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Henderickx MMEL, Hendriks N, Baard J, Wiseman OJ, Scotland KB, Somani BK, Şener TE, Emiliani E, Dragos LB, Villa L, Talso M, Bin Hamri S, Proietti S, Doizi S, Traxer O, Chew BH, Eisner BH, Monga M, Hsi RS, Stern KL, Leavitt DA, Rivera M, Wollin DA, Borofsky M, Canvasser NE, Ingimarsson JP, El Tayeb MM, Bhojani N, Gadzhiev N, Tailly T, Durutovic O, Nagele U, Skolarikos A, Schout BMA, Beerlage HP, Pelger RCM, Kamphuis GM. The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP-tool): a Delphi consensus project on standardised evaluation of flexible ureterorenoscopes. BJU Int 2023; 131:494-502. [PMID: 36208033 DOI: 10.1111/bju.15916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a standardised tool to evaluate flexible ureterorenoscopes (fURS). MATERIALS AND METHODS A three-stage consensus building approach based on the modified Delphi technique was performed under guidance of a steering group. First, scope- and user-related parameters used to evaluate fURS were identified through a systematic scoping review. Then, the main categories and subcategories were defined, and the expert panel was selected. Finally, a two-step modified Delphi consensus project was conducted to firstly obtain consensus on the relevance and exact definition of each (sub)category necessary to evaluate fURS, and secondly on the evaluation method (setting, used tools and unit of outcome) of those (sub)categories. Consensus was reached at a predefined threshold of 80% high agreement. RESULTS The panel consisted of 30 experts in the field of endourology. The first step of the modified Delphi consensus project consisted of two questionnaires with a response rate of 97% (n = 29) for both. Consensus was reached for the relevance and definition of six main categories and 12 subcategories. The second step consisted of three questionnaires (response rate of 90%, 97% and 100%, respectively). Consensus was reached on the method of measurement for all (sub)categories. CONCLUSION This modified Delphi consensus project reached consensus on a standardised grading tool for the evaluation of fURS - The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP) tool. This is a first step in creating uniformity in this field of research to facilitate future comparison of outcomes of the functionality and handling of fURS.
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Affiliation(s)
- Michaël M E L Henderickx
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Nora Hendriks
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Urology, Alrijne Hospital, Leiden, The Netherlands
| | - Joyce Baard
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Oliver J Wiseman
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kymora B Scotland
- Department of Urology, University of California, Los Angeles, CA, USA
| | - Bhaskar K Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK
| | - Tarik E Şener
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Laurian B Dragos
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Luca Villa
- Department of Urology, Università Vita - Salute San Raffaele, Milan, Italy
| | - Michele Talso
- Department of Urology, ASST Fatebenefratelli Sacco - Ospedale Luigi Sacco University Hospital, Milan, Italy
| | - Saeed Bin Hamri
- Department of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Steeve Doizi
- Department of Urology, Hopital Tenon, Paris, France
- Sorbonne Université, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, France
| | - Olivier Traxer
- Department of Urology, Hopital Tenon, Paris, France
- Sorbonne Université, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, France
| | - Ben H Chew
- Department of Urology, University of British Columbia, Vancouver, BC, Canada
| | - Brian H Eisner
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Manoj Monga
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen L Stern
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | - David A Leavitt
- Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel A Wollin
- Department of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Noah E Canvasser
- Department of Urology, University of California Davis Health System, Sacramento, CA, USA
| | | | - Marawan M El Tayeb
- Department of Urology, Baylor Scott & White Medical Center - Temple, Temple, TX, USA
| | - Naeem Bhojani
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | | | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Otas Durutovic
- Department of Urology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Udo Nagele
- Department of Urology, General Hospital Hall I.T., Hall in Tirol, Austria
| | | | | | - Harrie P Beerlage
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leids UMC, University of Leiden, Leiden, The Netherlands
| | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
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Choong S, DE LA Rosette J, Denstedt J, Zeng G, Sarica K, Mazzon G, Saltirov I, Pal SK, Agrawal M, Desai J, Petrik A, Buchholz N, Maroclo MV, Gordon S, Sridhar A. Classification and standardized reporting of percutaneous nephrolithotomy (PCNL): International Alliance of Urolithiasis (IAU) Consensus Statements. Minerva Urol Nephrol 2021; 74:110-118. [PMID: 33439573 DOI: 10.23736/s2724-6051.20.04107-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to reach a consensus in the classification and standardized reporting for the different types of PCNLs. METHODS The RAND/UCLA appropriateness methodology was used to reach a consensus. Thirty-two statements were formulated reviewing the literature on guidelines and consensus on PCNLs, and included procedure specific details, outcome measurements and a classification for PCNLs. Experts were invited to two rounds of input, the first enabled independent modifications of the proposed statements and provided the option to add statements. The second round facilitated scoring of all statements. Each statement was discussed in the third round to decide which statements to include. Any suggestion or disagreement was debated and discussed to reach a consensual agreement. RESULTS Twenty-five recommendations were identified to provide standardized reporting of procedure and outcomes. Consensual scoring above 80% were strongly agreed upon by the panel. The top treatment related outcomes were size of sheath used (99.1%) and position for PCNL (93.5%). The highest ranked Outcome Measures included definition of postoperative hospital length of stay (94.4%) and estimated blood loss (93.5%). CONCLUSIONS The consensus statements will be useful to clarify operative technique, in the design of clinical trials and standardized reporting, and presentation of results to compare outcomes of different types of PCNLs.
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Affiliation(s)
- Simon Choong
- Institute of Urology, University College London Hospitals, London, UK
| | | | - John Denstedt
- Division of Urology, University of Western Ontario, London, ON, Canada
| | - Guohua Zeng
- Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kemal Sarica
- School of Medicine, Department of Urology, Biruni University, Istanbul, Turkey
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy -
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Shashi K Pal
- Department of Urology, Apollo Group of Hospitals and Holy Family Hospital, New Delhi, India
| | - Madhu Agrawal
- Department of Urology, Center for Minimally-Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | - Janak Desai
- Department of Urology, Samved Hospital, Ahmedabad, India
| | - Aleš Petrik
- Department of Urology, Region Hospital Ceske Budejovice, Prague, Czech Republic
| | - Noor Buchholz
- Department of Urology, Sobeh's Vascular and Medical Center, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Marcus V Maroclo
- Unit of Endourology, Hospital de Base of the Federal District, Brasília, Brazil
| | - Stephen Gordon
- Department of Urology, Epsom and St. Helier University Hospitals NHS Trust, Surrey, UK
| | - Ashwin Sridhar
- Institute of Urology, University College London Hospitals, London, UK
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Henderickx MMEL, Sträter-Ruiter AEC, van der West AE, Beerlage HP, Zondervan PJ, Lagerveld BW. Laparoscopic cryoablation for small renal masses: Oncological outcomes at 5-year follow-up. Arab J Urol 2020; 19:159-165. [PMID: 34104491 PMCID: PMC8158258 DOI: 10.1080/2090598x.2020.1863308] [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] [Indexed: 11/10/2022] Open
Abstract
Objective: To evaluate the oncological outcome at 5-year follow-up after laparoscopic cryoablation (LCA) for small renal masses (SRMs), as there is an increasing interest in ablative therapy for cT1a renal tumours due to the rising incidence of SRMs, the trend towards minimally invasive nephron-sparing treatments, and the ageing population. Patients and methods: Between 2004 and 2015, 233 consecutive LCA were performed in 219 patients for SRMs at two referral centres. We only included those patients with ≥5 years of follow-up (n = 165) in a prospectively maintained database. A descriptive analysis was conducted for pre-, peri- and postoperative characteristics. A Kaplan–Meier analysis assessed overall (OS), disease-specific (DSS), and recurrence-free survival (RFS). Results: The median (interquartile range [IQR]) age of our patient cohort was 68 (60.5–76) years. The median (IQR) body mass index was 26.2 (23.8–29) kg/m2, and the median (IQR) Charlson Comorbidity Index score corrected for age was 4 (2.5–6). The median (IQR) tumour diameter was 28 (21–33) mm. In all, 15% developed a complication in the first 30 days after LCA, of which 1% had a major complication (Clavien–Dindo Grade ≥III). The median (IQR) preoperative estimated glomerular filtration rate (eGFR) was 82.5 (65–93.75) mL/min/1.73 m2. The median eGFR decreased by 16.4% and 15.2% at the 3-month and 5-year follow-up, respectively. Persistence was found in 1%, local recurrence in 2%, and systemic progression in 4%. The OS, DSS, and RFS were 74%, 96.9% and 95.4%, respectively. Conclusion: LCA is a safe and effective treatment for SRMs in selected cases and shows good oncological outcomes after 5 years of follow-up, with only 1% developing a major complication.
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Affiliation(s)
- Michaël M E L Henderickx
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | | | - Alwine E van der West
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Harrie P Beerlage
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Patricia J Zondervan
- Department of Urology, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Brunolf W Lagerveld
- Department of Urology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
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Borgbjerg J, Bylling T, Andersen G, Thygesen J, Mikkelsen A, Nielsen TK. CT-guided cryoablation of renal cancer: radiation burden and the associated risk of secondary cancer from procedural- and follow-up imaging. Abdom Radiol (NY) 2020; 45:3581-3588. [PMID: 32285178 DOI: 10.1007/s00261-020-02527-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To estimate radiation dose and the associated risk of secondary cancer risk related to percutaneous cryoablation (PCA) and follow-up imaging in a cohort of patients treated for small renal masses (SRMs). METHODS A total of 149 patients underwent PCA for a SRM at our institution. Based on CT dose reports, we calculated the mean effective dose for a CT-guided PCA procedure and post-ablative follow-up CT. Applying follow-up recommendations by a multidisciplinary expert panel, we calculated the total radiation dose for the PCA procedure and the CT surveillance program corresponding to a minimal and preferable follow-up regime (5-year vs 10-year). Estimates of the lifetime attributable cancer risk for different age groups were calculated based on the cumulative effective dose based on the latest BEIR VII report. RESULTS Total dose for the PCA treatment and follow-up CTs amounted to 174 and 294 mSv for a minimal and preferable protocol, respectively. Follow-up CTs accounted for the majority of the total effective dose for the minimal and preferable protocol (89% vs 94%). CT fluoroscopy contributed only to a limited amount of the total radiation dose for the minimal and preferable protocol (1.8% vs 1.1%). A 70-year-old male undergoing PCA treatment has a lifetime attributable cancer risk of 0.8% (1 in 131) when completing the preferable follow-up protocol. The same regimen in a 30-year-old female results in a lifetime attributable risk of cancer of 3.4% (1 in 29). CONCLUSION Radiation dose and the associated risk of secondary cancer are high for patients with SRMs undergoing PCA and post-ablative follow-up imaging in particular in younger patients. Radiation exposure in the PCA procedure itself accounts for only a limited amount of the total radiation. Radiologists and clinicians must strive to implement radiation dose saving measures especially with respect to the follow-up regime.
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Nielsen TK, Vedel PF, Borgbjerg J, Andersen G, Borre M. Renal cryoablation: five- and 10-year survival outcomes in patients with biopsy-proven renal cell carcinoma. Scand J Urol 2020; 54:408-412. [PMID: 32700594 DOI: 10.1080/21681805.2020.1794954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate the long-term oncological efficacy of renal cryoablation (CA) of small renal tumors. MATERIALS AND METHODS A review of patients treated with CA for a biopsy confirmed renal cell carcinoma less than 4 cm in diameter. All patients were identified from a prospectively maintained clinical database. Treatment efficacy was computed using the Kaplan-Meier method to estimate disease-free survival (DFS) and overall survival rates (OS). RESULTS A total of 179 patients (116 men and 63 women) with a mean age of 64 years (95% CI = 63 - 66) were included in the analysis. Mean tumor size was 27 mm (95% CI = 25.5-28.0) with a low, moderate and high PADUA complexity score in 30.2%, 44.7% and 16.2% of the cases, respectively. A total of 19 patients (11%) were diagnosed with residual unablated tumor, six patients (3%) were diagnosed with late local recurrence and six patients (3%) were diagnosed with metastatic disease. The estimated 5 years image confirmed the DFS rate was 79% (95% CI = 70-85). The estimated 5- and 10-year OS rates were 82% (95% CI = 75-87) and 61% (95% CI = 48-71), respectively. During the 10-year follow-up period a total of five patients (3%) died due to renal cancer, while 46 patients (26%) died from other causes. CONCLUSIONS CA appears to be an effective treatment modality for patients with small renal tumors. The present study demonstrated low rates of local recurrence and disease progression with excellent long-term cancer-specific survival.
