Irreversible Electroporation to Treat Malignant Tumor Recurrences Within the Pelvic Cavity: A Case Series

Abstract

ObjectiveTo describe the initial experience with irreversible electroporation (IRE) to treat pelvic tumor recurrences.MethodsA retrospective single-center analysis was performed. Adverse events were recorded using Common Terminology Criteria of Adverse Events (CTCAE) 4.0. Clinical outcome was determined using pain- and general- symptom assessment, including Seddon’s peripheral nerve injury (PNI) types. Radiological outcome was evaluated by comparing baseline with three-month 18F-FDG PET-CT follow-up.ResultsEight patients (nine tumors [recurrences of primary rectal (n = 4), anal (n = 1), sigmoid (n = 1), cervical (n = 1), and renal cell carcinoma (n = 1)]) underwent percutaneous IRE as salvage therapy. Median longest tumor diameter was 3.7 cm (range 1.2–7.0). One CTCAE grade III adverse event (hemorrhage) and eight CTCAE grade II complications occurred in 6/8 patients: vagino-tumoral fistula (n = 1), lower limb motor loss (n = 3; PNI type II) with partial recovery in one patient, hypotonic bladder (n = 2; PNI types I and II) with complete recovery in one patient, and upper limb motor loss (n = 2; PNI type II) with partial recovery in both patients. No residual tumor tissue was observed at 3-month follow-up. After a median follow-up of 12 months, local progression was observed in 5/9 lesions (4/5 were >3 cm pre-IRE); one lesion was successfully retreated. Debilitating preprocedural pain (n = 3) remained unchanged (n = 1) or improved (n = 2).ConclusionIRE may represent a suitable technique to treat pelvic tumor recurrences, although permanent neural function loss can occur. Complete ablation seems realistic for smaller lesions; for larger lesions symptom control should be the focus.

Irreversible electroporation in renal tumours: A systematic review of safety and early oncological outcomes

“…This review found IRE to be safe for use in SRMs; as it was not associated with any mortalities, there were few 15 6 Good -Diehl et al 16 5 Good Fair Vroomen et al 17 1 Fair Poor Canvasser et al 18 41 Good Fair Liu et al 19 5 Fair Fair Wendler et al 20 7 Good Good Wendler et al 21 As above Good -Buijs et al 22 10 Good -Gul et al 23 1 Fair Fair clinically significant adverse events, and negligible effects on renal function. The two most observed adverse effects were transient haematuria and asymptomatic peri-renal haematomas.…”

“…The full study designs of the included studies and the patient characteristics within the studies can be found in Tables 1 and 2. [14][15][16][17][18][19][20][21][22][23] Overall NOQAT Evaluation Scores were assigned to each article (Table 3). Generally, articles performed better at reporting safety and efficacy, as 6/10 were scored as good, however only 1/7 studies reporting on oncological outcomes was deemed to be of good quality.…”

“…The rest of the included studies had 10 or less patients, 2 of which only included 1 patient relevant to this review. 17,23 Clearly this makes meaningful clinical implications difficult in the absence of larger studies supporting any oncological findings. Follow up time presented an additional barrier in determining robust oncological outcomes.…”

“…There were no 30-day mortalities reported in any of the studies. [14][15][16][17][18][19][20][21][22][23] Formal assessment tools for categorising complications were used in 6 of the 10 papers. [16][17][18]20,22,23 The most frequently used (4/6) was the Clavien-Dindo classification.…”

“…[14][15][16][17][18][19][20][21][22][23] Formal assessment tools for categorising complications were used in 6 of the 10 papers. [16][17][18]20,22,23 The most frequently used (4/6) was the Clavien-Dindo classification. The most reported adverse events were transient haematuria occurring in 11/83 patients, and asymptomatic perirenal haematomas occurring in 7 patients.…”