M.P. Laguna Pes

The safety and efficacy of irreversible electroporation for the ablation of prostate cancer: a multicentre prospective human in vivo pilot study protocol

Introduction Current surgical and ablative treatment options for prostate cancer have a relatively high incidence of side effects, which may diminish the quality of life. The side effects are a consequence of procedure-related damage of the blood vessels, bowel, urethra or neurovascular bundle. Ablation with irreversible electroporation (IRE) has shown to be effective in destroying tumour cells and harbours the advantage of sparing surrounding tissue and vital structures. The aim of the study is to evaluate the safety and efficacy and to acquire data on patient experience of minimally invasive, transperineally image-guided IRE for the focal ablation of prostate cancer. Methods and analysis In this multicentre pilot study, 16 patients with prostate cancer who are scheduled for a radical prostatectomy will undergo an IRE procedure, approximately 30 days prior to the radical prostatectomy. Data as adverse events, side effects, functional outcomes, pain and quality of life will be collected and patients will be controlled at 1 and 2 weeks post-IRE, 1 day preprostatectomy and postprostatectomy. Prior to the IRE procedure and the radical prostatectomy, all patients will undergo a multiparametric MRI and contrast-enhanced ultrasound of the prostate. The efficacy of ablation will be determined by whole mount histopathological examination, which will be correlated with the imaging of the ablation zone. Ethics and dissemination The protocol is approved by the ethics committee at the coordinating centre (Academic Medical Center (AMC) Amsterdam) and by the local Institutional Review Board at the participating centres. Data will be presented at international conferences and published in peer-reviewed journals. Conclusions This pilot study will determine the safety and efficacy of IRE in the prostate. It will show the radiological and histopathological effects of IRE ablations and it will provide data to construct an accurate treatment planning tool for IRE in prostate tissue. Trial registration number Clinicaltrials.gov database: NCT01790451.

Histopathological Outcomes after Irreversible Electroporation for Prostate Cancer: Results of an Ablate and Resect Study

PURPOSE Irreversible electroporation is a tissue ablation modality that uses high voltage electric energy to induce an increase in cell membrane permeability. This causes destabilization of the existing cellular transmembrane potential leading to cell death, due to the inability to maintain cellular homeostasis. This phase I-II study was designed to evaluate the histopathological outcomes of irreversible electroporation to prostate and surrounding tissue in radical prostatectomy specimens. MATERIALS AND METHODS Sixteen patients with prostate cancer underwent an irreversible electroporation ablation without curative intent, followed by radical prostatectomy scheduled 4 weeks later. For histopathological examination of the prostate, whole mounted tissue slices were examined by dedicated genitourinary pathologists. The borders of the ablation zone and residual tumor were outlined on the slides. RESULTS The irreversible electroporation ablation zones were characterized as areas of fibrosis, necrosis and loss of epithelial tissue in terms of denudation in the glandular structures. The ablation zone was well demarcated, showing trenchant delineations between viable and nonviable tissue. The ablated tissue showed mild to moderate inflammation, with atrophic cells in 1 case. The area was surrounded by hemorrhage at the location of the electrodes. No skip lesions or viable tissue was seen in the ablation zone. Fibrinoid necrosis of the neurovascular bundle was observed in 13 patients and denudation of the urothelium of the prostatic urethra was seen in 9. CONCLUSIONS Histopathological assessment of the prostate 4 weeks after irreversible electroporation ablation showed sharply demarcated fibrotic and necrotic tissue in the ablation zone. No viable tissue was observed in the irreversible electroporation ablation zone.

