Irreversible electroporation of renal cell carcinoma: a first-in-man phase I clinical study.
OBJECTIVE
Irreversible electroporation (IRE) is a newly developed nonthermal tissue-ablation technique in which high-voltage electrical pulses of microsecond duration are applied to induce irreversible permeabilisation of the cell membrane, presumably through nanoscale defects in the lipid bilayer, leading to apoptosis. The purpose of this study was to assess the feasibility and safety of ablating renal cell carcinoma (RCC) tissue by IRE.


METHODS
Six patients scheduled for curative resection of RCC were included. IRE was performed during anaesthesia immediately before the resection with electrographic synchronisation. Central haemodynamics were recorded before and 5 min after electroporation. Five-channel electrocardiography (ECG) was used for detailed analysis of ST waveforms. Blood sampling and 12-lead ECG were performed before, during, and at scheduled intervals after the intervention.


RESULTS
Analysis of ST waveforms and axis deviations showed no relevant changes during the entire study period. No changes in central haemodynamics were seen 5 min after IRE. Similarly, haematological, serum biochemical, and ECG variables showed no relevant differences during the investigation period. No changes in cardiac function after IRE therapy were found. One case of supraventricular extrasystole was encountered. Initial histopathologic examination showed no immediate adverse effects of IRE (observation of delayed effects will require a different study design).


CONCLUSIONS
IRE seems to offer a feasible and safe technique by which to treat patients with kidney tumours and could offer some potential advantages over current thermal ablative techniques.
Pech
Maciej
M
Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany. maciej.pech@med.ovgu.de
Janitzky
Andreas
A
Wendler
Johann Jacob
JJ
Strang
Christof
C
Blaschke
Simon
S
Dudeck
Oliver
O
Ricke
Jens
J
Liehr
Uwe-Bernd
UB
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D004562:Electrocardiography; D018274:Electroporation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional