Journal article
Irreversible Electroporation for the Treatment of Small Renal Masses: 5-Year Outcomes
Journal of endourology, Vol.35(11), pp.1586-1592
11/01/2021
DOI: 10.1089/end.2021.0115
PMID: 33926224
Abstract
Introduction: Irreversible electroporation (IRE) is a nonthermal ablative technology that applies high-voltage short-pulse electrical current to create cellular membrane nanopores and ultimately results in apoptosis. This is thought to overcome thermal limitations of other ablative technologies. We report 5-year oncologic outcomes of percutaneous IRE for small renal masses. Patients and Methods: A single-institution retrospective review of cT1a renal masses treated with IRE from April 2013 to December 2019 was performed. Those with <1 month follow-up were excluded. IRE was performed with the NanoKnife(C) System (Angiodynamics, Latham, NY). Renal mass biopsy was obtained before or during ablation in most circumstances; biopsy was excluded in some patients because of concern for IRE probe displacement. Postablation guideline-based surveillance imaging was performed. Initial treatment failure was defined as persistent tumor enhancement on first post-treatment imaging. Survival analysis was performed through the Kaplan-Meier method for effectively treated tumors (SPSS; IBM, Armonk, NY). Results: IRE was used to treat 48 tumors in 47 patients. Twenty-two per 48 tumors (45.8%) were biopsy-confirmed renal cell carcinoma (RCC). No complications >= Clavien Grade III occurred and 36 patients (76.6%) were discharged the same day. Initial treatment success rate was 91.7% (n = 44/48); three treatment failures were managed with salvage radiofrequency ablation and one with robotic partial nephrectomy. Median follow-up was 50.4 months (interquartile range 29.0-65.5). The 5-year local recurrence-free survival was 81.4% in biopsy-confirmed RCC patients and 81.0% in all patients. Five-year metastasis-free survival was 93.3% and 97.1%, respectively, and 5-year overall survival was 92.3% and 90.6%, respectively. Five-year cancer-specific survival was 100% for both biopsy-confirmed RCC and all patient groups. Conclusions: IRE has low morbidity, but suboptimal intermediate-term oncologic outcomes compared with conventional thermal ablation techniques for small low-complexity tumors. Use of IRE should be restricted to select cases.
Details
- Title: Subtitle
- Irreversible Electroporation for the Treatment of Small Renal Masses: 5-Year Outcomes
- Creators
- Jessica C. Dai - The University of Texas Southwestern Medical CenterTara N. Morgan - The University of Texas Southwestern Medical CenterRyan L. Steinberg - University of IowaBrett A. Johnson - Univ Texas Southwestern, Dept Urol, 2001 Inwood Dr,WCB3,Suite 4-886,MC 9110, Dallas, TX 75390 USAAlaina Garbens - The University of Texas Southwestern Medical CenterJeffrey A. Cadeddu - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of endourology, Vol.35(11), pp.1586-1592
- Publisher
- Mary Ann Liebert, Inc
- DOI
- 10.1089/end.2021.0115
- PMID
- 33926224
- ISSN
- 0892-7790
- eISSN
- 1557-900X
- Number of pages
- 7
- Language
- English
- Date published
- 11/01/2021
- Academic Unit
- Urology
- Record Identifier
- 9984319968902771
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