First Delayed Resection Findings After Irreversible Electroporation (IRE) of Human Localised Renal Cell Carcinoma (RCC) in the IRENE Pilot Phase 2a Trial.
BACKGROUND
It is postulated that focal IRE affords complete ablation of soft-tissue tumours while protecting the healthy peritumoral tissue. Therefore, IRE may be an interesting option for minimally invasive, kidney-tissue-sparing, non-thermal ablation of renal tumours.


OBJECTIVE
With this current pilot study ("IRENE trial"), we present the first detailed histopathological data of IRE of human RCC followed by delayed tumour resection. The aim of this interim analysis of the first three patients was to investigate the ablation efficiency of percutaneous image-guided focal IRE in RCC, to assess whether a complete ablation of T1a RCC and tissue preservation with the NanoKnife system is possible and to decide whether the ablation parameters need to be altered.


METHODS
Following resection 4 weeks after percutaneous IRE, the success of ablation and detailed histopathological description were used to check the ablation parameters.


RESULTS
The IRE led to a high degree of damage to the renal tumours (1 central, 2 peripheral; size range 15-17 mm). The postulated homogeneous, isomorphic damage was only partly confirmed. We found a zonal structuring of the ablation zone, negative margins and, enclosed within the ablation zone, very small tumour residues of unclear malignancy.


CONCLUSIONS
According to these initial, preliminary study results of the first three renal cases, a new zonal distribution of IRE damage was described and the curative intended, renal saving focal ablation of localised RCC below <3 cm by percutaneous IRE by the NanoKnife system appears to be possible, but needs further, systematic evaluation for this treatment method and treatment protocol.
Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. johann.wendler@med.ovgu.de.
Johann Jakob
JJ
Wendler
Department of Radiology, University of Magdeburg, Magdeburg, Germany. jens.Ricke@med.ovgu.de.
Jens
J
Ricke
Department of Radiology, University of Magdeburg, Magdeburg, Germany. macej.pech@med.ovgu.de.
Maciej
M
Pech
Department of Radiology, University of Magdeburg, Magdeburg, Germany. frank.fischbach@med.ovgu.de.
Frank
F
Fischbach
Department of Radiology, University of Magdeburg, Magdeburg, Germany. julian.juergens@med.ovgu.de.
Julian
J
Jürgens
Institute of Pathology, University of Magdeburg, Magdeburg, Germany. sandra.siedentopf@med.ovgu.de.
Sandra
S
Siedentopf
Institute of Pathology, University of Magdeburg, Magdeburg, Germany. albert.roessner@med.ovgu.de.
Albert
A
Roessner
Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. markus.porsch@med.ovgu.de.
Markus
M
Porsch
Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. daniel.baumunk@med.ovgu.de.
Daniel
D
Baumunk
Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. martin.schostak@med.ovgu.de.
Martin
M
Schostak
Institute of Pathology, Sana Klinikum Offenbach Am Main, Offenbach Am Main, Germany. jens.koellermann@sana.de.
Jens
J
Köllermann
Department of Urology, University Hospital, Otto von Guericke University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany. uwe-bernd.liehr@med.ovgu.de.
Uwe-Bernd
UB
Liehr
D055011:Ablation Techniques / Q000379:methods; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000628:therapy*; D003952:Diagnostic Imaging; D004562:Electrocardiography; D018274:Electroporation / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D010865:Pilot Projects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Ablation; Focal therapy (FT); Irreversible electroporation (IRE); Kidney; Renal cell carcinoma (RCC); Small renal mass (SRM)