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Irreversible Electroporation for Renal Masses Not Amenable to Thermal Ablation in Non-Surgical Candidates: Mid-term Clinical Follow-up

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Sources of Funding: none

Introduction

Irreversible Electroporation (IRE) is an emerging ablative modality for patients with renal tumors that are not candidates for surgery or conventional thermal ablation. This study aims to evaluate technical success, safety, and outcomes for IRE treated complicated renal tumors.

Methods

A single institution retrospective review of all renal tumors treated with Computed Tomography (CT) guided IRE between May 2013 and February 2016 was performed. A total of 17 patients underwent IRE with NanoKnife (AngioDynamics, Queensbury, New York) for primary or secondary renal malignancies. Technical success was defined as delivery of all planned pulses during ablation and verifying complete ablation by immediate post-procedure CT imaging. Local recurrence was defined as residual enhancement or increased tumor size following technical success. Follow?up imaging was scheduled at 1, 3, 6, 12, 18, and 24 months. Complications were defined using Clavien-Dino (CD) classification.

Results

IRE was performed on 18 complicated renal tumors with median RENAL score of 6.5 ( 1st quartile 6, 3rd quartile 9) and median tumor size of 2.2 cm (1st quartile 2.0, 3rd quartile 3.1). Most were clear cell renal cell carcinomas (n=13). Technical success was achieved in 17/18 tumor treatments (94.4%). One (5.6%) case was aborted due to bleeding (CD grade IIIb) requiring embolization. Minor CD grade one or two complications were present in 7/18 cases (38.9%), including post?procedural urinary retention (4/18, 22.2%), hypoglycemia (1/18, 5.6%), hematuria (1/18, 5.6%), and back pain (1/18, 5.6%). Patients lost to follow up were excluded (n=3) from follow-up analysis. Median follow?up was 392 days, 1st quartile 203, 3rd quartile 696). Two local recurrences (14.2%) occurred on days 320 and 230 post?procedure with RENAL Scores of 9 and 8, respectively. Both cases were successfully treated with cryoablation and follow up showed no residual tumor at 723 and 617 days post cryoablation, respectively.

Conclusions

IRE appears to be a safe and efficacious option for the treatment of renal tumors in patients that are not candidates for surgery or thermal ablation techniques. Further research is warranted with larger sample sizes and continued follow up.

Funding

none

Authors
Robert Medairos
Wei Phin Tan
Kelsey Gallo
Kalyan Latchamsetty
Jordan Tasse
Christopher Coogan
Bulent Arslan
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