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Affiliation(s)
| | | | - Jens Borgbjerg
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Soria F, Marra G, Allasia M, Gontero P. Retreatment after focal therapy for failure: a bridge too far? Curr Opin Urol 2019; 28:544-549. [PMID: 30124516 DOI: 10.1097/mou.0000000000000536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW To summarize the current knowledge about the evaluation of disease persistence and recurrence after focal therapy ablation (FTA) for small renal masses and to assess the outcomes and complications of related treatment options. RECENT FINDINGS FTA procedures continuously increased over the last 20 years, being now performed in more than one on 10 patients with T1a renal cell carcinoma. Disease recurrence seems to occur more often following radiofrequency ablation (RFA) compared with cryoablation. Evidence about the management of disease recurrence is scarce. Treatment options are similar to those available for de novo renal cell carcinomas, and include reablation, partial or radical nephrectomy and observation. Reablation is feasible, safe and can be easily done in the majority of cases. Oncological outcomes of repeated ablation, although encouraging, remain mostly uninvestigated and unreported. SUMMARY In case of disease persistence or recurrence after FTA, observation may be an acceptable approach, reserving repeated ablation or surgery only in those exhibiting significant tumor growth. In these patients repeated ablation with RFA is safe and noninvasive. Surgery after FTA presents technical difficulties related to perinephric scarring, especially with regards to nephron-sparing surgery. This should be taken into consideration in patients' counseling as well as in decision-making process.
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Affiliation(s)
- Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Giancarlo Marra
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Marco Allasia
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
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Rossi SH, Blick C, Handforth C, Brown JE, Stewart GD. Essential Research Priorities in Renal Cancer: A Modified Delphi Consensus Statement. Eur Urol Focus 2019; 6:991-998. [PMID: 30772357 DOI: 10.1016/j.euf.2019.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/21/2018] [Accepted: 01/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Identification of clear and focused research priorities is crucial to drive research forward. OBJECTIVE To identify research priorities in renal cell carcinoma (RCC) through a multidisciplinary collaboration between clinicians, researchers, and patients. DESIGN, SETTING, AND PARTICIPANTS In phase I, 44 RCC experts provided 24 literature reviews within their field, summarising research gaps (RGs). Three expert discussion meetings and patient interviews were performed, and 39 potential RGs were identified. In phase II, experts (N=82) scored these gaps on a nine-point scale (1-3: not important; 4-6: important; 7-9: critical) through a multistep Delphi process involving three online surveys and two further consensus meetings. The surveys aimed to reach a consensus, defined as ≥70% agreement by experts. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three iterations of the Delphi survey were performed. The results obtained after the third Delphi survey were distributed amongst the RCC experts and patient representatives for final feedback. RESULTS AND LIMITATIONS In the first Delphi survey, the response rate was 56% (46/82), increasing to 67% (55/82) and 71% (58/82) in the second and third iterations, respectively. Survey respondents included 45.7% urologists, 37.0% oncologists, 8.7% radiologists, and 8.6% other specialists (pathologists, health economists, geneticist, and scientists). The process resulted in the identification of 14 crucial RGs, across a broad range of RCC themes. Key themes included further research into systemic therapies for RCC and management strategies that maximise quality of life, especially in patient groups that are "difficult to treat" and have rarer RCC subtypes. Two crucial RGs relate to biomarkers and novel imaging approaches for both localised and metastatic disease, to enable prognostic risk stratification and individualise patient management. Study participants were from a UK and European setting; therefore, we acknowledge that the RGs identified represent European priorities. CONCLUSIONS These RGs will facilitate international collaboration towards a concerted attempt to improve patients' survival and quality of life. PATIENT SUMMARY We formed a collaboration between researchers, clinicians, and patients to identify research priorities in kidney cancer. We identified 14 priorities that will improve patient outcomes by focusing on research efforts.
