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Sun G, Eisenbrey JR, Smolock AR, Lallas CD, Anton KF, Adamo RD, Shaw CM. Percutaneous Microwave Ablation versus Cryoablation for Small Renal Masses (≤4 cm): 12-Year Experience at a Single Center. J Vasc Interv Radiol 2024; 35:865-873. [PMID: 38360294 DOI: 10.1016/j.jvir.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To determine whether microwave ablation (MWA) has equivalent outcomes to those of cryoablation (CA) in terms of technical success, adverse events, local tumor recurrence, and survival in adult patients with solid enhancing renal masses ≤4 cm. MATERIALS AND METHODS A retrospective review was performed of 279 small renal masses (≤4 cm) in 257 patients (median age, 71 years; range, 40-92 years) treated with either CA (n = 191) or MWA (n = 88) between January 2008 and December 2020 at a single high-volume institution. Evaluations of adverse events, treatment effectiveness, and therapeutic outcomes were conducted for both MWA and CA. Disease-free, metastatic-free, and cancer-specific survival rates were tabulated. The estimated glomerular filtration rate was employed to examine treatment-related alterations in renal function. RESULTS No difference in patient age (P = .99) or sex (P = .06) was observed between the MWA and CA groups. Cryoablated lesions were larger (P < .01) and of greater complexity (P = .03). The technical success rate for MWA was 100%, whereas 1 of 191 cryoablated lesions required retreatment for residual tumor. There was no impact on renal function after CA (P = .76) or MWA (P = .49). Secondary analysis using propensity score matching demonstrated no significant differences in local recurrence rates (P = .39), adverse event rates (P = .20), cancer-free survival (P = .76), or overall survival (P = .19) when comparing matched cohorts of patients who underwent MWA and CA. CONCLUSIONS High technical success and local disease control were achieved for both MWA and CA. Cancer-specific survival was equivalent. Higher adverse event rates after CA may reflect the tendency to treat larger, more complex lesions with CA.
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Affiliation(s)
- George Sun
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda R Smolock
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kevin F Anton
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert D Adamo
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colette M Shaw
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Panhelleux M, Balssa L, David A, Thiery-Vuillemin A, Kleinclauss F, Frontczak A. Evaluation of local control after percutaneous microwave ablation versus partial nephrectomy: A propensity score matched study. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102534. [PMID: 37798161 DOI: 10.1016/j.purol.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The incidence of small renal tumors (≤4cm) is on the rise. The gold standard treatment is partial nephrectomy (PN) but focal therapy can be a good alternative. We evaluated oncological control after treatment of T1a renal tumors by microwave ablation (MWA) compared to PN. METHODS This is a retrospective, single-center study of all patients treated for TNM stage T1a renal tumors by either PN or MWA between 2010 and 2020. A propensity score was calculated and patients were matched 2:1 to compare recurrence-free survival, metastasis-free survival and overall survival between groups. We also compared postoperative complications using the Clavien-Dindo classification. RESULTS After matching and propensity score, the two groups (41 MWA and 82 PN) were comparable. The median follow-up was 23 months (interquartiles, 9-48 months). Recurrence-free survival was higher in the PN group compared to MWA, with a recurrence rate of 17.1% in the MWA group vs 4.9% in the PN group (P=0.003). MWA treatment was a risk factor for tumor recurrence (P=0.002), but there was no significant difference in terms of metastasis-free survival (P=0.549) or overall survival (P=0.539). MWA was associated with fewer postoperative complications (P=0.0005). CONCLUSION This study shows that MWA was associated with higher risk of recurrence but similar metastasis-free survival and overall survival compared to PN. Recurrence was treated with new MWA or active surveillance. MWA may be an interesting alternative to PN for small renal tumors. LEVEL OF EVIDENCE Grade C.
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Affiliation(s)
- M Panhelleux
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France.
| | - L Balssa
- Urology Department, University Hospital Center, Besançon, France
| | - A David
- Radiology Department, University Hospital Center, Besançon, France
| | - A Thiery-Vuillemin
- University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France; Oncology Department, University Hospital Center, Besançon, France
| | - F Kleinclauss
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
| | - A Frontczak
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
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3
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Efthymiou E, Velonakis G, Charalampopoulos G, Mazioti A, Brountzos E, Kelekis N, Filippiadis D. Computed tomography-guided percutaneous microwave ablation for renal cell carcinoma: evaluating the performance of nephrometry scores. Eur Radiol 2023; 33:7388-7397. [PMID: 37318604 DOI: 10.1007/s00330-023-09774-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/22/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES The purpose of the current study is to evaluate the performance of RENAL and mRENAL scores, in the prediction of oncological outcomes in patients treated with microwave ablation (MWA) for (T1) renal cell carcinomas (RCC). METHODS Institutional database retrospective research identified 76 patients with a biopsy-proven solitary T1a (84%) or T1b (16%) RCC; all patients underwent CT-guided MWA ablation. Tumor complexity was reviewed by calculating RENAL and mRENAL scores. RESULTS The majority of the lesions were exophytic (82.9%), with > 7 mm nearness to the collecting system (53.9%), located posteriorly (73.6%), and lower to polar lines (61.8%). Mean RENAL and mRENAL scores were 5.7 (SD = 1.9) and 6.1 (SD = 2.1) respectively. Progression rates were significantly higher with greater tumor size (> 4 cm), with < 4 mm nearness to the collecting system, for tumors crossing a polar line and with the anterior location. None of the above was associated with complications. RENAL and mRENAL scores were significantly higher in patients with incomplete ablation. The ROC analysis showed the significant prognostic ability of both RENAL and mRENAL scores for progression. In both scores, the optimal cut-off point was 6.5. Univariate Cox regression analysis for progression showed a hazard ratio of 7.73 for the RENAL score and 7.48 for the mRENAL score. CONCLUSION The results of the present study show that the risk of progression was higher in patients with RENAL and mRENAL score of > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. CLINICAL RELEVANCE STATEMENT CT-guided percutaneous MWA is a safe and effective technique for the treatment of T1a renal cell carcinomas. Different morphometric parameters of RCC tumors including RENAL and mRENAL score > 6.5, size, proximity to the collecting system, and crossing of polar lines impact the efficacy of MWA and progression survival rates. KEY POINTS • The risk of progression is higher in patients with RENAL and mRENAL score > 6.5, in T1b tumors, close to the collective system (< 4 mm), crossing polar lines and anterior location. • The significant prognostic ability of the mRENAL score for progression was higher than the respective of the RENAL score. • Complications were not associated with any of the above factors.
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Affiliation(s)
- Evgenia Efthymiou
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece.
| | - Georgios Velonakis
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Georgios Charalampopoulos
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
| | - Dimitrios Filippiadis
- Second Department of Radiology, University General Hospital ATTIKON, National and Kapodistrian University of Athens, Rimini 1, 12462, Athens, Greece
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Savage CH, Devane AM, Li Y, Li M, Schammel NC, Little ME, Schammel C, Pigg RA, El Khudari H, Rais-Bahrami S, Huang J, Gunn AJ. Limited ability of the renal ablation-specific (MC)2 risk scoring system to predict major adverse events from percutaneous renal microwave ablation. Clin Imaging 2023; 100:30-35. [PMID: 37187107 DOI: 10.1016/j.clinimag.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To access if the (MC)2 scoring system can identify patients at risk for major adverse events following percutaneous microwave ablation of renal tumors. METHODS Retrospective review of all adult patients who underwent percutaneous renal microwave ablation at two centers. Patient demographics, medical histories, laboratory work, technical details of the procedure, tumor characteristics, and clinical outcomes were collected. The (MC)2 score was calculated for each patient. Patients were assigned to low-risk (<5), moderate-risk (5-8) and high-risk (>8) groups. Adverse events were graded according to the criteria from the Society of Interventional Radiology guidelines. RESULTS A total of 116 patients (mean age = 67.8 [95%CI 65.5-69.9], 66 men) were included. 10 (8.6%) and 22 (19.0%) experienced major or minor adverse events, respectively. The mean (MC)2 score for patients with major adverse events (4.6 [95%CI 3.3-5.8]) was not higher than those with either minor adverse events (4.1 [95%CI 3.4-4.8], p = 0.49) or no adverse events (3.7 [95%CI 3.4-4.1], p = 0.25). However, mean tumor size was greater in those with major adverse events (3.1 cm [95%CI 2.0-4.1]) than minor adverse events (2.0 cm [95%CI 1.8-2.3], p = 0.01). Patients with central tumors were also more likely to experience major adverse events compared to those without central tumors (p = 0.02). The area under the receiver operator curve to predict major adverse events was 0.61 (p = 0.15), indicating a poor ability of the (MC)2 score to predict major adverse events. CONCLUSION The (MC)2 risk scoring system does not accurately identify patients at risk for major adverse events from percutaneous microwave ablation of renal tumors. The mean tumor size and central tumor location may serve as a better indicator for risk assessment of major adverse events.
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Affiliation(s)
- Cody H Savage
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - A Michael Devane
- Department of Radiology, Clemson University School of Health Research, Clemson, SC, United States of America.
| | - Yufeng Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Mei Li
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Noah C Schammel
- University of South Carolina School of Medicine, Greenville, SC, United States of America.
| | - Madison E Little
- University of South Carolina School of Medicine, Greenville, SC, United States of America.
| | - Christine Schammel
- Department of Pathology, Prisma Health, Richland County, SC, United States of America.
