Irreversible electroporation (IRE) in renal cell carcinoma (RCC): a mid-term clinical experience

Abstract

Objectives To evaluate the safety and efficacy of CT-guided IRE of clinical T1a (cT1a) renal tumours close to vital structures and to assess factors that may influence the technical success and early oncological durability. Methods CT-guided IRE (2015–2020) was prospectively evaluated. Patients’ demographics, technical details/success, Clavien-Dindo (CD) classification of complications (I–V) and oncological outcome were collated. Statistical analysis was performed to determine variables associated with complications. The overall 2- and 3-year cancer-specific (CS), local recurrence-free (LRF) and metastasis-free (MF) survival rates are presented using the Kaplan-Meier curves. Results Thirty cT1a RCCs (biopsy-proven/known VHL disease) in 26 patients (age 32–81 years) were treated with IRE. The mean tumour size was 2.5 cm and the median follow-up was 37 months. The primary technical success rate was 73.3%, where 22 RCCs were completely IRE ablated. Seven residual diseases were successfully ablated with cryoablation, achieving an overall technical success rate of 97%. One patient did not have repeat treatment as he died from unexpected stroke at 4-month post-IRE. One patient had CD-III complication with a proximal ureteric injury. Five patients developed > 25% reduction of eGFR immediately post-IRE. All patients have preservation of renal function without the requirement for renal dialysis. The overall 2- and 3-year CS, LRF and MF survival rates are 89%, 96%, 91% and 87%. Conclusion CT-guided IRE in cT1a RCC is safe with acceptable complications. The primary technical success rate was suboptimal due to the early operator’s learning curve, and long-term follow-up is required to validate the IRE oncological durability. Key Points • Irreversible electroporation should only be considered when surgery or image-guided thermal ablation is not an option for small renal cancer. • This non-thermal technique is safe in the treatment of small renal cancer and the primary technical success rate was 73.3%. • This can be used when renal cancer is close to important structure.

Local Release of TGF‐β Inhibitor Modulates Tumor‐Associated Neutrophils and Enhances Pancreatic Cancer Response to Combined Irreversible Electroporation and Immunotherapy

“…Interestingly, a tertiary lymphoid‐like structure was observed (red arrow), which has been reported to favor the outcome of immunotherapy. [ 26 ] It should be noted that IRE has also been used in the clinical and preclinical treatment of liver, [ 27 ] breast, [ 28 ] renal cancers, [ 29 ] etc. To test if our findings could extend to other tumor types, the treatment regimens were further evaluated in orthotopic 4T1 murine breast cancer model with a positive TGF‐ β expression (Figure S5 , Supporting Information).…”

The Role of Focal Therapy and Active Surveillance for Small Renal Mass Therapy

“…We prospectively evaluated CT [ 37 ]—it navigated IRE and showed suboptimal results and acceptable complications ( Table 1 ). Thirty RCC tumors with an average size of 2.5 cm were treated with this method and achieved a primary technique success rate of 73.3%, which improved to 97% after performing CA-7 residual disease.…”

Percutaneous treatment of renal tumours

“…In a study looking at thirty renal cell carcinomas treated with IRE over a median follow-up of 37 months, there was a technical success rate of 73.3%. 34 Because of the relatively lower technical success rate, this study suggested that IRE should only be used for cases where the tumour is close to critical structures.…”