Synchronous Esophageal and Renal Cell Carcinoma: Incidence and Possible Treatment Strategies

Background: The occurrence of synchronous malignancies in patients suffering from esophageal cancer is a frequent phenomenon, but the reported incidence of synchronous renal cell carcinoma (RCC) is very low. The present study investigated the incidence of synchronously detected RCC since the introduction of preoperative CT scans in a tertiary referral center for esophageal cancer patients. Methods: The medical records of 392 consecutive patients included in a prospective database of patients scheduled to undergo surgery for esophageal tumors were scrutinized for the presence of renal neoplasms. The coincidence of esophageal cancer and RCC was then estimated by analyzing only those patients who were operated on for an esophageal malignancy after a CT scan was obtained. Results: 192 patients were operated on for an esophageal malignancy after abdominal CT scanning was performed. RCC was diagnosed in 4 of these patients resulting in an incidence of synchronous esophageal and renal malignancies of 2.1%. Conclusion: Since the introduction of CT scanning the incidence of synchronous RCC in esophageal cancer patients appears to be much higher than previously reported and suggests a genetic and/or environmental association between these malignancies. Simultaneous treatment of both tumors appeared safe at our institute.

Crioablación laparoscópica de las pequeñas masas renales

Resumen Objetivos Revision del estado actual de la crioblacion de las pequenas masas renales y descripcion preliminar de la serie del AMC. Material y metodos Busqueda bibliografica (PubMed/Medline/Embase) y analisis de las series mas importantes. La presente serie incluye 13 pacientes portadores de masas renales unicas de pequeno tamano tratados mediante crioablacion laparoscopica con sondas ultrafinas (1,5 mm diametro). El seguimiento postoperatorio se realizo mediante CT y/o RMI trimestralmente durante el primer ano y semestralmente durante el segundo. Resultados No existen estudios randomizados comparando la crioablacion de las masas renales de diametro ≤ 4 cm con la cirugia parcial o radical. La tasa de complicaciones es baja y la tasa de recurrencia o persistencia, a corto plazo, minima salvo en una serie de crioablacion guiada por la imagen (8%). El diametro tumoral maximo tratado en nuestra serie es de 3,2 cm. Los tumores se abordaron retro o transperitonealmente dependiendo de su situacion. El tiempo quirurgico medio fue de 208 minutos (106-379) y el tiempo medio de exposicion a temperaturas inferiores a -20oC en la periferia tumoral fue de 10 minutos. A tiempo medio de seguimiento de 8 meses no se objetivo recurrencia tumoral. Conclusion La crioablacion laparoscopica o guiada mediante imagen de las masas renales de pequeno tamano parece una alternativa aceptable si bien el tiempo medio de seguimiento es todavia corto en la mayoria de las series.

Testicular tumour size and rete testis invasion as prognostic factors for the risk of relapse of clinical stage I seminoma testis patients under surveillance: A systematic review by the Testicular Cancer Guidelines Panel

Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Urology, Hospital Gregorio Marañón, Madrid, Spain; Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Portugal; Division of Gastroenterology and Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada; Department of Urology, AMC University Hospital Amsterdam, The Netherlands; Department of Internal Medicine II, Oncology, Hematology and Stem Cell Transplantation with Section Pneumology, University Hospital Eppendorf, Hamburg, Germany; g Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Pathology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Oncology, Akershus University Hospital, Lørenskog, Norway and University of Oslo, Oslo, Norway; Department of Urology, Düsseldorf University Hospital, Heinrich-Heine-University Düsseldorf, Germany

29 Temperatuurontwikkeling gedurende irreversibele elektroporatie in varkensnieren

SamenvattingIrreversibele elektroporatie (IRE) is een ablatietechniek die gebruikmaakt van elektrische pulsen tussen twee of meer naaldelektroden, voor de destructie van weefsel. Hoewel IRE in theorie niet afhankelijk is van thermische energie voor weefseldestructie, zou het herhaaldelijk toedienen van elektrische pulsen van hoge intensiteit kunnen leiden tot temperatuurverhoging.

Láser y tumores vesicales

Bladder cancer is one of the most frequents pathologies in urology. The introduction of the laser among the technical tools supposed a great advance, but the initial results with the first model failed with the expectations. Nevertheless, nowadays we have at our disposal a great variety of laser for urological use, with different functions and applications. We perform a review and try to assess the actual indications for its employment in the treatment of bladder cancer, as well as future applications.