| | - Richard A Pigg
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Husammedin El Khudari
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Junjian Huang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
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5
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Lanza C, Carriero S, Biondetti P, Angileri SA, Carrafiello G, Ierardi AM. Advances in imaging guidance during percutaneous ablation of renal tumors. Semin Ultrasound CT MR 2023; 44:162-169. [DOI: 10.1053/j.sult.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Safety and efficacy of RFA versus MWA for T1a renal cell carcinoma: a propensity score analysis. Eur Radiol 2023; 33:1040-1049. [PMID: 36066733 PMCID: PMC9889465 DOI: 10.1007/s00330-022-09110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/06/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Percutaneous radiofrequency ablation (RFA) is stated as a treatment option for renal cell carcinoma (RCC) smaller than 4 cm (T1a). Microwave ablation (MWA) is a newer technique and is still considered experimental in some guidelines. The objective of this study was to compare the safety and efficacy of RFA and MWA for the treatment of RCC. METHODS Patients with T1a RCC treated by RFA or MWA in two referral centers were retrospectively analyzed. Patient records were evaluated to generate mRENAL nephrometry scores. Local tumor progression (LTP) was considered when new (recurrence) or residual tumor enhancement within/adjacent to the ablation zone was objectified. Differences in LTP-free interval (residual + recurrence) between ablation techniques were assessed with Cox proportional hazards models and propensity score (PS) methods. RESULTS In 164 patients, 87 RFAs and 101 MWAs were performed for 188 RCCs. The primary efficacy rate was 92% (80/87) for RFA and 91% (92/101) for MWA. Sixteen patients had residual disease (RFA (n = 7), MWA (n = 9)) and 9 patients developed recurrence (RFA (n = 7), MWA (n = 2)). LTP-free interval was significantly worse for higher mRENAL nephrometry scores. No difference in LTP-free interval was found between RFA and MWA in a model with inverse probability weighting using PS (HR = 0.99, 95% CI 0.35-2.81, p = 0.98) and in a PS-matched dataset with 110 observations (HR = 0.82, 95% CI 0.16-4.31, p = 0.82). Twenty-eight (14.9%) complications (Clavien-Dindo grade I-IVa) occurred (RFA n = 14, MWA n = 14). CONCLUSION Primary efficacy for ablation of RCC is high for both RFA and MWA. No differences in efficacy and safety were observed between RFA and MWA. KEY POINTS • Both RFA and MWA are safe and effective ablation techniques in the treatment of T1a renal cell carcinomas. • High modified RENAL nephrometry scores are associated with shorter local tumor progression-free interval. • MWA can be used as heat-based ablation technique comparable to RFA for the treatment of T1a renal cell carcinomas.
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7
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Lucignani G, Rizzo M, Ierardi AM, Piasentin A, De Lorenzis E, Trombetta C, Liguori G, Bertolotto M, Carrafiello G, Montanari E, Boeri L. Percutaneous Microwave Ablation is Comparable to Cryoablation for the Treatment of T1a Renal Masses: Results From a Cross-Sectional Study. Clin Genitourin Cancer 2022; 20:e506-e511. [PMID: 35965197 DOI: 10.1016/j.clgc.2022.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Percutaneous microwave ablation (MWA) of renal masses (RM) is still considered experimental as opposed to established procedures such as cryoablation (CA). We aimed to compare perioperative, functional and oncological outcomes of patients with RM treated with CA and MWA. MATERIALS AND METHODS Data from 116 (69.9%) and 50 (30.1%) patients treated with CA and MWA for RM were analyzed. Patients' demographics and perioperative data were collected including nephrometry scores, complications, pre- and postprocedural renal function. Tumor persistence and recurrence were recorded. Descriptive statistics compared functional outcomes between groups. Cox regression analyses tested risk factors associated with recurrence. RESULTS Groups were similar in terms of RM diameter, nephrometry scores and histology distribution. Median follow-up was 26 (13-46) and 24 (14-36) months for CA and MWA, respectively. The rate of overall (36.2% for CA vs. 24% for MWA, P= .1) and major (Clavien ≥ 3a) complications (1.7% vs. 5.4%, P = .1) were similar among groups. The median decline of renal function after 6 months follow-up did not differ between CA and MWA (P = .8). Tumor persistence [4.3% vs. 12%] and recurrence [9.5% and 7.1%] rates were similar for CA and MWA. Three years recurrence free and overall survival were 91% versus 95% (log-rank P = .77) and 80 versus 88% (log-rank P = .23) in the CA and MWA groups, respectively. At Cox analysis no predictors were found associated with recurrence. CONCLUSION Despite being considered still experimental, MWA showed comparable outcomes relative to CA in terms of safety, preservation of renal function and oncological efficacy.
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Affiliation(s)
- Gianpaolo Lucignani
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Rizzo
- Department of Urology, University of Trieste, Cattinara Hospital - ASUGI, Trieste, Italy
| | - Anna Maria Ierardi
- Department of Radiology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Piasentin
- Department of Urology, University of Trieste, Cattinara Hospital - ASUGI, Trieste, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital - ASUGI, Trieste, Italy
| | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital - ASUGI, Trieste, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
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The Role of Focal Therapy and Active Surveillance for Small Renal Mass Therapy. Biomedicines 2022; 10:biomedicines10102583. [PMID: 36289844 PMCID: PMC9599744 DOI: 10.3390/biomedicines10102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022] Open
Abstract
Small and low-grade renal cell carcinomas have little potential for metastasis and disease-related mortality. As a consequence, the main problem remains the use of appropriately tailored treatment for each individual patient. Surgery still remains the gold standard, but many clinicians are questioning this approach and present the advantages of focal therapy. The choice of treatment regimen remains a matter of debate. This article summarizes the current treatment options in the management of small renal masses.
