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Irreversible Electroporation (IRE) in Renal Tumors

  • Kidney Diseases (G Ciancio, Section Editor)
  • Published:
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Abstract

Small renal masses (SRMs) have been traditionally managed with surgical resection. Minimally invasive nephron-sparing treatment methods are preferred to avoid harmful consequences of renal insufficiency, with partial nephrectomy (PN) considered the gold standard. With increase in the incidence of the SRMs and evolution of ablative technologies, percutaneous ablation is now considered a viable treatment alternative to surgical resection with comparable oncologic outcomes and better nephron-sparing property. Traditional thermal ablative techniques suffer from unique set of challenges in treating tumors near vessels or critical structures. Irreversible electroporation (IRE), with its non-thermal nature and connective tissue-sparing properties, has shown utility where traditional ablative techniques face challenges. This review presents the role of IRE in renal tumors based on the most relevant published literature on the IRE technology, animal studies, and human experience.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance,•• Of major importance

  1. Chang X et al. Radiofrequency ablation versus partial nephrectomy for clinical T1a renal-cell carcinoma: long-term clinical and oncologic outcomes based on a propensity score analysis. J Endourol. 2015;29(5):518–25.

    Article  PubMed  Google Scholar 

  2. Lorber G et al. Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer. Urol Oncol. 2014;32(7):1017–23.

    Article  PubMed  Google Scholar 

  3. Olweny EO et al. Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol. 2012;61(6):1156–61.

    Article  PubMed  Google Scholar 

  4. Psutka SP et al. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol. 2013;63(3):486–92.

    Article  PubMed  Google Scholar 

  5. Thompson RH et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67(2):252–9.

    Article  PubMed  Google Scholar 

  6. Choueiri TK et al. Thermal ablation vs surgery for localized kidney cancer: a surveillance, epidemiology, and end results (SEER) database analysis. Urology. 2011;78(1):93–8.

    Article  PubMed  Google Scholar 

  7. Gervais DA. Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol. 2013;24(8):1135–8.

    Article  PubMed  Google Scholar 

  8. Kurup AN. Percutaneous ablation for small renal masses-complications. Semin Intervent Radiol. 2014;31(1):42–9.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Cantwell CP et al. Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot study of retrograde pyeloperfusion with cooled dextrose 5% in water. J Vasc Interv Radiol. 2008;19(7):1034–40.

    Article  PubMed  Google Scholar 

  10. Ginat DT, Saad WE. Bowel displacement and protection techniques during percutaneous renal tumor thermal ablation. Tech Vasc Interv Radiol. 2010;13(2):66–74.

    Article  PubMed  Google Scholar 

  11. Davalos RV, Mir LM, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng. 2005;33(2):223–31.

    Article  CAS  PubMed  Google Scholar 

  12. Edd JF, Davalos RV. Mathematical modeling of irreversible electroporation for treatment planning. Technol Cancer Res Treat. 2007;6(4):275–86.

    Article  PubMed  Google Scholar 

  13. Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality—clinical implications. Technol Cancer Res Treat. 2007;6(1):37–48.

    Article  PubMed  Google Scholar 

  14. Deodhar A et al. Renal tissue ablation with irreversible electroporation: preliminary results in a porcine model. Urology. 2011;77(3):754–60.

    Article  PubMed  Google Scholar 

  15. Wendler JJ et al. Angiography in the isolated perfused kidney: radiological evaluation of vascular protection in tissue ablation by nonthermal irreversible electroporation. Cardiovasc Intervent Radiol. 2012;35(2):383–90.

    Article  PubMed  Google Scholar 

  16. Tracy CR, Kabbani W, Cadeddu JA. Irreversible electroporation (IRE): a novel method for renal tissue ablation. BJU Int. 2011;107(12):1982–7.

    Article  PubMed  Google Scholar 

  17. Wendler JJ 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(4):921–6.

    Article  PubMed  Google Scholar 

  18. Wendler JJ et al. Short- and mid-term effects of irreversible electroporation on normal renal tissue: an animal model. Cardiovasc Intervent Radiol. 2013;36(2):512–20.

    Article  CAS  PubMed  Google Scholar 

  19. Sommer CM et al. Irreversible electroporation of the pig kidney with involvement of the renal pelvis: technical aspects, clinical outcome, and three-dimensional CT rendering for assessment of the treatment zone. J Vasc Interv Radiol. 2013;24(12):1888–97.

    Article  PubMed  Google Scholar 

  20. Wimmer T et al. Planning irreversible electroporation in the porcine kidney: are numerical simulations reliable for predicting empiric ablation outcomes? Cardiovasc Intervent Radiol. 2015;38(1):182–90.

    Article  PubMed  Google Scholar 

  21. Kim HB et al. Changes of apoptosis in tumor tissues with time after irreversible electroporation. Biochem Biophys Res Commun. 2013;435(4):651–6.

    Article  CAS  PubMed  Google Scholar 

  22. Pech M et al. Irreversible electroporation of renal cell carcinoma: a first-in-man phase I clinical study. Cardiovasc Intervent Radiol. 2011;34(1):132–8. First safety and feasibility study of renal IRE in humans.

    Article  PubMed  Google Scholar 

  23. Thomson KR et al. Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol. 2011;22(5):611–21. This study reported first human results of IRE in clinical practice, including first results on renal IREin humans.

    Article  PubMed  Google Scholar 

  24. Trimmer CK et al. Minimally invasive percutaneous treatment of small renal tumors with irreversible electroporation: a single-center experience. J Vasc Interv Radiol. 2015;26(10):1465–71. This study is the largest series (20 tumors) reported so far on renal IRE in humans.

    Article  PubMed  Google Scholar 

  25. Narayanan G et al. Vessel patency post irreversible electroporation. Cardiovasc Intervent Radiol. 2014;37(6):1523–9.

    Article  PubMed  Google Scholar 

  26. Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng. 2005;33(2):223–31.

    Article  CAS  PubMed  Google Scholar 

  27. Maor E et al. The effect of irreversible electroporation on blood vessels. Technol Cancer Res Treat. 2007;6(4):307–12.

    Article  PubMed  Google Scholar 

  28. Faroja M et al. Irreversible electroporation ablation: is all the damage nonthermal? Radiology. 2013;266(2):462–70.

    Article  PubMed  Google Scholar 

  29. Golberg A et al. Tissue heterogeneity in structure and conductivity contribute to cell survival during irreversible electroporation ablation by “electric field sinks. Sci Rep. 2015;5:8485.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  30. Ben-David E et al. Irreversible electroporation: treatment effect is susceptible to local environment and tissue properties. Radiology. 2013;269(3):738–47.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Wendler JJ et al. A prospective phase 2a pilot study investigating focal percutaneous irreversible electroporation (IRE) ablation by NanoKnife in patients with localised renal cell carcinoma (RCC) with delayed interval tumour resection (IRENE trial). Contemp Clin Trials. 2015;43:10–9. Prospective trial on renal IRE describing study design.

    Article  CAS  PubMed  Google Scholar 

  32. Wagstaff PG et al. The efficacy and safety of irreversible electroporation for the ablation of renal masses: a prospective, human, in-vivo study protocol. BMC Cancer. 2015;15:165. Prospective trial on renal IRE describing study design.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Wendler JJ, 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. 2015. Human Localised Renal Cell Carcinoma (RCC) in the IRENE Pilot Phase 2a Trial. Cardiovasc Intervent Radiol, 2015. This article is an intrim report of IRENE trial - first published report of a prospective trial on renal IRE. First description of zonal structuring on histopathology.

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Authors and Affiliations

  1. Department of Radiology, Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue Grd Fl. C-085, 33136, Miami, FL, USA

    Govindarajan Narayanan

  2. Department of Radiology, Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Avenue Grd Fl. C-080, 33136, Miami, FL, USA

    Mehul H. Doshi

Authors
  1. Govindarajan Narayanan
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Correspondence to Govindarajan Narayanan.

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Conflict of Interest

Govindarajan Narayanan is a consultant for Angiodynamics and one-time speaker for Guerbet.

Mehul H. Doshi declares no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Kidney Diseases

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Narayanan, G., Doshi, M.H. Irreversible Electroporation (IRE) in Renal Tumors. Curr Urol Rep 17, 15 (2016). https://doi.org/10.1007/s11934-015-0571-1

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  • DOI: https://doi.org/10.1007/s11934-015-0571-1

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