We review the safety and early oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in small renal masses (SRMs). Following PROSPERO registration (CRD42020197943), a systematic search of MEDLINE, EMBASE and SCOPUS databases according to PRISMA guidelines was performed. Critical appraisal of the included studies was performed using the Newcastle-Ottawa Scale. Of 224 articles screened, 10 met the inclusion criteria. In total, 83 patients were identified. Except for one cohort study ( n = 41), the remaining studies were case series of n < 10. Follow up was <12 months in 7/10 articles (range 3–34 months). About 10/10 articles reported safety outcomes. There were no 30-day mortalities. The most frequently reported adverse events were transient haematuria (11/83) and asymptomatic perirenal haematomas (7/83). About 62/63 patients with reported length of stay were discharged within 24 h. No significant long-term changes in renal function were reported. About 7/10 articles reported oncological outcomes. Only one article assessed histopathological outcomes, whilst the remaining studies used cross-sectional imaging modalities to assess efficacy, recurrence or disease progression. About 4/7 patients with histopathology outcomes, showed complete response (CR). About 43/55 patients with radiological outcomes showed CR. No mortalities were reported due to SRMs. These initial findings support IRE as safe and feasible in managing SRMs. However, results from larger studies with longer follow-up are needed to evaluate oncological outcomes and compare these with other ablation methods.
Purpose Intratympanic (IT) injections of corticosteroids have emerged as a non-ablative alternative to gentamicin in the management of refractory Meniere’s disease. However, currently, the duration of the symptom control achieved via intratympanic corticosteroids is under reported. Methods We retrospectively reviewed the notes of all patients who underwent IT injections of dexamethasone for the treatment of definite Meniere’s disease at a single tertiary referral university centre over a 6-year period. We included demographic information, the number of procedures patients required, duration of symptom-control achieved (time interval between repeat IT injections), and the presence of co-morbidities, with a focus on the presence of autoimmune disease. Results We identified 27 patients who underwent a total of 42 procedures; 23/27 (85.2%) patients demonstrated clinical response with a median period of symptom control of 14.5 months (range 1–64, IQR 10.25). The median longest asymptomatic period per patient was 19 months (range 11–64, IQR: 18). Interestingly, all patients with autoimmune disease (7/27) demonstrated a clinical response; autoimmune disease was found to be a statistically significant predictor of response to treatment (p = 0.002). In patients who received repeated treatment following disease relapse, there was no difference in duration of symptom-control achieved. Conclusions IT steroids can provide an effective alternative to gentamicin ablation. Symptom control is achieved for a median of 14.5 months, and treatment can be repeated with no loss of efficacy. Those patients who have an underlying autoimmune co-morbidity are more likely to demonstrate a clinical response to therapy, which may provide insight into the underlying pathophysiology of Meniere’s disease.
Introduction Thermal tumour ablation techniques are effective alternatives to nephrectomy for small renal masses (SRM). Thermal effects limit their use in tumours adjacent to vital structures. We review safety and oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in SRMs. Method MEDLINE, EMBASE, and SCOPUS databases were interrogated up to 29/11/2020 for studies reporting safety and oncological outcomes for SRMs in humans treated by IRE. Results Of 224 results screened, 10 met the inclusion criteria. In total, 83 patients were identified. Except for one cohort study (n = 41), remaining studies were case series of n < 10. Follow up was <12 months in 7/10 articles (Range 3-34 months). 10/10 articles reported safety outcomes. There were no 30-day mortalities. The most reported adverse events were transient haematuria (11/83) and asymptomatic perirenal haematomas (7/83). 62/63 patients with reported length of stay were discharged within 24 hours. No significant long-term changes in renal function were reported. 7/10 articles reported oncological outcomes. Only 1 article assessed histopathology outcomes. Remaining studies used CT, PET, or MRI for assessment. 4/7 (57%) patients with histopathology outcomes, showed complete response (CR). 43/55 (78%) patients with imaging base outcomes, showed CR. No mortalities were reported due to SRMs. Conclusions Initial findings support IRE as safe and feasible in managing SRMs. Results from larger studies with longer follow-up are needed to evaluate oncological outcomes and compare these with other ablation methods. Discrepancy between CR rates in histopathology vs imaging assessment could indicate higher sensitivity of histopathology for assessing outcomes.
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