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Gholinejad M, Pelanis E, Aghayan D, Fretland ÅA, Edwin B, Terkivatan T, Elle OJ, Loeve AJ, Dankelman J. Generic surgical process model for minimally invasive liver treatment methods. Sci Rep 2022; 12:16684. [PMID: 36202857 PMCID: PMC9537522 DOI: 10.1038/s41598-022-19891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
Surgical process modelling is an innovative approach that aims to simplify the challenges involved in improving surgeries through quantitative analysis of a well-established model of surgical activities. In this paper, surgical process model strategies are applied for the analysis of different Minimally Invasive Liver Treatments (MILTs), including ablation and surgical resection of the liver lesions. Moreover, a generic surgical process model for these differences in MILTs is introduced. The generic surgical process model was established at three different granularity levels. The generic process model, encompassing thirteen phases, was verified against videos of MILT procedures and interviews with surgeons. The established model covers all the surgical and interventional activities and the connections between them and provides a foundation for extensive quantitative analysis and simulations of MILT procedures for improving computer-assisted surgery systems, surgeon training and evaluation, surgeon guidance and planning systems and evaluation of new technologies.
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Affiliation(s)
- Maryam Gholinejad
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Egidius Pelanis
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Davit Aghayan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of HPB Surgery, Oslo University Hospital, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of HPB Surgery, Oslo University Hospital, Oslo, Norway
| | - Turkan Terkivatan
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Arjo J Loeve
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
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10
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Li S, Huang J, Jang S, Schammel NC, Schammel C, Som A, El Khudari H, Devane AM, Gunn AJ. Utility of the RENAL Nephrometry Scoring System in Predicting Adverse Events and Outcomes of Percutaneous Microwave Ablation of Renal Tumors. J Vasc Interv Radiol 2022; 33:695-701. [PMID: 35311666 DOI: 10.1016/j.jvir.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/24/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the utility of the radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (RENAL) nephrometry scoring system at predicting adverse events and outcomes in percutaneous microwave ablation (MWA) of renal tumors. MATERIALS AND METHODS A retrospective review of 116 patients who underwent MWA from 2004 to 2018 at 2 large university hospitals was conducted. Patient demographics and tumor characteristics were collected. The RENAL nephrometry scores were calculated, and procedure-related adverse events were stratified into minor and major (the Society of Interventional Radiology classification of class C or higher). Technical and oncologic outcomes were based on follow-up magnetic resonance imaging and computed tomography scans after ablation. RESULTS The mean RENAL score was 6.6 (range, 4-11), and the mean tumor size was 24 mm. Follow-up ranged between 16 and 161 weeks (median, 50 weeks; mean, 65 weeks). Oncologic control was achieved in 96% (n = 111) of patients. The major and minor adverse event rates were 8.6% (n = 10) and 17% (n = 19), respectively. The mean RENAL score for patients with recurrent and/or residual tumor (8.2 ± 2.7) was higher than that for patients without disease recurrence (6.5 ± 3.5, P = .05). However, in a multivariate analysis, the RENAL score was not found to be an independent predictor of oncologic outcomes (odds ratio, 1.548; P = .092). CONCLUSIONS The RENAL nephrometry score has minimal utility for predicting outcomes and adverse events in MWA of renal tumors. The inconsistent nature of RENAL nephrometry scoring in percutaneous ablation procedures underscores the need for an ablation-specific risk stratification system.
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Affiliation(s)
- Sienna Li
- Harvard Medical School, Boston, Massachusetts.
| | - Junjian Huang
- Department of Radiology, University of Alabama School of Medicine, Birmingham, Alabama
| | - Sean Jang
- Boston University, Boston, Massachusetts
| | - Noah C Schammel
- University of South Carolina, School of Medicine, Greenville, South Carolina
| | | | - Avik Som
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Husam El Khudari
- Department of Radiology, University of Alabama School of Medicine, Birmingham, Alabama
| | - A Michael Devane
- Department of Radiology, Clemson University School of Health Research, Clemson, South Carolina
| | - Andrew J Gunn
- Department of Radiology, University of Alabama School of Medicine, Birmingham, Alabama
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11
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Lomoschitz FM, Stummer H. Applied Change Management in Interventional Radiology—Implementation of Percutaneous Thermal Ablation as an Additional Therapeutic Method for Small Renal Masses. Diagnostics (Basel) 2022; 12:diagnostics12061301. [PMID: 35741111 PMCID: PMC9222117 DOI: 10.3390/diagnostics12061301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
Interventional radiology (IR) has the potential to offer minimally invasive therapy. With this potential, new and arising IR methods may sometimes be in competition with established therapies. To introduce new methods, transformational processes are necessary. In organizations, structured methods of change management, such as the eight-step process of Kotter—(1) Establishing a sense of urgency, (2) Creating the guiding coalition, (3) Developing a vision and strategy, (4) Communicating the change vision, (5) Empowering employees for broad-based action, (6) Generating short-term wins, (7) Consolidating gains and producing more change, and (8) Anchoring new approaches in the culture—are applied based on considerable evidence. In this article, the application of Kotter’s model in the clinical context is shown through the structured transformational process of the organizational implementation of the percutaneous thermal ablation of small renal masses. This article is intended to familiarize readers in the medical field with the methods of structured transformational processes applicable to the clinical setting.
