Abstract
ObjectivesTo 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.MethodsCT-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.ResultsThirty 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%.ConclusionCT-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.
Highlights
Since 2017, both AUA and ESMO have issued guidance where image-guided thermal ablation can be considered a valid treatment option for small renal cancer (< 3 cm) [1, 2]
This technology has since been explored in treating renal cancer in the need of minimising collateral damage when sited in an awkward location as a problem-solving technique and the intention is not to replace the current conventional thermal ablative energy in the treatment of small renal cancer
This study aims to evaluate the initial clinical safety and efficacy of Irreversible electroporation (IRE) in the treatment of sporadic clinical T1a biopsy-proven RCC close to vital structures and to assess the factors that may influence the technical success and the early oncological durability
Summary
Since 2017, both AUA and ESMO have issued guidance where image-guided thermal ablation can be considered a valid treatment option for small renal cancer (< 3 cm) [1, 2]. Over the 5 years, we prospectively collated all patients’ clinical outcomes that were referred to our cancer institution for image-guided ablation; following consensus from the renal cancer multidisciplinary (MDT) team, IRE treatment has been performed when other thermal ablative technology had been considered unsuitable because of the risk of collateral damage. To our knowledge, this early clinical experience has the longest median follow-up period post-IRE of biopsy-proven RCC published to date. This study aims to evaluate the initial clinical safety and efficacy of IRE in the treatment of sporadic clinical T1a (cT1a) biopsy-proven RCC close to vital structures and to assess the factors that may influence the technical success and the early oncological durability
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