If further work with irreversible electroporation refines its capacity for discrete tissue ablation deep within the kidney and adjacent to large blood vessels, and especially if larger tumors can be addressed, then this would be a major step forward in the minimally invasive treatment of localized renal cancer.
Dr. Wolf, a member of the Urology Times Editorial Council, is professor of urology at the University of Michigan, Ann Arbor.
A recent Urology Times article highlights interesting research by University of Texas Southwestern Medical Center urologists on the use of irreversible electroporation (IRE) in renal tumors.
IRE is a non-thermal tissue destruction technology that applies short pulses of DC electric current to create cell membrane pores and subsequent apoptosis. Morgan and associates from UT Southwestern applied the treatment via two to five percutaneous probes. The potential advantages of IRE are that the destructive mechanism is not impacted by adjacent blood flow (ie, large blood vessels) and that there is sharp demarcation of treated and untreated tissue.
However, probe placement must be very exact, probes must be completely encased in tissue, and the patient must be under complete neuromuscular blockade. The authors report one recurrence in eight patients at a follow-up of 1 year, although this is the first clinical study and it is reasonable to expect greater success as experience is gained.
Current percutaneous ablation technologies (radiofrequency and cryotherapy) are most effective for exophytic lesions less than 3 cm in diameter. Treatment of larger and deeper lesions, especially ones that are close to large blood vessels, are associated with a greater failure rate. Of course, the standard nephron-sparing treatment-partial nephrectomy-is more technically difficult (and complication prone) in this same group of patients. It is for these patients that we are most in need of an alternative.
Fortunately, IRE appears to be applicable to deep intra-renal lesions. If further work with this technology refines its capacity for discrete tissue ablation deep within the kidney and adjacent to large blood vessels, and especially if larger tumors can be addressed, then this would be a major step forward in the minimally invasive treatment of localized renal cancer.
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