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Affiliation(s)
- Friedrich M. Lomoschitz
- Department of Diagnostic and Interventional Radiology, Clinic Hietzing, Wolkersbergenstrasse 1, A-1130 Vienna, Austria
- Institute for Management and Economics in Health Care, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria;
- Correspondence:
| | - Harald Stummer
- Institute for Management and Economics in Health Care, UMIT—University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, A-6060 Hall in Tirol, Austria;
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Clinical Study on the Efficacy of Microwave Ablation (MA) in the Treatment of Stage I Renal Clear Cell Carcinoma by CT and MRI Imaging. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8446294. [PMID: 35178237 PMCID: PMC8843974 DOI: 10.1155/2022/8446294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/05/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022]
Abstract
We have proposed an effective mechanism to corroborate the efficacy of microwave ablation (MA) in the treatment of stage I renal clear cell carcinoma in this paper. For this purpose, a total of 96 patients with stage I renal clear cell carcinoma presented in our hospital from May 2018 to January 2021 were randomly divided into CT group (n = 48) and MRI group (n = 48). Patients in both groups were treated with microwave ablation after pathological diagnosis. Patients in the CT group received enhanced CT examination to monitor the therapeutic effect; in contrast, patients in the MRI group received MRI examination to monitor their therapeutic effect. The focus areas before and after tumor microwave ablation were compared between the two groups. The patients were followed up to 1 year after the operation, and the microwave ablation inactivation rates of the two groups were compared according to the postoperative follow-up results. There was no significant difference between CT and MRI in the levels of long and short diameter before and after microwave ablation of renal clear cell carcinoma (P > 0.05). In the CT group, CT examination was performed within 24 hours after microwave ablation treatment, and 44 of 48 ablation lesions showed complete ablation. The remaining 4 lesions showed nodular heterogeneous enhancement in the arterial phase, indicating that the tumor remained. Microwave ablation was performed on the residual lesions during the operation, and then enhanced CT was performed again to show that the lesions were ablated completely. In the MRI group, MRI examination was performed within 24 hours after microwave ablation treatment, and 45 of 48 ablation lesions showed complete ablation. The remaining 3 lesions showed nodular heterogeneous enhancement in the arterial phase, indicating that the tumor remained. Microwave ablation was performed on the residual lesions during the operation, and MRI examination showed that the lesions were ablated completely. The patients were followed up to 1 year after the operation, and the microwave ablation inactivation rate of the two groups was compared according to the postoperative follow-up results as the gold standard. The inactivation rate of microwave ablation in the CT group was 89.58 (43/48). The inactivation rate of microwave ablation in the MRI group was 100.00% (48/48). The inactivation rate of microwave ablation in the MRI group was higher than that in the CT group (χ2 = 5.275, P = 0.021).
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Taiji R, Lin EY, Lin YM, Yevich S, Avritscher R, Sheth RA, Ruiz JR, Jones AK, Chintalapani G, Nishiofuku H, Tanaka T, Kichikawa K, Gupta S, Odisio BC. Combined Angio-CT Systems: A Roadmap Tool for Precision Therapy in Interventional Oncology. Radiol Imaging Cancer 2021; 3:e210039. [PMID: 34559007 DOI: 10.1148/rycan.2021210039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Combined angiography-CT (angio-CT) systems, which combine traditional angiographic imaging with cross-sectional imaging, are a valuable tool for interventional radiology. Although cone-beam CT (CBCT) technology from flat-panel angiography systems has been established as an adjunct cross-sectional imaging tool during interventional procedures, the intrinsic advantages of angio-CT systems concerning superior soft-tissue imaging and contrast resolution, along with operational ease, have sparked renewed interest in their use in interventional oncology procedures. Owing to increases in affordability and usability due to an improved workflow, angio-CT systems have become a viable alternative to stand-alone flat-panel angiographic systems equipped with CBCT. This review aims to provide a comprehensive technical and clinical guide for the use of angio-CT systems in interventional oncology. The basic concepts related to the use of angio-CT systems, including concepts related to workflow setup, imaging characteristics, and acquisition parameters, will be discussed. Additionally, an overview on the clinical applications and the benefits of angio-CT systems in routine therapeutic and palliative interventional oncology procedures will be reviewed. Keywords: Ablation Techniques, CT-Angiography, Interventional-Body, Interventional-MSK, Chemoembolization, Embolization, Radiation Therapy/Oncology, Abdomen/GI, Skeletal-Axial Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Ryosuke Taiji
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Ethan Y Lin
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Yuan-Mao Lin
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Steven Yevich
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Rony Avritscher
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Rahul A Sheth
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Joseph R Ruiz
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - A Kyle Jones
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Gouthami Chintalapani
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Hideyuki Nishiofuku
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Toshihiro Tanaka
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Kimihiko Kichikawa
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Sanjay Gupta
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Bruno C Odisio
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
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Efthymiou E, Siatelis A, Liakouras C, Makris G, Chrisofos M, Kelekis A, Brountzos E, Kelekis N, Filippiadis D. Computed Tomography-Guided Percutaneous Microwave Ablation for Renal Cell Carcinoma: Impact of Tumor Size on the Progression Survival Rates. Diagnostics (Basel) 2021; 11:diagnostics11091618. [PMID: 34573960 PMCID: PMC8472140 DOI: 10.3390/diagnostics11091618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of renal cell carcinoma (RCC) along with identifying prognostic factors affecting the progression survival rate. Institutional database retrospective research identified 69 patients with a biopsy proven solitary T1a (82.6%) or TIb (17.4%) RCC who have underwent percutaneous CT-guided MWA. Kaplan–Meier survival estimates for events were graphed and Cox regression analysis was conducted. Mean patient age was 70.4 ± 11.5 years. Mean size of the lesions was 3 ± 1.3 cm. Mean follow up time was 35.6 months (SD = 21.1). The mean progression free survival time from last ablation was 84.2 months. For T1a tumors, the cumulative progression free survival rate for 1, 6, 12 and 36 months were 100% (SE = 0%), 91.2% (SE = 3.7%), 91.2% (SE = 3.7%) and 87.5% (SE = 4.4%); the recurrence free survival rate for T1a RCC was 94.9%. For T1b tumors, the cumulative progression free survival rate for 1, 6, 12 and 36 months were 100% (SE = 0%), 63.6% (SE = 14.5%), 63.6% (SE = 14.5%) and 63.6% (SE = 14.5%). Grade 1 complications were recorded in 5 (7.2%) patients. Significantly greater hazard for progression was found in cases with a tumor size > 4 cm (HR = 9.09, p = 0.048). No statistically important difference regarding tumor progression was recorded between T1a tumors with a diameter ≤3 cm and >3 cm. In summary, the results of the present study show that CT guided percutaneous MWA is an effective technique for treatment of T1a renal cell carcinomas, irrespective of tumor size. T1b tumors were associated with higher progression rates.
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Affiliation(s)
- Evgenia Efthymiou
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Argyris Siatelis
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Christos Liakouras
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Georgios Makris
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Michael Chrisofos
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Alexis Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Elias Brountzos
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
- Correspondence:
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15
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Spiliopoulos S, Marzoug A, Ra H, Arcot Ragupathy SK. Long-term outcomes of CT-guided percutaneous cryoablation of T1a and T1b renal cell carcinoma. Diagn Interv Radiol 2021; 27:524-528. [PMID: 34313238 PMCID: PMC8289428 DOI: 10.5152/dir.2021.20342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We aimed to evaluate the long-term outcomes of computed tomography-guided percutaneous cryoablation (PCA) for biopsy-confirmed renal cell carcinoma (RCC). METHODS This was a single-center, retrospective study investigating all patients treated with PCA between January 2010 and February 2019 for RCC tumors. Primary outcome measures included overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and cancer-specific survival (CSS). Secondary outcome measures included kidney function, complications, technical success, hospital stay, procedural time, and the identification of factors affecting the primary outcomes. RESULTS Fifty-three consecutive patients with 54 lesions (T1a: 49/54; T1b: 5/54) were included. Mean tumor diameter was 28.0±8.5 mm and mean R.E.N.A.L. score was 7.2±2.0. Technical success was 100% (54/54 lesions) after two reinterventions for incomplete ablation. Mean follow-up time was 46.7±28.6 months (range, 3-122 months). Local recurrence was noted in 5 patients (9.2%). According to Kaplan-Meyer analysis, OS was 98.2%, 94.2%, 71.2%, and 58.2% at 1, 3, 5, and 8 years. One patient (1.9%) died of cancer and CSS was 95.8% at 8 years. DFS was 100.0%, 95.5%, and 88.6%, and PFS was 100%, 94.3%, and 91.0%, at 1, 2, and 5 years. Clavien-Dindo grade II complication rate was 7.8% (5/64 procedures). There were no complications classified as grade III or greater. Mean creatinine increase was 7.1±6.3 μm/L (p = 0.31). No patient advanced to dialysis during follow up. Mean procedural time was 163±45 min. Median hospital stay was 2.0 days (IQR, 1-2.5 days). Diabetes was the only independent predictor of decreased OS (hazard ratio 4.3, 95% CI 0.043-0.914; p = 0.038). CONCLUSION PCA for stage T1a and T1b RCC provides favorable long-term oncological and renal function preservation outcomes, with acceptable complication rates.
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Affiliation(s)
- Stavros Spiliopoulos
- Department of Clinical Radiology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK;Division of Interventional Radiology, 2nd Department of Radiology, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Athens, Greece
| | - Abdelaziz Marzoug
- Department of Clinical Radiology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Hae Ra
- Department of Clinical Radiology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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16
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Microwave ablation of cT1a renal cell carcinoma: oncologic and functional outcomes at a single center. Clin Imaging 2021; 76:199-204. [PMID: 33964597 DOI: 10.1016/j.clinimag.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Percutaneous ablation is an established alternative to surgical intervention for small renal masses. Radiofrequency and cryoablation have been studied extensively in the literature. To date, series assessing the efficacy and safety of microwave ablation (MWA) are limited. We present a cohort of 110 renal tumors treated with MWA. METHODS A review of the medical record between January 2015 and July 2019 was performed, retrospectively identifying 101 patients (110 tumors). All ablations were performed by a single board-certified urologist/interventional radiologist. Demographic information, intraoperative, postoperative, and follow-up surveillance data were recorded. RESULTS Median (IQR) age was 69.7 years (60.8-77.0); 27 (24%) were female. Median (IQR) BMI was 27.0 (25.1-30.2) and Charleston Comorbidity Index was 5.0 (4.0-6.0). 82 tumors were biopsy-confirmed renal cell carcinoma/oncocytic neoplasms. Median (IQR) tumor size was 2.0 cm (1.5-2.6). Median (IQR) RENAL nephrometry score was 6.0 (5.0-8.0). Technical success was achieved in all patients and all but one patient were discharged on the same day. Median (IQR) eGFR at baseline and 1 year were 71.9 mL/min/1.73 m2 (56.5-82) and 63.0 mL/min/1.73 m2 (54.0-78.2); the difference was -5.3 (p = 0.12). Two Clavien-Dindo type-I complications, one type-II complication, and one type-III complication were experienced in this cohort. Median radiographic follow-up was 376.5 days with 2 tumors (2.4% of RCC/oncocytic neoplasms) having recurred to date. CONCLUSIONS MWA is a safe and efficacious treatment option for small renal masses with minimal adverse events and low rates of recurrence in this cohort of 101 patients. Continued follow-up is needed to assess long-term outcomes.
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Aarts BM, Baetens TR, Munoz DC, Oudkerk SF, Solouki AM, Horsch AD, Bex A, Beets-Tan RGH, Klompenhouwer EG, Gómez FM. Cryoablation for the Treatment of Residual or Recurrent Disease After Prior Microwave Ablation of Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2021; 44:1144-1146. [PMID: 33723666 DOI: 10.1007/s00270-021-02811-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- B M Aarts
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - T R Baetens
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - D Corominas Munoz
- Department of Interventional Radiology, Hospital Clinic Universitari de Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain
| | - S F Oudkerk
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A M Solouki
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A D Horsch
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - A Bex
- Department of Urology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science, Pond Street, London, NW3 2QG, UK
| | - R G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - E G Klompenhouwer
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - F M Gómez
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Interventional Radiology, Hospital Clinic Universitari de Barcelona, Carrer de Villarroel 170, 08036, Barcelona, Spain
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John JB, Anderson M, Dutton T, Stott M, Crundwell M, Llewelyn R, Gemmell A, Bufacchi R, Spiers A, Campain N. Percutaneous microwave ablation of renal masses in a UK cohort. BJU Int 2020; 127:486-494. [PMID: 32871034 DOI: 10.1111/bju.15224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To report a tertiary referral centre's experience of microwave ablation (MWA) for suspected renal cell carcinoma (RCC), describing complications and oncological outcomes. PATIENTS AND METHODS Consecutive MWA procedures (n = 113) for renal masses (October 2016 to September 2019) were maintained on a prospective database. Data describing patient, disease, procedure, complications, and oncological outcomes were analysed. RESULTS The median (range) age was 68 (33-85) years, 73% were male, and the median Charlson Comorbidity Index was 0. The median (interquartile range [IQR]) tumour diameter was 25 (20-32) mm. In all, 95% had renal mass biopsy, with histologically confirmed cancer in 75%. The median (IQR) R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score was 7 (6-8). The median ablation time was 6 min and length of stay was 1 day for 95% of the patients. Clavien-Dindo complication Grades I, II, IIIb and IV occurred in 18%, 1.8%, 0.9% and 0.9%, respectively. The median follow-up was 12 months and the median (IQR) renal function change was -4 (-18 to 0)%. One patient (0.9%) had local recurrence, treated with re-ablation; two developed metastatic progression; and two (1.8%) had indeterminate findings on follow-up (one lung nodule and one possible local recurrence), managed with ongoing protocolised computed tomography surveillance. Post-procedure complications were associated with total ablation time (odds ratio [OR] 1.152/min, 95% confidence interval [CI] 1.040-1.277) and total ablation energy (OR 1.017/kJ, 95% CI 1.001-1.033). CONCLUSIONS We describe the largest UK series of MWA treatment for T1a/small T1b renal masses to date. MWA was well tolerated, with 95% discharged the following day and low complication/re-admission rates. Current follow-up demonstrates favourable disease control. MWA appears to be safe and effective and should be considered in future prospective comparisons of treatments for T1a/small T1b renal masses.