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Affiliation(s)
- Sabrina H Rossi
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK
| | - Christopher Blick
- Harold Hopkins Department of Urology, Royal Berkshire Hospital, Reading, UK
| | - Catherine Handforth
- Academic Unit of Clinical Oncology and Cancer Clinical Trials Unit,Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - Janet E Brown
- Academic Unit of Clinical Oncology and Cancer Clinical Trials Unit,Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
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Russo U, Maestroni U, Papapietro RV, Trunfio V, Ziglioli F, Ferretti S, Brunese L, Carrafiello G, De Filippo M. Imaging after radiofrequency ablation of renal tumors. Future Oncol 2018; 14:2915-2922. [DOI: 10.2217/fon-2017-0661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The number of percutaneous radiofrequency ablation procedures performed for renal tumors is progressively increasing worldwide. Periodic imaging follow-up has the double role to guarantee the treatment efficacy over time and to early detect any possible complication. Tumor size reductions, as well as the appearance of the characteristic ‘halo sign’, are normal findings that represent good ablative outcomes. However the most reliable factor of ablation efficacy remains the total absence of contrast enhancing zones within the ablated area. The aim of this article is to illustrate the typical aspect of an effective radiofrequency ablation treatment, which are the imaging findings that may suggest the presence of residual tumoral tissue and which are the main early and late procedural complications.
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Affiliation(s)
- Umberto Russo
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | | | - Roberto Vito Papapietro
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | - Vincenzo Trunfio
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
| | | | | | - Luca Brunese
- Department of Medicine & Health Sciences, University of Molise, Campobasso, Italy
| | | | - Massimo De Filippo
- Department of Medicine & Surgery, Unit of Radiologic Science, University of Parma, Maggiore Hospital, Via Gramsci 14, Parma, Italy
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Wendler JJ, Pech M, Fischbach F, Jürgens J, Friebe B, Baumunk D, Porsch M, Blaschke S, Schindele D, Siedentopf S, Ricke J, Schostak M, Köllermann J, Liehr UB. Initial Assessment of the Efficacy of Irreversible Electroporation in the Focal Treatment of Localized Renal Cell Carcinoma With Delayed-interval Kidney Tumor Resection (Irreversible Electroporation of Kidney Tumors Before Partial Nephrectomy [IRENE] Trial—An Ablate-and-Resect Pilot Study). Urology 2018; 114:224-232. [DOI: 10.1016/j.urology.2017.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/15/2017] [Accepted: 12/09/2017] [Indexed: 12/11/2022]
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Pessoa RR, Autorino R, Laguna MP, Molina WR, Gustafson D, Nogueira L, da Silva RD, Werahera PN, Kim FJ. Laparoscopic Versus Percutaneous Cryoablation of Small Renal Mass: Systematic Review and Cumulative Analysis of Comparative Studies. Clin Genitourin Cancer 2017; 15:513-519.e5. [DOI: 10.1016/j.clgc.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/01/2017] [Accepted: 02/19/2017] [Indexed: 01/24/2023]
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11
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Wendler JJ, Pech M, Köllermann J, Friebe B, Siedentopf S, Blaschke S, Schindele D, Porsch M, Baumunk D, Jürgens J, Fischbach F, Ricke J, Schostak M, Böhm M, Liehr UB. Upper-Urinary-Tract Effects After Irreversible Electroporation (IRE) of Human Localised Renal-Cell Carcinoma (RCC) in the IRENE Pilot Phase 2a Ablate-and-Resect Study. Cardiovasc Intervent Radiol 2017; 41:466-476. [DOI: 10.1007/s00270-017-1795-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/05/2017] [Indexed: 01/20/2023]
