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Rendon RA, Kapoor A, Breau R, Leveridge M, Feifer A, Black PC, So A. Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus. Can Urol Assoc J 2014; 8:E398-412. [PMID: 25024794 DOI: 10.5489/cuaj.1894] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Anil Kapoor
- Department of Surgery, Division of Urology, McMaster University, Hamilton, ON
| | - Rodney Breau
- Division of Urology, University of Ottawa, Ottawa, ON
| | - Michael Leveridge
- Departments of Urology and Oncology, Queen's University, Kingston, ON
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Moreland AJ, Ziemlewicz TJ, Best SL, Hinshaw JL, Lubner MG, Alexander ML, Brace CL, Kitchin DR, Hedican SP, Nakada SY, Lee FT, Abel EJ. High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol 2014; 28:1046-52. [PMID: 24846329 DOI: 10.1089/end.2014.0190] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Percutaneous radiofrequency ablation and cryoablation are accepted alternative treatments for small renal cell carcinomas (RCC) in high-risk patients. The recent development of high-powered microwave (MW) ablation offers theoretical advantages over existing ablation systems, including higher tissue temperatures, more reproducible ablation zones, and shorter procedural times. The purpose of this study is to review the feasibility, safety, and early efficacy of a novel high-powered percutaneous MW ablation system to treat RCC. METHODS An institutional database identified 53 consecutive patients with biopsy-proven RCC ≤4 cm (55 tumors) who were treated with percutaneous MW ablation using a novel MW ablation system. All patients had percutaneous renal mass biopsy, which identified RCC before ablation. Postprocedure follow-up imaging was performed by contrast-enhanced computed tomography or magnetic resonance imaging. RESULTS Mean patient age was 66 years and 81% of patients were male. RCC subtypes included clear cell (n=25), papillary (n=12), and unspecified (n=18) and Fuhrman grades 1, 2, 3, and ungraded in 15, 25, 1, and 14 patients, respectively. The mean tumor diameter was 2.6 cm (range 0.8-4.0 cm). Six low-grade complications were recorded during 53 (11.3%) procedures: five Clavien Grade 1 (urine retention, fluid overload, and atrial fibrillation) and one Grade 2 (hemorrhage requiring transfusion). The postprocedure estimated glomerular filtration rate was not significantly changed from preprocedure levels (median: -1.1%, p=0.10). Median follow-up was 8 months (interquartile range [IQR] 5-18.25) with 0/38 (0%) patients demonstrating evidence of local recurrence or metastasis during surveillance imaging. CONCLUSIONS Use of a high-powered MW ablation system for the treatment of T1a RCC is feasible, safe, and efficacious with short-term follow-up. A longer follow-up is warranted to evaluate oncologic outcomes.
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Affiliation(s)
- Anna J Moreland
- 1 Department of Radiology, University of Wisconsin , Madison, Wisconsin
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203
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Lorber G, Glamore M, Doshi M, Jorda M, Morillo-Burgos G, Leveillee RJ. Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer. Urol Oncol 2014; 32:1017-23. [PMID: 24996776 DOI: 10.1016/j.urolonc.2014.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 02/28/2014] [Accepted: 03/03/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Few studies report long-term follow-up of renal cancer treated by radiofrequency ablation (RFA), thus limiting the comparison of this modality to well-established long-term follow-up series of surgically resected renal masses. Herein, we report long-term oncologic outcomes of renal cancer treated with RFA in a single institution. METHODS AND MATERIALS We retrospectively reviewed patients treated between November 2001 and October 2012 with laparoscopic-guided or computed tomography-guided RFA. All treatments were performed with real-time thermometry ensuring target ablation temperature (>60°C) was adequately reached. Only patients with biopsy-confirmed T1a-category cancer and a follow-up period>48 months were included in our analysis. Follow-up included office visits, laboratory work, and periodic contrast-enhanced imaging. Survival was calculated using the Kaplan-Meier analysis. Overall complications were reported using the Clavien-Dindo scale. RESULTS Of 434 RFA cases, 53 treatments in 50 patients met the inclusion criteria. Of these, 29 were treated with computed tomography-guided RFA and 24 with laparoscopic-guided RFA. The mean follow-up interval was 65.6 months (48.5-120.2), and the mean renal mass size was 2.3 cm (0.3-4.0). There were 4 (7.5%) local recurrences and 1 case of distant metastases with no local recurrence. The 5-year overall survival was 98%, cancer-specific survival was 100%, and recurrence-free survival was 92.5%. The complication rate was 26.4%, which included 71% of Clavien-Dindo grade I and 29% of grade II. Mean estimated glomerular filtration rate preoperatively and at the most recent follow-up visit was 77 and 66 ml/min, respectively. CONCLUSIONS When performed on selected patients, while monitoring real-time temperatures to ensure adequate treatment end points, RFA offers favorable long-term oncologic outcomes approaching those reported for partial nephrectomy.
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Affiliation(s)
- Gideon Lorber
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL.
| | - Michael Glamore
- Florida International University, College of Medicine, Miami, FL
| | - Mehul Doshi
- Department of Vascular and Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL
| | - Merce Jorda
- Department of Pathology, University of Miami, Miller School of Medicine, Miami, FL
| | | | - Raymond J Leveillee
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL
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Gunn AJ, Gervais DA. Percutaneous ablation of the small renal mass-techniques and outcomes. Semin Intervent Radiol 2014; 31:33-41. [PMID: 24596438 DOI: 10.1055/s-0033-1363841] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An increasing number of T1a renal cell carcinomas are being diagnosed in recent years, in part due to incidental detection from the increased use of cross-sectional imaging. Although partial nephrectomy is still considered the primary treatment for these small renal masses, percutaneous ablation is now being performed as a standard therapeutic, nephron-sparing approach in patients who are poor surgical candidates. Clinical studies to date have demonstrated that percutaneous ablation is an effective therapy with acceptable outcomes and low risk in the appropriate clinical settings. This article will review various clinical aspects regarding the percutaneous ablation of small renal masses, including patient selection, preprocedural preparations, and the procedural considerations of commonly employed ablative technologies. Specific techniques such as radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, and high-intensity focused ultrasound will be addressed in detail. In addition, the technical and oncologic outcomes of percutaneous ablation will be discussed and referenced to that of partial nephrectomy.
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Affiliation(s)
- Andrew J Gunn
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School
| | - Debra A Gervais
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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Forauer AR, Dewey BJ, Seigne JD. Cancer-free survival and local tumor control after impendence-based radiofrequency ablation of biopsy-proven renal cell carcinomas with a minimum of 1-year follow-up. Urol Oncol 2014; 32:869-76. [PMID: 24946958 DOI: 10.1016/j.urolonc.2014.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/20/2014] [Accepted: 03/19/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES There are numerous reports describing the use of radiofrequency ablation (RFA) to treat renal cell carcinoma. Many series, however, describe heterogeneous populations, lack histologic descriptions, use various RFA systems, and indicate tumor destruction by different ablation end points. This study examined the outcomes of computed tomography-guided, impedance-based RFA of biopsy-proven renal cell carcinoma clinically staged as T1a with a minimum of 1 year of postablation follow-up. METHODS AND MATERIALS This retrospective study identified all consecutive patients who had undergone renal RFA since May 2005 at our institution. Patients without biopsy-proven renal cell carcinoma (RCCa) were excluded. Of the patients who met these criteria, evaluation was limited to patients with a minimum of 12 months of follow-up. Data collected from the patients' electronic medical and radiologic records included demographic data, tumor-related data, procedural details, and clinical follow-up visits. RESULTS A total of 39 patients (46 lesions) met the inclusion criteria. The mean tumor diameter was 2.6 cm (range: 1.2-4.0 cm). The most common histologies were clear cell (n = 27) and papillary (n = 16) renal cancer. The lesion location was equally divided between upper pole (n = 16), middle pole (n = 16), and lower pole (n = 14). Overall, 83% of the tumors were exophytic. No residual or recurrent enhancing mass was identified in the ablation bed on post-RFA imaging during the mean follow-up period of 35.3 months (range: 12-83). All patients were treated in a single encounter and no lesion required a second ablation; technical success (absence of residual tumor) on the initial post-RFA imaging study was 46 of 46 (100%). Clinical success was achieved in 45 of 46 lesions (98%); residual, viable tumor was found in a pretransplant nephrectomy specimen on postprocedure day 127. The mean cancer-free survival was 36.2 months. Comparison of preablation and postablation renal function found no statistically significant change. CONCLUSIONS The consistent outcomes in our post-RFA imaging and clinical surveillance allow us to offer image-guided ablation to patients with T1a RCCa as a valid treatment option offering long-term cancer-free survival. Impedance-based RFA in a carefully selected patient population with T1a RCCa is a reliable treatment option, with disease-free survival rates that are comparable to partial nephrectomy.
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Affiliation(s)
- Andrew R Forauer
- Division of Interventional Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Benjamin J Dewey
- Geisel School of Medicine at Dartmouth College, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - John D Seigne
- Division of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 2014; 273:241-60. [PMID: 24927329 DOI: 10.1148/radiol.14132958] [Citation(s) in RCA: 825] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article .
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215 (M.A.); Department of Radiology, Ospedale Generale, Busto Arsizio, Italy (L.S.); Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.L.B.); Department of Radiology, Southampton University Hospitals, Southampton, England (D.J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.R.C., J.W.C.); Department of Ultrasound, School of Oncology, Peking University, Beijing, China (M.H.C.); Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea (B.I.C.); Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France (T.d.B.); Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (G.D.D.); Department of Diagnostic Radiology, Rhode Island Hospital, Providence, RI (D.E.D.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.A.G.); Medical Imaging, University Health Network, Laval, Quebec, Canada (D.G.); Imaging Department, the London Clinic, London, England (A.R.G.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (F.T.L.); Department of Radiology, Royal Infirmary, Glasgow, Scotland (E.L.); Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy (R.L.); Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Mich (P.J.L.); Busto Arsizio, Italy (T.L.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.S.L.); Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, Calif (J.P.M.); Department of Radiology, Ospedale Valduce, Como, Italy (M.F.M.); Department of Radiology, Albert Einstein Medical Center, Phil
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Brunocilla E, Borghesi M, Schiavina R, Della Mora L, Dababneh H, La Manna G, Monti C, Martorana G. Small Renal Masses Initially Managed Using Active Surveillance: Results From a Retrospective Study With Long-Term Follow-Up. Clin Genitourin Cancer 2014; 12:178-81. [DOI: 10.1016/j.clgc.2013.11.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/11/2013] [Accepted: 11/08/2013] [Indexed: 12/01/2022]
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Advances in Interventional Oncology: Percutaneous Therapies. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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209
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Klatte T, Kroeger N, Zimmermann U, Burchardt M, Belldegrun AS, Pantuck AJ. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation. World J Urol 2014; 32:597-605. [PMID: 24700308 DOI: 10.1007/s00345-014-1284-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/17/2014] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. OBJECTIVE To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. METHODS A PubMed wide the literature search of was conducted. RESULTS International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. CONCLUSION Ablative techniques pose a valid treatment option in selected patients.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
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211
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Chang X, Ji C, Zhao X, Zhang F, Lian H, Zhang S, Liu G, Zhang G, Gan W, Li X, Guo H. The Application of R.E.N.A.L. Nephrometry Scoring System in Predicting the Complications After Laparoscopic Renal Radiofrequency Ablation. J Endourol 2014; 28:424-9. [PMID: 24364623 DOI: 10.1089/end.2013.0497] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Xiaofeng Chang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Changwei Ji
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaozhi Zhao
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fan Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huibo Lian
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shiwei Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guangxiang Liu
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Gutian Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weidong Gan
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaogong Li
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Gervais DA. Cryoablation versus radiofrequency ablation for renal tumor ablation: time to reassess? J Vasc Interv Radiol 2014; 24:1135-8. [PMID: 23885912 DOI: 10.1016/j.jvir.2013.05.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/11/2013] [Accepted: 05/11/2013] [Indexed: 01/03/2023] Open
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213
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Park SY, Kim CK, Park BK. Dual-energy CT in assessing therapeutic response to radiofrequency ablation of renal cell carcinomas. Eur J Radiol 2014; 83:e73-9. [DOI: 10.1016/j.ejrad.2013.11.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/24/2013] [Accepted: 11/22/2013] [Indexed: 01/20/2023]
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[Focal therapy in urology: kidney cancer]. Urologia 2014; 80:276-82. [PMID: 24419921 DOI: 10.5301/ru.2013.11659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2013] [Indexed: 11/20/2022]
Abstract
Focal therapy has gained attention in the treatment of small renal masses (SRM). However, its use is limited due to scarce data on long-term outcomes. The availability of such data is significantly lower as compared to the relevant data on surgery outcomes. At the same time, minimally invasive surgery has seen the development of laparoscopic nephron-sparing surgery and, recently, robot-assisted surgery. Our purpose is to review the possibilities of treatment for SMR with particular attention on focal therapy. Clinical series and comprehensive reviews support safety and mid/long-term efficacy of renal cryoablation or radiofrequency ablation. Comparative studies and meta-analysis outlined oncological inferiority against partial nephrectomy in local tumor control. For smaller and more peripheral lesions, radiofrequency ablation showed best indications than cryoablation. There are significant demographic and tumor differences between patients treated by one or another approach. The correct indication for each treatment seems to be of key importance to achieve the best oncological and functional outcome. Open partial nephrectomy remains the gold standard treatment for PMR, but laparoscopic approaches have been showing similar results.
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Brunocilla E, Borghesi M, Schiavina R, Palmieri F, Pernetti R, Monti C, Martorana G. Active surveillance for small renal masses diagnosed in elderly or comorbid patients: looking for the best treatment strategy. Actas Urol Esp 2014; 38:1-6. [PMID: 24126193 DOI: 10.1016/j.acuro.2013.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Aim of this study is to provide our results after long-term active surveillance (AS) protocol for small renal masses (SRMs), and to report the outcomes of patients who remained in AS compared to those who underwent delayed surgical intervention. PATIENTS AND METHODS We retrospectively reviewed our database of 58 patients diagnosed with 60 contrast enhancing SRMs suspicious for renal cell carcinoma (RCC). All patients had clinical and radiological follow-up every 6 months. We evaluated the differences between patients who remained on AS and those who underwent surgical delayed intervention. RESULTS The mean age was 75 years, the mean follow-up was 88.5 months. The median initial tumor size at presentation was 2.6cm, and the median estimated tumor volume was 8.7cm(3). The median linear growth rate of the cohort was 0.7cm/year, and the median volumetric growth rate was 8.8 cm(3)/year. Death for metastatic disease occurred in 2 patients (3.4%). No correlation was found between initial tumor size and size growth rate. The mean linear and volumetric growth rates of the group of patients who underwent surgery was higher than in those who remained on surveillance (1.9 vs. 0.4cm/year and 16.1 vs. 4.6 cm(3)/year, respectively; P<.001). CONCLUSIONS Most of SRMs demonstrate to have an indolent course and low metastatic potential. Malignant disease could have faster linear and volumetric growth rates, thus suggesting the need for a delayed surgical intervention. In properly selected patients with low life-expectancy, AS could be a reasonable option in the management of SRMs.
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Takaki H, Soga N, Kanda H, Nakatsuka A, Uraki J, Fujimori M, Yamanaka T, Hasegawa T, Arima K, Sugimura Y, Sakuma H, Yamakado K. Radiofrequency Ablation versus Radical Nephrectomy: Clinical Outcomes for Stage T1b Renal Cell Carcinoma. Radiology 2014; 270:292-9. [DOI: 10.1148/radiol.13130221] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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217
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Chang A, Finelli A, Berns JS, Rosner M. Chronic kidney disease in patients with renal cell carcinoma. Adv Chronic Kidney Dis 2014; 21:91-5. [PMID: 24359991 DOI: 10.1053/j.ackd.2013.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 01/04/2023]
Abstract
Renal cell carcinoma (RCC) is diagnosed in over 65,000 Americans annually, and earlier detection and advances in surgical techniques have resulted in improved oncological outcomes. Given that diabetes and hypertension are independent risk factors for the development of RCC, it is not surprising that diabetic nephropathy or hypertensive nephrosclerosis are commonly encountered in these patients. Data support that at least one third of the 300,000 kidney cancer survivors in the United States have or will develop CKD; however, the effect of CKD in this clinical setting has largely evaded the attention of the medical community. It is likely that CKD which develops from postsurgical therapy for RCC may limit long-term outcomes by increasing the risk for cardiovascular morbidity and mortality. To further improve the clinical outcomes for kidney cancer patients, better recognition and management of CKD, which requires coordination among urologists, pathologists, and nephrologists, will be essential.