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Affiliation(s)
- Joseph B John
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Moira Anderson
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Thomas Dutton
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Mark Stott
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Rhys Llewelyn
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew Gemmell
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rory Bufacchi
- Department of Neuroscience, Physiology and Pharmacology, University College London (UCL), London, UK
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Yong C, Mott SL, Laroia S, Tracy CR. Outcomes of Microwave Ablation for Small Renal Masses: A Single Center Experience. J Endourol 2020; 34:1134-1140. [PMID: 32611205 DOI: 10.1089/end.2020.0348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To investigate the safety of microwave ablation (MWA) as an emerging technology for treating small renal masses. Materials and Methods: Patients with renal masses treated at a high-volume center with MWA between March 2015 and June 2019 were retrospectively identified. Safety, changes in renal function, primary treatment efficacy, and the natural history of imaging characteristics of masses postablation were examined. Results: Forty-five patients underwent MWA during the study period. Median age was 71 years (range 31-87). Median RENAL nephrometry score was 6 (range 4-9) with mean tumor size 2.6 ± 0.7 cm. Thirty-three percent of tumors were within 4 mm of the collecting system. Median total microwave energy applied was 400 W (range 105-2600 W). There was no significant change in creatinine (p = 0.21) or glomerular filtration rate (GFR) (p = 0.09) from preoperative to postoperative day 1 (POD#1) levels. There was a statistically but not clinically significant decrease in hemoglobin from preoperative to POD#1 levels (estimated -0.06 from 7 days before procedure to POD#1, p = 0.02). There was no durable change in creatinine (p = 0.16) or GFR (p = 0.72) at median follow-up of 7.5 months. There were 4 (9%) complications: three Clavien grade 1 and one Clavien grade 3 that led to loss of the kidney. Tumor size decreased postoperatively by an estimated -0.03 cm/month (range 0-1.9 cm, p < 0.01). Initial technical success was 100%. Primary treatment efficacy was 94%. Conclusion: MWA shows promise as an alternative thermal ablative technique with excellent short-term outcomes.
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Affiliation(s)
- Courtney Yong
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | - Sarah L Mott
- Biostatistics Core, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, USA
| | - Sandeep Laroia
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Chad R Tracy
- Department of Urology, University of Iowa, Iowa City, Iowa, USA.,Department of Radiology, University of Iowa, Iowa City, Iowa, USA
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Mauri G, Mistretta FA, Bonomo G, Camisassi N, Conti A, Della Vigna P, Ferro M, Luzzago S, Maiettini D, Musi G, Piacentini N, Varano GM, de Cobelli O, Orsi F. Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center. Cancers (Basel) 2020; 12:cancers12051183. [PMID: 32392792 PMCID: PMC7281086 DOI: 10.3390/cancers12051183] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/24/2020] [Accepted: 05/02/2020] [Indexed: 12/21/2022] Open
Abstract
Image-guided thermal ablations are increasingly applied in the treatment of renal cancers, under the guidance of ultrasound (US) or computed tomography (CT). Sometimes, multiple ablations are needed. The aim of the present study was to evaluate the long-term results in patients with renal mass treated with radiofrequency ablation (RFA) with both US and CT, with a focus on the multiple ablations rate. 149 patients (median age 67 years) underwent RFA from January 2008 to June 2015. Median tumor diameter was 25 mm (IQR 17–32 mm). Median follow-up was 54 months (IQR 44–68). 27 (18.1%) patients received multiple successful ablations, due to incomplete ablation (10 patients), local tumor progression (8 patients), distant tumor progression (4 patients) or multiple tumor foci (5 patients), with a primary and secondary technical efficacy of 100%. Complications occurred in 13 (8.7%) patients (6 grade A, 5 grade C, 2 grade D). 24 patients died during follow-up, all for causes unrelated to renal cancer. In conclusion, thermal ablations with the guidance of US and CT are safe and effective in the treatment of renal tumors in the long-term period, with a low rate of patients requiring multiple treatments over the course of their disease.
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Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.B.); (N.C.); (P.D.V.); (D.M.); (G.M.V.); (F.O.)
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy;
- Correspondence:
| | - Francesco Alessandro Mistretta
- Department of Urology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (M.F.); (S.L.); (G.M.); (N.P.)
| | - Guido Bonomo
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.B.); (N.C.); (P.D.V.); (D.M.); (G.M.V.); (F.O.)
| | - Nicola Camisassi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.B.); (N.C.); (P.D.V.); (D.M.); (G.M.V.); (F.O.)
| | - Andrea Conti
- Department of Urology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (M.F.); (S.L.); (G.M.); (N.P.)
| | - Paolo Della Vigna
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.B.); (N.C.); (P.D.V.); (D.M.); (G.M.V.); (F.O.)
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (M.F.); (S.L.); (G.M.); (N.P.)
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (M.F.); (S.L.); (G.M.); (N.P.)
| | - Daniele Maiettini
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.B.); (N.C.); (P.D.V.); (D.M.); (G.M.V.); (F.O.)
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (M.F.); (S.L.); (G.M.); (N.P.)
| | - Nicolò Piacentini
- Department of Urology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (M.F.); (S.L.); (G.M.); (N.P.)
| | - Gianluca Maria Varano
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.B.); (N.C.); (P.D.V.); (D.M.); (G.M.V.); (F.O.)
| | - Ottavio de Cobelli
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, 20122 Milan, Italy;
- Department of Urology, European Institute of Oncology IRCCS, 20141 Milan, Italy; (F.A.M.); (A.C.); (M.F.); (S.L.); (G.M.); (N.P.)
| | - Franco Orsi
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.B.); (N.C.); (P.D.V.); (D.M.); (G.M.V.); (F.O.)
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