Percutaneous irreversible electroporation for the treatment of small renal masses: The first Canadian case series

  • Bonnie Liu University of Saskatchewan
  • Jordyn Clark University of Saskatchewan
  • Trustin Domes University of Saskatchewan, Department of Surgery
  • Chris Wall University of Saskatchewan, Department of Radiology
  • Kunal Jana University of Saskatchewan, Department of Surgery
Keywords: Renal cell carcinoma, small renal mass, irreversible electroporation, minimally invasive

Abstract

Introduction: Irreversible electroporation (IRE) is a novel technology used in the minimally invasive treatment of small solid organ tumors. Currently, there is a paucity of literature studying treatment of small renal masses (SRMs) with IRE. Our pilot study is the first case series in Canada to use IRE in the treatment of SRMs.

Methods: This retrospective cohort pilot study includes five patients (three females and two males) who presented with a SRM that was deemed not amendable to any treatment other than a radical nephrectomy or IRE. The IRE procedures were carried out by an interventional radiologist in conjunction with a urologist using the Angiodynamics NanoKnife IRE device.

Results: Mean tumor size was 28 mm (range 18–39), with a mean R.E.N.A.L. nephrometry score of 8.4±0.55. Over a mean followup of 22.8 months (range 14–31), four out of the five patients did not have a radiological recurrence. No adverse events were reported after the five IRE procedures. Renal function was stable post-IRE, with no to negligible decreases in estimated glomerular filtration rate detected (range +2 to -13 mL/min/1.73 m2).

Conclusions: Our pilot study demonstrates that renal percutaneous IRE is safe to use in the context of challenging-to-treat SRMs. Early radiological and renal function outcomes are encouraging, but further study is required to assess oncological success. The small sample size, retrospective nature of the study, relatively short followup, and lack of routine renal biopsy to confirm malignancy are the major limitations noted.

Author Biographies

Bonnie Liu, University of Saskatchewan
Student at the University of Saskatchewan, MD Candidate 2019
Jordyn Clark, University of Saskatchewan
Student at the University of Saskatchewan, MD Candidate 2019
Trustin Domes, University of Saskatchewan, Department of Surgery
Director of Undergraduate Surgical Education, Adjunct Professor of Surgery, Division of Urology 
Chris Wall, University of Saskatchewan, Department of Radiology
Adjunct Professor, Division of Radiology
Kunal Jana, University of Saskatchewan, Department of Surgery
Adjunct Professor of Surgery, Division of Urology

References

Silk M, Tahour D, Srimathveeravalli G, et al. The state of irreversible electroporation in interventional oncology. Semin Interv Radiol 2014;31:111-7.

Pech M, Janitzky A, Wendler JJ, et al. Irreversible electroporation of renal cell carcinoma: A first-in-man phase I clinical study. Cardiovasc Intervent Radiol 2011;34:132-8.

Scheffer HJ, Nielsen K, de Jong MC, et al. Irreversible electroporation for nonthermal tumor ablation in the clinical setting: A systematic review of safety and efficacy. J Vasc Interv Radiol 2014;25:997-1011.

Vroomen LGPH, Petre EN, Cornelis FH, et al. Irreversible electroporation and thermal ablation of tumors in the liver, lung, kidney and bone: What are the differences? Diagn Interv Imaging 2017;98:609-17.

Cannon R, Ellis S, Hayes D, et al. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol 2013;107:544-9.

Thomson KR, Cheung W, Ellis SJ, et al. Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol 2011;22:611-21.

Tracy CR, Kabbani W, Cadeddu JA. Irreversible electroporation (IRE): a novel method for renal tissue ablation. BJU Int 2011;107:1982-7.

Wendler JJ, Pech M, Porsch M, et al. Urinary tract effects after multifocal nonthermal irreversible electroporation of the kidney: acute and chronic monitoring by magnetic resonance imaging, intravenous urography and urinary cytology. Cardiovasc Intervent Radiol 2012;35:921-6.

Trimmer CK, Khosla A, Morgan M, et al. Minimally invasive percutaneous treatment of small renal tumors with irreversible electroporation: A single-center experience. J Vasc Interv Radiol 2015;26:1465-71.

Wendler JJ, Pech M, Fischbach F, et al. Initial assessment of the efficacy of irreversible electroporation (IRE) in the focal treatment of localised renal-cell carcinoma (RCC) with delayed-interval kidney tumour resection (IRENE trial – an ablate-and-resect pilot study). Urology 2018;114:224-32.

Buijs M, van Lienden KP, Wagstaff PG, et al. Irreversible electroporation for the ablation of renal cell carcinoma: A prospective, human, in vivo study protocol (IDEAL phase 2b). JMIR Res Protoc 2017;6:e21.

Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth. JURO 182:844-53.

Ha SC, Zlomke HA, Cost N, et al. The past, present, and future in management of small renal masses. J Oncol 2015;1-7.

Schmit GD, Thompson RH, Kurup AN, et al. Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors. JURO 2013;189:30-5.

Rubinsky B, Onik G, Mikus P. Irreversible electroporation: A new ablation modality — clinical implications. Technol Cancer Res Treat 2007;6:37-48.

Narayanan G, Bhatia S, Echenique A, et al. Vessel patency post irreversible electroporation. Cardiovasc Intervent Radiol 2014;37:1523-9.

Wendler JJ, Pech M, Köllermann J, et al. Upper-urinary-tract effects after irreversible electroporation (IRE) of human localised renal-cell carcinoma (RCC) in the IRENE pilot phase 2a ablate-and-resect study. Cardiovasc Intervent Radiol 2018;41:466-476.

Diehl SJ, Rathmann N, Kostrzewa M, et al. Irreversible electroporation for surgical renal masses in solitary kidneys: Short-term interventional and functional outcome. J Vasc Interv Radiol 2016;27:1407-13.

Trimmer CK, Khosla A, Morgan M, Stephenson SL, Ozayar A, Cadeddu JA. Minimally invasive percutaneous treatment of small renal tumors with irreversible electroporation: A single-center experience. J Vasc Interv Radiol 2015;26:1465-71.

Canvasser NE, Sorokin I, Lay AH, et al. Irreversible electroporation of small renal masses: suboptimal oncologic efficacy in an early series. World J Urol 2017;35:1549-55.

Wendler JJ, Ricke J, Pech M, et al. First delayed resection findings after irreversible electroporation (IRE) of human localised renal cell carcinoma (RCC) in the IRENE pilot phase 2a trial. Cardiovasc Intervent Radiol 2016;39:239-50.

Published
2018-11-19
How to Cite
Liu, B., Clark, J., Domes, T., Wall, C., & Jana, K. (2018). Percutaneous irreversible electroporation for the treatment of small renal masses: The first Canadian case series. Canadian Urological Association Journal, 13(9). Retrieved from https://cuaj.ca/index.php/journal/article/view/5728
Section
Original Research