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Bianchi M, Gandaglia G, Trinh QD, Hansen J, Becker A, Abdollah F, Tian Z, Lughezzani G, Roghmann F, Briganti A, Montorsi F, Karakiewicz PI, Sun M. A population-based competing-risks analysis of survival after nephrectomy for renal cell carcinoma. Urol Oncol 2014; 32:46.e1-7. [DOI: 10.1016/j.urolonc.2013.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/17/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Yang R, Lian H, Zhang G, Wang W, Gan W, Li X, Yan X, Zhang S, Zhao X, Guo H. Laparoscopic Radiofrequency Ablation with Intraoperative Contrast-Enhanced Ultrasonography for T1bN0M0 Renal Tumors: Initial Functional and Oncologic Outcomes. J Endourol 2014; 28:4-9. [PMID: 23998802 DOI: 10.1089/end.2013.0397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Rong Yang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Huibo Lian
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Gutian Zhang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Wei Wang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Weidong Gan
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Xiaogong Li
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Xiang Yan
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Shiwei Zhang
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Xiaozhi Zhao
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
| | - Hongqian Guo
- The Affiliated Drum Tower Hospital of Nanjing University, School of Medicine, Nanjing, People's Republic of China
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Waingankar N, Kavoussi LR. Another horse is leaving the stable. BJU Int 2013; 113:7. [PMID: 24330060 DOI: 10.1111/bju.12428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nikhil Waingankar
- The Arthur Smith Institute for Urology, North Shore - Long Island Jewish Health System, New Hyde Park, NY, USA.
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221
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Veltri A, Gazzera C, Busso M, Solitro F, Piccoli GB, Andreetto B, Garetto I. T1a as the Sole Selection Criterion for RFA of Renal Masses: Randomized Controlled Trials versus Surgery Should Not Be Postponed. Cardiovasc Intervent Radiol 2013; 37:1292-8. [DOI: 10.1007/s00270-013-0812-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/24/2013] [Indexed: 01/20/2023]
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222
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Yu J, Liang P, Yu XL, Cheng ZG, Han ZY, Zhang X, Dong J, Mu MJ, Li X, Wang XH. US-guided percutaneous microwave ablation versus open radical nephrectomy for small renal cell carcinoma: intermediate-term results. Radiology 2013; 270:880-7. [PMID: 24475805 DOI: 10.1148/radiol.13130275] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To review intermediate-term clinical outcomes of microwave ablation (MWA) compared with open radial nephrectomy (ORN) in small renal cell carcinoma (RCC) patients and to identify prognostic factors associated with two techniques. MATERIALS AND METHODS This retrospective study was institutional review board-approved. A total of 163 patients (127 men and 36 women) with small RCC (≤4 cm) were included from April 2006 to March 2012. Sixty-five patients underwent MWA and 98 patients underwent ORN. Survival, recurrence, and renal function changes were compared between the two groups. Effect of changes in key parameters (ie, overall survival, RCC-related survival, and metastasis-free survival) was statistically analyzed with the log-rank test. RESULTS Although overall survival after MWA was lower than that after ORN (P = .002), RCC-related survival was comparable to ORN (P = .78). Estimated 5-year overall survival rates were 67.3% after MWA and 97.8% after ORN; for RCC-related survival, estimated 5-year rates were 97.1% after MWA and 97.8% after ORN. There was one local tumor recurrence 32 months after MWA and none after ORN. Major complication rates were comparable (P = .81) between the two techniques (MWA, 2.5% vs ORN, 3.1%). The MWA group had less surgical time (P < .001), estimated blood loss (P < .001), and postoperative hospitalization (P < .001). Multivariate analysis showed age (P = .014), tumor type (P = .003), postoperative urea nitrogen (P = .042), comorbid disease (P = .005), and treatment modality (P < .001) may become survival rate predictors. CONCLUSION In intermediate term, ultrasonographically guided percutaneous MWA and ORN provide comparable results in oncologic outcomes. MWA appears to be a safe and effective technique for management of small RCC in patients with little loss of renal function.
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Affiliation(s)
- Jie Yu
- From the Departments of Interventional Ultrasound (J.Y., P.L., X.L.Y., Z.G.C., Z.Y.H., M.J.M., X.L.) and Urology Surgery (X.Z., J.D.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; and Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (X.H.W.)
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223
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Branger N, Maurin C, Daniel L, André M, Coulange C, Vacher-Coponnat H, Lechevallier E. [Treatment by radiofrequency ablation for a renin-secreting juxtaglomerular tumour: a case report]. Prog Urol 2013; 24:349-52. [PMID: 24821557 DOI: 10.1016/j.purol.2013.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/29/2013] [Accepted: 10/01/2013] [Indexed: 11/26/2022]
Abstract
Juxtaglomerular cell tumors are rare and benign tumors, occurring in young patients. The standard treatment is partial nephrectomy. We report the case of a young 22-year-old patient with a renin-secreting tumor diagnosed during an exploration of severe hypertension associated with hypokalemia that we treated by radiofrequency ablation.
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Affiliation(s)
- N Branger
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France.
| | - C Maurin
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - L Daniel
- Service d'anatomie pathologique, CHU Timone, Assistance Publique des hôpitaux de Marseille, 13005 Marseille, France
| | - M André
- Service de radiologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 13005 Marseille, France
| | - C Coulange
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - H Vacher-Coponnat
- Service de néphrologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 13005 Marseille, France
| | - E Lechevallier
- Service d'urologie, CHU Conception, Assistance Publique des hôpitaux de Marseille, 147, boulevard Baille, 13385 Marseille cedex 5, France
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224
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Ma Y, Bedir S, Cadeddu JA, Gahan JC. Long-term outcomes in healthy adults after radiofrequency ablation of T1a renal tumours. BJU Int 2013; 113:51-5. [PMID: 24053553 DOI: 10.1111/bju.12366] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To report the long-term oncological and renal function outcomes in healthy adults treated with radiofrequency ablation (RFA) for small renal masses. MATERIALS AND METHODS We retrospectively analysed the medical records of otherwise healthy patients (those with American Society of Anesthesiologists symptom score 1 or 2) with clinical T1a renal tumours who underwent RFA at our institution between March 2001 and July 2012. Radiographic follow-up with contrast imaging was performed at 6 weeks, 6 months, 1 year and annually thereafter. Local recurrence was defined as any new enhancing lesion (>10 HU) after the initial negative post-treatment computed tomography results. The estimated glomerular filtration rates (eGFRs) before and after RFA were calculated using the Cockgroft-Gault equation. RESULTS We performed RFA on 58 renal tumours in 52 patients. The mean tumour size was 2.2 cm with a median (interquartile range) follow-up of 60 (48-90) months. Three (5.1%) of the treated masses had tumour recurrence after initial RFA. The 5- and 10-year recurrence-free survival rate was 94.2%. There were no recurrences after 3 years. Three (5.1%) patients died during the follow-up, which gave 5- and 10-year overall survival rates of 95.7% and 91.1%. No patient developed metastatic renal cell carcinoma (RCC) and none died from RCC. Paired analysis showed that the eGFR values at a median follow-up of 40 months did not differ significantly from those before RFA. CONCLUSION With long-term follow-up, RFA provides durable oncological and functional outcomes for selected T1a renal tumours in otherwise healthy patients.
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Affiliation(s)
- Yunbo Ma
- Department of Urology, Liaocheng People's Hospital, Liaocheng, Shandong, China
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225
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Patard JJ, Baumert H, Bensalah K, Bernhard JC, Bigot P, Escudier B, Grenier N, Hétet JF, Long JA, Méjean A, Paparel P, Richard S, Rioux-Leclercq N, Coloby P, Soulié M. Recommandations en onco-urologie 2013 du CCAFU: Cancer du rein. Prog Urol 2013; 23 Suppl 2:S177-204. [DOI: 10.1016/s1166-7087(13)70055-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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226
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Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU Int 2013; 113:416-28. [PMID: 24053769 PMCID: PMC4233988 DOI: 10.1111/bju.12349] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives Patients and Methods Results Conclusions
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Affiliation(s)
- Tze M Wah
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, Leeds Teaching Hospitals Trust, St. James's University Hospital, Leeds, UK
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227
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Youn CS, Park JM, Lee JY, Song KH, Na YG, Sul CK, Lim JS. Comparison of laparoscopic radiofrequency ablation and open partial nephrectomy in patients with a small renal mass. Korean J Urol 2013; 54:603-8. [PMID: 24044094 PMCID: PMC3773590 DOI: 10.4111/kju.2013.54.9.603] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/26/2013] [Indexed: 01/01/2023] Open
Abstract
Purpose We have performed both open partial nephrectomy (OPN) and laparoscopic radiofrequency ablation (RFA) on selected patients since January 2007 and have been following these patients through serial laboratory assessments and computed tomography (CT). The purpose of the present study was to evaluate long-term oncologic outcomes and renal function status for laparoscopic RFA versus OPN at a minimum follow-up of 3 years. Materials and Methods A total of 55 patients with exophytic, single small renal masses were treated with either OPN (n=14) or laparoscopic RFA (n=41) by a single surgeon. The indications for laparoscopic RFA were as follows: 1) cases with the greatest dimension of the renal mass <3 cm, and 2) cases in which the collecting system, renal calyx, and great vessels were free from the tumor margins by 1 cm. Results The estimated blood loss (EBL), the operation time, and the mean number of hospital days was significantly lower in the laparoscopic RFA group than in the OPN group. Oncologic data did not differ significantly between the two groups. Creatine clearance levels did not differ significantly compared with those before the operation in either group. Conclusions Our data suggest excellent therapeutic outcomes with laparoscopic RFA with achievement of effective operative times, hospital stays, and EBL compared with OPN. According to our indications for laparoscopic RFA, laparoscopic RFA is an effective minimally invasive therapy for the treatment of small renal masses, yielding oncologic outcomes and renal function equivalent to those of OPN.
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Affiliation(s)
- Chang Shik Youn
- Department of Urology, Chungnam National University School of Medicine, Daejeon, Korea
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228
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Hegg RM, Schmit GD, Kurup AN, Weisbrod AJ, Boorjian SA, Atwell TD. Ultrasound-Guided Transhepatic Radiofrequency Ablation of Renal Tumors: A Safe and Effective Approach. Cardiovasc Intervent Radiol 2013; 37:508-12. [DOI: 10.1007/s00270-013-0716-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
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229
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Haskal ZJ. Editor's suggested readings in interventional oncology. J Vasc Interv Radiol 2013; 24:1165-6. [PMID: 23885914 DOI: 10.1016/j.jvir.2013.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Ziv J Haskal
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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230
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Castro A, Jenkins LC, Salas N, Lorber G, Leveillee RJ. Ablative therapies for small renal tumours. Nat Rev Urol 2013; 10:284-91. [DOI: 10.1038/nrurol.2013.68] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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231
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Salagierski M, Akdogan B, Brookman-May S, Dobrowolska-Glazar B, Ficarra V, Langenhuijsen JF, Marszalek M, Minervini A, Rodriguez-Faba O, Roscigno M, Vandromme A, Volpe A, Joniau S. What Is the Contemporary Role of Radiofrequency Ablation in the Management of Small Renal Masses? Are Small Lesions the Radiologist's Tumors? Eur Urol 2013; 63:493-5. [DOI: 10.1016/j.eururo.2012.09.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/26/2012] [Indexed: 01/20/2023]
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