486–494CrossRefPubMedGoogle Scholar
  15. 15.
    Ting F, Tran M, Böhm M, Siriwardana A, Van Leeuwen PJ, Haynes A-M, Delprado W, Shnier R, Stricker PD (2016) Focal irreversible electroporation for prostate cancer: functional outcomes and short-term oncological control. Prostate Canc P D 19(1):46–52CrossRefGoogle Scholar
  16. 16.
    Deodhar A, Monette S, Single GW, Hamilton WC, Thornton R, Maybody M, Coleman JA, Solomon SB (2011) Renal tissue ablation with irreversible electroporation: preliminary results in a porcine model. Urology 77(3):754–760CrossRefPubMedGoogle Scholar
  17. 17.
    Tracy CR, Kabbani W, Cadeddu JA (2011) Irreversible electroporation (IRE): a novel method for renal tissue ablation. BJU Int 107(12):1982–1987CrossRefPubMedGoogle Scholar
  18. 18.
    Olweny EO, Kapur P, Tan YK, Park SK, Adibi M, Cadeddu JA (2013) Irreversible electroporation: evaluation of nonthermal and thermal ablative capabilities in the porcine kidney. Urology 81(3):679–684CrossRefPubMedGoogle Scholar
  19. 19.
    Pech M, Janitzky A, Wendler JJ, Strang C, Blaschke S, Dudeck O, Ricke J, Liehr U-B (2011) Irreversible electroporation of renal cell carcinoma: a first-in-man phase I clinical study. Cardiovasc Inter Rad 34(1):132–138CrossRefGoogle Scholar
  20. 20.
    Wendler JJ, Ricke J, Pech M, Fischbach F, Jürgens J, Siedentopf S, Roessner A, Porsch M, Baumunk D, Schostak M, Köllermann J, Liehr U-B (2015) First delayed resection findings after irreversible electroporation (IRE) of human localised renal cell carcinoma (RCC) in the IRENE Pilot Phase 2a trial. Cardiovasc Inter Rad 4(39):239–250.Google Scholar
  21. 21.
    Diehl SJ, Rathmann N, Kostrzewa M, Ritter M, Smakic A, Schoenberg SO, Kriegmair MC (2016) Irreversible electroporation for surgical renal masses in solitary kidneys: short-term interventional and functional outcome. J Vasc Interv Radiol 27(9):1407–1413CrossRefPubMedGoogle Scholar
  22. 22.
    Trimmer CK, Khosla A, Morgan M, Stephenson SL, Ozayar A, Cadeddu JA (2015 Oct) Minimally invasive percutaneous treatment of small renal tumors with irreversible electroporation: a single-center experience. J Vasc Interv Radiol 26(10):1465–1471CrossRefPubMedGoogle Scholar
  23. 23.
    Kutikov A, Uzzo RG (2009) The R.E.N.A.L nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182(3):844–853CrossRefPubMedGoogle Scholar
  24. 24.
    Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH, Herrell SD, Hilton S, Jonasch E, Lin DW, Reuter VE, Chang SS (2013) Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol 190:407–416CrossRefPubMedGoogle Scholar
  25. 25.
    Dindo D, Demartines N, Clavien P-A (2004 Aug) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH, Faraday MM, Kaouk JH, Leveillee RJ, Matin SF, Russo P, Uzzo RG, Practice Guidelines Committee of the American Urological Association (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279CrossRefPubMedGoogle Scholar
  27. 27.
    Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924CrossRefPubMedGoogle Scholar
  28. 28.
    Crispen PL, Boorjian SA, Lohse CM, Sebo TS, Cheville JC, Blute ML, Leibovich BC (2008) Outcomes following partial nephrectomy by tumor size. J Urol 180(5):1912–1917CrossRefPubMedGoogle Scholar
  29. 29.
    Balageas P, Cornelis F, Le Bras Y, Hubrecht R, Bernhard JC, Ferrière JM, Ravaud A, Grenier N (2013) Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients. Eur Radiol 23(7):1925–1932CrossRefPubMedGoogle Scholar
  30. 30.
    Zargar H, Samarasekera D, Khalifeh A, Remer EM, O’Malley C, Akca O, Autorino R, Kaouk JH (2015 Apr) Laparoscopic vs percutaneous cryoablation for the small renal mass: 15-year experience at a single center. Urology 85(4):850–855CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Noah E. Canvasser
    • 1
  • Igor Sorokin
    • 1
  • Aaron H. Lay
    • 1
  • Monica S. C. Morgan
    • 1
  • Asim Ozayar
    • 1
  • Clayton Trimmer
    • 2
  • Jeffrey A. Cadeddu
    • 1
    • 2
  1. 1.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations