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Wang Y, Butaney M, Wilder S, Ghani K, Rogers CG, Lane BR. The evolving management of small renal masses. Nat Rev Urol 2024; 21:406-421. [PMID: 38365895 DOI: 10.1038/s41585-023-00848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/18/2024]
Abstract
Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort.
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Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Khurshid Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Brian R Lane
- Division of Urology, Corewell Health West, Grand Rapids, MI, USA.
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
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2
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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] [Grants] [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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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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Koebe SD, Curci NE, Caoili EM, Triche BL, Dreyfuss LD, Allen GO, Brace CL, Davenport MS, Abel EJ, Wells SA. Contrast-enhanced CT immediately following percutaneous microwave ablation of cT1a renal cell carcinoma: Optimizing cancer outcomes. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2674-2680. [PMID: 35278110 DOI: 10.1007/s00261-022-03481-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the effect of intra-procedural contrast-enhanced CT (CECT) and same-session repeat ablation (SSRA) on primary efficacy, the complete eradication of tumor after the first ablation session as confirmed on first imaging follow-up, of clinically localized T1a (cT1a) renal cell carcinoma (RCC). METHODS 398 consecutive patients with cT1a RCC were treated with cryoablation between 10/2003 and 12/2017, radiofrequency (RFA) or microwave ablation (MWA) between 1/2010 and 12/2017. SSRA was performed for residual tumor identified on intra-procedural CECT. Kruskal-Wallis and Pearson's chi-squared tests were performed to assess differences in continuous and categorical variables, respectively. Multivariate linear regression was used to determine predictors for primary efficacy and decline in estimated glomerular filtration rate. RESULTS 347 consecutive patients (231 M, mean age 67.5 ± 9.1 years) were included. Median tumor diameter was smaller [2.5 vs 2.7 vs 2.6 (p = 0.03)] and RENAL Nephrometry Score (NS) was lower [6 vs 7 vs 7 (p = 0.009] for MWA compared to the RFA and cryoablation cohorts, respectively. Primary efficacy was higher in the MWA cohort [99.4% (170/171)] compared to the RFA [91.4% (85/93)] and cryoablation [92.8% (77/83)] cohorts (p = 0.001). Microwave ablation and SSRA was associated with higher primary efficacy on multivariate linear regression (p = 0.01-0.03). CONCLUSION MWA augmented by SSRA, when residual tumor is identified on intra-procedural CECT, may improve primary efficacy for cT1a RCC.
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Affiliation(s)
- Samuel D Koebe
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nicole E Curci
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Elaine M Caoili
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Leo D Dreyfuss
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Glenn O Allen
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | | | - E Jason Abel
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Shane A Wells
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/376. 600 Highland Avenue, Madison, WI, 53792, USA.
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Su T, Zhang Z, Zhao M, Hao G, Tian Y, Jin L. Percutaneous Microcoil Localization of a Small, Totally Endophytic Renal Mass for Nephron-Sparing Surgery: A Case Report and Literature Review. Front Oncol 2022; 12:916787. [PMID: 35903709 PMCID: PMC9316585 DOI: 10.3389/fonc.2022.916787] [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: 04/10/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Small, totally endophytic renal masses present a technical challenge for surgical extirpation due to poor identifiability during surgery. The method for the precise localization of totally endophytic tumours before nephron-sparing surgery could be optimized. An asymptomatic 70-year-old male presented with a right-sided, 16-mm, totally endophytic renal mass on computed tomography (CT). CT-guided percutaneous microcoil localization was carried out prior to laparoscopy to provide a direction for partial nephrectomy. During the 25 minutes of the localization procedure, the patient underwent five local CT scans, and his cumulative effective radiation dosage was 5.1 mSv. The span between localization and the start of the operation was 15 hours. The laparoscopic operation time was 105 minutes, and the ischaemia time was 25 minutes. The postoperative recovery was smooth, and no perioperative complications occurred. Pathology showed the mass to be renal clear cell carcinoma, WHO/ISUP grade 2, with a 2-mm, clear surgical margin. The patient remained free of recurrence on follow-up for eleven months. To our knowledge, this application of microcoil implantation prior to laparoscopic partial nephrectomy towards an intrarenal mass could be an early reported attempt for the localized method applied in renal surgery. The percutaneous microcoil localization of endophytic renal tumours is potentially safe and effective prior to laparoscopic partial nephrectomy.
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7
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Split-bolus CT urography after microwave ablation of renal cell carcinoma improves image quality and reduces radiation exposure. Abdom Radiol (NY) 2022; 47:2230-2237. [PMID: 35238963 DOI: 10.1007/s00261-022-03448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare image quality and radiation dose between single-bolus 2-phase and split-bolus 1-phase CT Urography (CTU) performed immediately after microwave ablation (MWA) of clinically localized T1 (cT1) RCC. METHODS Forty-two consecutive patients (30 M, mean age 67.5 ± 9.0) with cT1 RCC were treated with MWA from 7/2013 to 12/2013 at two academic quaternary-care institutions. Renal parenchymal enhancement, collecting system opacification and distention and size-specific dose estimate (SSDE) were quantified and image quality subjectively assessed on single-bolus 2-phase versus split-bolus 1-phase CTU. Kruskal-Wallis and Pearson's Chi-squared tests were performed to assess differences in continuous and categorical variables, respectively. Two-sample T test with equal variances was used to determine differences in quantitative and qualitative image data. RESULTS Median tumor diameter was larger [2.9 cm (IQR 1.7-5.3) vs 3.6 cm (IQR 1.7-5.7), p = 0.01] in the split-bolus cohort. Mean abdominal girth (p = 0.20) was similar. Number of antennas used and unenhanced CTs obtained before and during MWA were similar (p = 0.11-0.32). Renal pelvis opacification (2.5 vs 3.5, p < 0.001) and distention (4 mm vs 8 mm, p < 0.001) were improved and renal enhancement (Right: 127 HU vs 177 HU, p = 0.001; Left: 124 HU vs 185 HU, p < 0.001) was higher for the split-bolus CTU. Image quality was superior for split-bolus CTU (3.2 vs 4.0, p = 0.004). Mean SSDE for the split-bolus CTU was significantly lower [163.9 mGy (SD ± 73.9) vs 36.3 mGy (SD ± 7.7), p < 0.001]. CONCLUSION Split-bolus CTU immediately after MWA of cT1 RCC offers higher image quality, improved opacification/distention of the collecting system and renal parenchymal enhancement at a lower radiation dose.
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Krieger JR, Lee FT, McCormick T, Ziemlewicz TJ, Hinshaw JL, Wells SA, Laeseke PE, Stratchko L, Alexander M, Hedican SP, Best SL, Borza T, Nakada SY, Abel EJ. Microwave Ablation of Renal Cell Carcinoma. J Endourol 2021; 35:S33-S37. [PMID: 34499558 DOI: 10.1089/end.2020.1078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Management options for small renal masses include active surveillance, partial nephrectomy, radical nephrectomy, and thermal ablation. For tumors typically ≤3 cm in size, thermal ablation is a good option for those desiring an alternative to surgery or active surveillance, especially in patients who are considered high surgical risk. We favor microwave ablation because of the more rapid heating, higher temperatures that overcome the heat sink effect of vessels, reproducible cell kill, and a highly visible ablation zone formed by water vapor that corresponds well to the zone of necrosis. For central tumors, we favor cryoablation because of the slower formation of the ablation zone and less likelihood of damage to the collecting system. With microwaves, it is important to monitor the ablation zone in real time (ultrasound is the best modality for this purpose), avoid direct punctures of the collecting system, and to place probes tangential to the collecting system to avoid burning open a persistent tract between the urothelium and extrarenal spaces or causing strictures. The surgical steps described in this video cover our use of high-frequency jet ventilation with general anesthesia to minimize organ motion, initial imaging and targeting, probe insertion, hydrodissection (a technique that enables displacement of adjacent structures), the ablation itself, and finally our dressing. Postoperative cares typically consist of observation with a same-day discharge or an overnight stay. Follow-up includes a magnetic resonance imaging abdomen with and without contrast, chest X-ray, and laboratories (basic metabolic panel, complete blood count, and C-reactive protein) 6 months postablation. Overall, percutaneous microwave ablation is an effective and safe treatment option for renal cell carcinoma in both T1a and T1b tumors in selected patients with multiple studies showing excellent oncologic outcomes when compared with partial and radical nephrectomy.
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Affiliation(s)
- Jordan R Krieger
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Fred T Lee
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy McCormick
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy J Ziemlewicz
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - J Louis Hinshaw
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shane A Wells
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul E Laeseke
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lindsay Stratchko
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Marci Alexander
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean P Hedican
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sara L Best
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Tudor Borza
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Stephen Y Nakada
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - E Jason Abel
- Departments of Urology and Radiology, The University of Wisconsin-Madison, Madison, Wisconsin, USA
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Papa M, Biondetti P, Colombo R, Ierardi AM, Angileri SA, Lucignani G, Boeri L, Montanari E, Cardone G, Scagnelli P, Carrafiello G. sABLATE: a simplified ABLATE score for prediction of complications and outcome in percutaneous thermal ablation of renal lesions. Med Oncol 2021; 38:126. [PMID: 34495438 DOI: 10.1007/s12032-021-01542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022]
Abstract
The aim of the study is to evaluate the performance of a simplified ABLATE score (sABLATE) in predicting complications and outcome with respect to RENAL, mRENAL, and ABLATE scores. This study included 136 renal lesions in 113 patients (M:F ratio = 2.5; mean age 70.8 years). 98 tumors underwent cryoablation at San Raffaele hospital between 01/2015 and 03/2020, while 37 underwent microwave ablation at San Paolo or Policlinico hospitals between 07/2016 and 03/2020. RENAL, mRENAL, ABLATE, and sABLATE scores were calculated using pre-procedural imaging. Data regarding complications and follow-up were registered. Mann-Whitney U test, ROC analyses, and logistic regression analyses were used for complications. Cox-regression analyses were performed for outcome. Mean tumor diameter was 23.2 mm. Mean and median RENAL, mRENAL, ABLATE, and sABLATE scores were 6.8 and 7, 6.9 and 7, 5.3, and 5, and 3.5 and 3, respectively. During a mean follow-up of 21.9 months (range 1-73), we registered 7 complications, 3 cases of residual disease, and 10 local tumor progressions. Mann-Whitney U test p values for complications for RENAL, mRENAL, ABLATE, and sABLATE were 0.51, 0.49, 0.66, and 0.056, respectively. ROC analyses for complications showed an AUC for RENAL, mRENAL, ABLATE, and sABLATE of 0.57, 0.57, 0.55, and 0.71, respectively. Regarding outcome, HR and p values of Cox-regression analyses were 1.30 and 0.36 for RENAL, 1.33 and 0.35 for mRENAL, 2.16 and 0.01 for ABLATE, 2.29 and 0.004 for sABLATE. sABLATE was the only score close to significance for complications, representing a progress even if not definitive. Regarding outcome, ABLATE confirmed its value, and sABLATE maintained validity despite being a simplification.
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Affiliation(s)
- Maurizio Papa
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Viale Savoia 4, 26900, Lodi, Italy.
| | - Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Roberta Colombo
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Gianpaolo Lucignani
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Luca Boeri
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Emanuele Montanari
- Urology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
| | - Gianpiero Cardone
- Diagnostic and Interventional Radiology Department, IRCCS Ospedale San Raffaele-Turro, Università Vita-Salute San Raffaele, Milan, Italy
| | - Paola Scagnelli
- Azienda Socio Sanitaria Territoriale (ASST) Lodi, Complex Unit of Radiology, Department of Diagnostic and Interventional Radiology, Viale Savoia 4, 26900, Lodi, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
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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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Park BK, Shen SH, Fujimori M, Wang Y. Thermal Ablation for Renal Cell Carcinoma: Expert Consensus from the Asian Conference on Tumor Ablation. Korean J Radiol 2021; 22:1490-1496. [PMID: 34448380 PMCID: PMC8390817 DOI: 10.3348/kjr.2020.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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Yu J, Wang H, Cheng ZG, Liu FY, Li QY, He GZ, Luo YC, Yu XL, Han ZY, Liang P. A multicenter 10-year oncologic outcome of ultrasound-guided percutaneous microwave ablation of clinical T1 renal cell carcinoma: will it stand the test of time? Eur Radiol 2021; 32:89-100. [PMID: 34195888 DOI: 10.1007/s00330-021-07900-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/11/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We updated the experience on percutaneous microwave ablation for renal cell carcinoma with five-center data and long-term follow-up. METHODS This retrospective study reviewed the T1N0M0 renal cell carcinoma patients who underwent microwave ablation between April 2006 and December 2019. Clinicopathological and procedural data were collected. Technical effectiveness and complications were assessed, and the Kaplan-Meier method was used for cancer-specific survival, disease-free survival, overall survival, and local neoplastic process analyses. RESULTS A total of 323 consecutive patients (mean age, 62.9 years ± 14.0) with 371 biopsy-proved tumors (mean diameter, 2.9 cm ± 1.2) were enrolled, and 42.6% of the tumors were located adjacent to collecting system/bowel and technical effectiveness was achieved in 360 (97.0%) tumors. For 275 cT1a patients, during median follow-up time of 66.0 months (IQR, 58.4-73.6), 10-year local neoplastic processes, cancer-specific survival, disease-free survival, and overall survival rates were 1.9%, 87.4%, 71.8, and 67.5%, respectively. For 48 cT1b patients, during the median follow-up time of 30.4 months (IQR, 17.7-44.8), 5-year local tumor progression, cancer-specific survival, disease-free survival, and overall survival rates were 11.3%, 91.4%, 69.1, and 89.2%, respectively. Major complications showed no differences between cT1a (3.5%) and cT1b (6.9%) patients (p = 0.28). A clinical risk stratification system was developed based on multivariable model to predict DFS and CSS with c-indexes of 0.78 (95% CI: 0.71-0.85) and 0.77 (95% CI: 0.65-0.90), respectively. CONCLUSIONS With matured follow-up at five institutions, ultrasound-guided percutaneous microwave ablation is a reliable treatment option for cT1a renal cell carcinoma even in dangerous location and appears to be promising for cT1b tumors. KEY POINTS • To our knowledge, this is the first multicenter cohort of long-term oncologic outcomes with percutaneous MWA of cT1 RCC. • The predicting model we developed is accurate to predict the long-term DFS and CSS, which can help to provide a better MWA prognostication over routinely available clinical information. • The available evidence shows that microwave ablation of clinical stage T1 RCC is safe and reliable with promising long-term oncologic outcomes, especially for cT1a RCC with excellent 10-year results.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Qin-Ying Li
- Department of Ultrasound, Puyang Hospital of Traditional Chinese Medicine of Henan Province, No. 135 Shengli East Road, Puyang, 457000, Henan Province, China
| | - Guang-Zhi He
- Department of Ultrasound, University of Chinese Academy of Sciences Shenzhen Hospital, 4253 Songbai Road, Matian Street, Guangming District, Shenzhen, Guangdong Province, China
| | - Yan-Chun Luo
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, PLA Medical College & Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Wang Z, Lu J, Huang W, Wu Z, Gong J, Wang Q, Liu Q, Wang C, Zhu Y, Ding X, Wang Z. A retrospective study of CT-guided percutaneous irreversible electroporation (IRE) ablation: clinical efficacy and safety. BMC Cancer 2021; 21:124. [PMID: 33546635 PMCID: PMC7866876 DOI: 10.1186/s12885-021-07820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background To evaluate the clinical efficacy and safety of ablating renal cell carcinoma (RCC) by irreversible electroporation (IRE). Methods Fifteen patients (19 lesions) with RCC who underwent IRE were retrospectively reviewed. Seven patients had solitary kidneys. Two lesions were located in the renal hilus. One patient had chronic renal insufficiency. Percutaneous biopsy for histopathology was performed. The best puncture path plan was evaluated before CT-guided IRE. The estimated glomerular filtration rate (eGFR) was compared vs baseline at 1–2 months after the ablation. Contrast-enhanced computed tomography imaging changes were evaluated immediately after IRE. Contrast-enhanced computed tomography/magnetic resonance was performed 1 month, 3 months, 6 months, 12 months and every year thereafter. The complications after treatment were also reviewed. Results The success rate of the procedure was 100%. The median tumor size was 2.4 (IQR 1.3–2.9) cm, with an median score of 6 (IQR 5.5–8) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). Two cases (3 lesions) were punctured through the liver. In other cases, puncture was performed through the perirenal space. There were no severecomplications in interventional therapy. Transient gross hematuria occurred in 2 patients (centrally located). Self-limiting perinephric hematomas occurred in 1 patient. Needle puncture path metastasis was found in 1 patient 2.5 years after IRE. The subcutaneous metastasis was surgically removed, and there was no evidence of recurrence. There was no significant change in eGFR levels in terms of short- term clinical outcomes (t = 0.348, P = 0.733). At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 15) was noted to have experienced needle tract metastasis and accepted salvage radiofrequency ablation (RFA) therapy. Conclusions IRE appears to be a safe and effective treatment for RCC that may offer a tissue-sparing method and complete ablation as an alternative therapy for RCC.
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Affiliation(s)
- Ziyin Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Jian Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Ju Gong
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Qingbing Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Qin Liu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Cangyi Wang
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Yu Zhu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China.
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China.
| | - Zhongmin Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China. .,Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China.
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Curci NE, Triche BL, Abel EJ, Bhutani G, Maciolek KA, Dreyfuss LD, Allen GO, Caoili EM, Davenport MS, Wells SA. Effect of iodinated contrast material on post-operative eGFR when administered during renal mass ablation. Eur Radiol 2021; 31:5490-5497. [PMID: 33492471 DOI: 10.1007/s00330-020-07613-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the effect of intravenous iodinated contrast on estimated glomerular filtration rate (eGFR) when administered immediately after thermal ablation of clinically localized T1a (cT1a) renal cell carcinoma (RCC). METHODS This HIPAA-compliant, dual-center retrospective study was performed under a waiver of informed consent. Three hundred forty-two consecutive patients with cT1a biopsy-proven RCC were treated with percutaneous ablation between January 2010 and December 2017. Immediate post-ablation contrast-enhanced CT was the routine standard of care at one institution (contrast group), but not the other (control group). One-month pre- and 6-month post-ablation eGFR were compared using the Wilcoxon signed-rank test or the Kruskal-Wallis test. Multivariate linear regression was used to determine the effect of contrast on eGFR. A 1:1 propensity score matching was performed for all patients with a logistic model using patient, tumor, and procedural covariates. RESULTS In total, 246 patients (158 M; median age 69 years, IQR 62-74) were included. Median tumor diameter (2.4 vs 2.5, p = 0.23) and RENAL nephrometry scores (6 vs 6, p = 0.92), surrogates for ablation zone size, were similar. Baseline kidney function was similar for the control and contrast groups, respectively (median eGFR: 70 vs 74 mL/min/1.73 m2, p = 0.29). There was an expected mild decline in eGFR after ablation (control: 70 vs 60 mL/min/1.73 m2, p < 0.001; contrast: 75 vs 71 mL/min/1.73 m2, p = 0.001). Intravenous iodinated contrast was not associated with a decline in eGFR on multivariate linear regression (1.91, 95% CI - 3.43-7.24, p = 0.46) or 1:1 propensity score-matched model (- 0.33, 95% CI - 6.81-6.15, p = 0.92). CONCLUSION Intravenous iodinated contrast administered during ablation of cT1a RCC has no effect on eGFR. KEY POINTS • Intravenous iodinated contrast administered during thermal ablation of clinically localized T1a renal cell carcinoma has no effect on kidney function. • Thermal ablation of clinically localized T1a renal cell carcinoma results in a mild decline in kidney function. • A decline in kidney function is similar for radiofrequency and microwave ablation of clinically localized T1a renal cell carcinoma.
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Affiliation(s)
- Nicole E Curci
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - E Jason Abel
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Gauri Bhutani
- Department of Medicine, Division of Nephrology, University of Wisconsin, Madison, WI, USA
| | | | - Leo D Dreyfuss
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Glenn O Allen
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - Elaine M Caoili
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Shane A Wells
- Department of Radiology, University of Wisconsin, Madison, WI, USA. .,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA.
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Park BK, Shen SH, Fujimori M, Wang Y. Asian Conference on Tumor Ablation guidelines for renal cell carcinoma. Investig Clin Urol 2021; 62:378-388. [PMID: 34190433 PMCID: PMC8246015 DOI: 10.4111/icu.20210168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 01/20/2023] Open
Abstract
Thermal ablation has been established as an alternative treatment for renal cell carcinoma (RCC) in patients who are poor candidates for surgery. However, while American and European guidelines have been established for American and European patients, respectively, no ablation guidelines for Asian patients with RCCs have been established many years after the Asian Conference on Tumor Ablation (ACTA) had been held. Given that Western guidelines are difficult to apply to Asian patients due to differences in body habitus, economic status, and insurance systems, the current review sought to establish the first version of the ACTA guidelines for treating a RCC with thermal ablation.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Mie Prefecture, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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Percutaneous Microwave Ablation of Category T1a Renal Cell Carcinoma: Intermediate Results on Safety, Technical Feasibility, and Clinical Outcomes of 119 Tumors. AJR Am J Roentgenol 2020; 216:117-124. [PMID: 32603227 DOI: 10.2214/ajr.20.22818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE. The purpose of this study was to assess the safety, technical results, and clinical outcomes of CT-guided percutaneous microwave ablation of category T1a renal cell carcinoma. MATERIALS AND METHODS. This retrospective study investigated consecutive patients who underwent CT-guided microwave ablation for T1a renal cell carcinoma from October 2015 to May 2019. Patient demographics including tumor characteristics, comorbidities, technical details, and clinical outcomes were evaluated. Local progression-free survival and overall survival rates were estimated using the Kaplan-Meier method. RESULTS. One hundred-six patients including 70 men (mean age, 68.5 ± 8.9 [SD] years; range, 49-86 years) and 36 women (mean age, 69.5 ± 10.0 years; range, 50-88 years) with an overall mean age of 68.8 ± 9.2 years (range, 49-88 years) with 119 T1a renal cell carcinomas were treated with CT-guided microwave ablation. Technical success was achieved for 100% of the tumors. Complete response was achieved in 101 (95.3%) patients and partial response was achieved in five (4.7%) patients. Local progression-free survival was 100.0%, 92.8%, and 90.6% at 1, 2, and 3 years, respectively. Overall survival was 99.0%, 97.7%, and 94.6% at 1, 2, and 3 years, respectively. Six patients (5.7%) had seven complications (five with Clavien-Dindo Grade I, Society of Interventional Radiology [SIR] category A, two with Clavien-Dindo Grade III, SIR category B) within 30 days of the procedure. CONCLUSION. CT-guided percutaneous microwave ablation is associated with high rates of technical success, excellent local progression-free survival and overall survival, and a low complication rate for category T1a renal cell carcinoma.
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Wetley KA, Abel EJ, Dreyfuss LD, Huang W, Brace CL, Wells SA. CT and MR imaging surveillance of stage 1 renal cell carcinoma after microwave ablation. Abdom Radiol (NY) 2020; 45:2810-2824. [PMID: 32715335 DOI: 10.1007/s00261-020-02662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe the CT and MR imaging findings after microwave ablation of clinical stage 1 renal cell carcinoma (RCC). METHODS This single-center retrospective study was performed under a waiver of informed consent. 49 patients (38 M/11F, mean age 66 ± 9.0) with 52 cT1a RCC and 19 patients (10M/9F, mean age 67 ± 9.7) with 19 cT1b RCC were treated with percutaneous microwave ablation between January 2012 and June 2014. The size and volume of the RCC and ablation zone were measured and the kidney, ablation zones and retroperitoneum were assessed at immediate post-procedure CT and surveillance CT and MRI. RESULTS Median imaging follow-up was 18 months (IQR 12-28). Ablation zones were heterogeneously hyperintense on T1W and hypointense on T2W MRI and hyperdense at CT. Thin peripheral, but no internal enhancement after contrast administration signified successful ablation zones. Ablation zones decreased in size, but did not resolve during surveillance. Immediate post-procedure subcapsular gas and hematoma (5/71, 7%) resolved prior to first follow-up. Focal, enhancing soft tissue within the ablation zone, invariably along the renal margin, signified local recurrence. Local recurrence rates were higher for T1b (2/19, 11%) compared to T1a (1/52, 2%). Urinomas (4/71, 6%) decreased in size and resolved during surveillance. Retroperitoneal fat necrosis (6/71, 9%), with opposed-phase loss of T1W MRI signal, was confirmed at histology after percutaneous biopsy. CONCLUSION CT and MR imaging features after microwave ablation of renal cell carcinoma are predictable and reliably demonstrate treatment success, early and delayed complications, and local recurrences that can guide patient management.
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Affiliation(s)
- Karla A Wetley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
| | - E Jason Abel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Leo D Dreyfuss
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Wei Huang
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA.
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Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2020; 43:1025-1033. [PMID: 32052093 PMCID: PMC7300114 DOI: 10.1007/s00270-020-02423-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 01/20/2023]
Abstract
Objectives To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC). Methods We analysed patients with a histologically proven RCC (≤ 7 cm) treated by MWA from April 2012–April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien–Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications. Results In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4–4.0). Primary efficacy was 89% (95%CI 0.81–0.94) for T1a lesions and 52% (95%CI 0.31–0.73) for T1b lesions (p < 0.001). Fifteen lesions (7 T1a) were re-ablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10–60 months. Six (4%) AEs grade > 3–5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012). Conclusion Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.
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