Table 2.
Summary of studies assessing irreversible electroporation (IRE) in localized cT1 primary renal cell carcinoma
| Study | Design | Level of evidencea | Technique | Number of cases | Charlson Comorbidity Index | Tumor size mean | Complications | Follow-up (months) | Renal function decrease | Residual disease (%) | Local recurrence (%) | Metastasis (%) | DFS (%) | OS (%) | CSS (%) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pech [19] | Phase I, prospective | 3 | Open IRE, general ANS | 6 | NR | 2.7 (range 2.0–3.9) | No complications | NR | NR | NR | NR | NR | NR | NR | NR |
| Thompson [20] | Prospective cohort | 3 | Percutaneous IRE US or CT guided, general ANS | 10 (7 patients) | NR | 2,2 (range 1.6–3.1) | Cardiac arrhythmias, partial ureteric obstruction | NR CT | NR | 2/7 residual at 3 months CT | NR | NR | NR | NR | NR |
| Trimmer [21] | Retrospective | 4 | Percutaneous CT-guided IRE, general ANS | 20 | NR | 2.2 ± 0.7 | Minor: perinephric hematomas, pain, urinary retention | 1 year in 30% available CT/MRI | Creatinine −0.04 mg/dL after 6 weeks |
2/20 residual at 6 months CT/MRI | 1/20 recurrence at 1 year CT/MRI | NR | NR | NR | NR |
| Diehl [22] | Retrospective | 4 | Percutaneous CT-guided IRE, general ANS | 7 (5 patients) | NR | 2.44 (1.5–3.8) | 2 minor complications: hematuria, AKI | Mean 6.4 (3–11) | Creatinine −2.75 mL/min in 3 months |
No residual MRI | NR | NR | NR | NR | NR |
| Wendler [23–25] | Phase 2a, prospective | 3 | Percutaneous CT-guided IRE, followed by resection, general ANS | 8 (7 patients) | Ranging 0–2 | Mean 2.2 (1.5–3.9) | Hematuria7/7, perirenal hematoma 2/7, pain 7/7 | Mean 25(15–36) | NR | 3/8 residual Pathology proven. | 1/8 recurrence | NR | NR | NR | NR |
| Canvasser [26] | Retrospective | 3 | Percutaneous CT-guided IRE, general ANS | 42 (41 patients) | NR | Mean 2.0 (1.0–3.6) | 22% Clavien grade I: perinephric hematoma, urinary retention, | Mean 22 (SD 12.4) | eGFR −6 mL/min |
3 failures/42 CT | 2/42 recurrence CT | NR | NR | NR | NR |
| Buijs [27] and submitted | Prospective, phase 2b/3 | 3 | Percutaneous CT-guided IRE, general ANS | 10 | Mean CCI corrected for age: 7 | 2.2 (1.1–3.9) | 1 × grade 3: obstruction ureter due to blood clot 1, 1 × grade 2: pyelonephritis 3 × grade 1: 1 perinephric hematoma, 1 painful voiding, 1 hematuria |
Mean 6 (3–12) | 2,6% decrease after 1 year | 1/10 residual CT | No recurrences | NR | NR | NR | NR |
Residual is defined as enhancement reported at the first imaging after IRE in the ablation zone
Recurrence is defined as new enhancement after a period of non-enhancement in or at the edge of the ablation zone
AKI acute kidney insufficiency, US ultrasound, CT computo-tomography, ANS anesthesia, DFS disease-free survival, OS overall survival, CSS cancer-specific survival, NR not reported, CCI Charlson Comorbidity Index
aLevel of evidence, Oxford 2011 [14]