Friday, August 26, 2016

Another NanoKnife® pilot study

In the previous post, I reported on a pilot study of focal irreversible electroporation (IRE or NanoKnife®) in Sydney and London. Murray et al. have published the early results of a pilot test at Memorial Sloan Kettering Cancer Center.

A chart review of 25 patients treated with partial gland IRE ablation revealed the following complications after a median follow-up of 10.9 months:
  • ·      14/25 patients incurred transient and mild to moderate (grade 2 or less) urinary symptoms, including blood in urine and urinary tract infection.
  • ·      2 patients had severe (grade 3) complications requiring intervention: epididymitis and urinary tract infection.
  • ·      Among those with good baseline urinary function, 94% were back to baseline function at 12 months. Two patients required pads.
  • ·      At 12 months, 1 previously potent patient had new erectile dysfunction.
There was a routine follow-up biopsy 6 months after treatment. At that time, 4/25 patients (16%) were found to have residual cancer in the ablation treatment zone. In the previously reported pilot study, 6/24 patients (25%) had residual disease after a first treatment. It is surprising that residual disease was found within the treatment zone here, indicating incomplete ablation. These levels of local recurrence are about the same as has been reported with other kinds of focal thermal ablation (e.g., HIFU, cryo, and laser).

IRE requires full anesthesia with complete paralysis, so if there is no advantage in terms of toxicity or cancer control, one of the other forms of ablation that require only local anesthesia may be a better choice for some. Still, these are only small pilot studies, and continued trials may perfect the technique and get better results.

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