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Focal ablation therapy for renal cancer in the era of active surveillance and minimally invasive partial nephrectomy. Nat Rev Urol 2017; 14:669-682. [PMID: 28895562 DOI: 10.1038/nrurol.2017.143] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Partial nephrectomy is the optimal surgical approach in the management of small renal masses (SRMs). Focal ablation therapy has an established role in the modern management of SRMs, especially in elderly patients and those with comorbidities. Percutaneous ablation avoids general anaesthesia and laparoscopic ablation can avoid excessive dissection; hence, these techniques can be suitable for patients who are not ideal surgical candidates. Several ablation modalities exist, of which radiofrequency ablation and cryoablation are most widely applied and for which safety and oncological efficacy approach equivalency to partial nephrectomy. Data supporting efficacy and safety of ablation techniques continue to mature, but they originate in institutional case series that are confounded by cohort heterogeneity, selection bias, and lack of long-term follow-up periods. Image guidance and surveillance protocols after ablation vary and no consensus has been established. The importance of SRM biopsy, its optimal timing, the type of biopsy used, and its role in treatment selection continue to be debated. As safety data for active surveillance and experience with minimally invasive partial nephrectomy are expanding, the role of focal ablation therapy in the treatment of patients with SRMs requires continued evaluation.
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Buijs M, van Lienden KP, Wagstaff PG, Scheltema MJ, de Bruin DM, Zondervan PJ, van Delden OM, van Leeuwen TG, de la Rosette JJ, Laguna MP. Irreversible Electroporation for the Ablation of Renal Cell Carcinoma: A Prospective, Human, In Vivo Study Protocol (IDEAL Phase 2b). JMIR Res Protoc 2017; 6:e21. [PMID: 28209559 PMCID: PMC5334515 DOI: 10.2196/resprot.6725] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background Irreversible electroporation (IRE) is an emerging technique delivering electrical pulses to ablate tissue, with the theoretical advantage to overcome the main shortcomings of conventional thermal ablation. Recent short-term research showed that IRE for the ablation of renal masses is a safe and feasible treatment option. In an ablate and resect design, histopathological analysis 4 weeks after radical nephrectomy demonstrated that IRE-targeted renal tumors were completely covered by ablation zone. In order to develop a validated long-term IRE follow-up study, it is essential to obtain clinical confirmation of the efficacy of this novel technology. Additionally, follow-up after IRE ablation obliges verification of a suitable imaging modality. Objective The objectives of this study are the clinical efficacy and safety of IRE ablation of renal masses and to evaluate the use of cross-sectional imaging modalities in the follow-up after IRE in renal tumors. This study conforms to the recommendations of the IDEAL Collaboration and can be categorized as a phase 2B exploration trial. Methods In this prospective clinical trial, IRE will be performed in 20 patients aged 18 years and older presenting with a solid enhancing small renal mass (SRM) (≤4 cm) who are candidates for ablation. Magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) will be performed at 1 day pre-IRE, and 1 week post-IRE. Computed tomography (CT), CEUS, and MRI will be performed at 3 months, 6 months, and 12 months post-IRE. Results Presently, recruitment of patients has started and the first inclusions are completed. Preliminary results and outcomes are expected in 2018. Conclusions To establish the position of IRE ablation for treating renal tumors, a structured stepwise assessment in clinical practice is required. This study will offer fundamental knowledge on the clinical efficacy of IRE ablation for SRMs, potentially positioning IRE as ablative modality for renal tumors and accrediting future research with long-term follow-up. Trial Registration Clinicaltrials.gov registration number NCT02828709; https://clinicaltrials.gov/ct2/show/NCT02828709 (archived by WebCite at http://www.webcitation.org/6nmWK7Uu9). Dutch Central Committee on Research Involving Human Subjects NL56935.018.16
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Affiliation(s)
- Mara Buijs
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Krijn P van Lienden
- Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Gk Wagstaff
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs Jv Scheltema
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Daniel M de Bruin
- Academic Medical Center, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands
| | - Patricia J Zondervan
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - Otto M van Delden
- Academic Medical Center, Department of Radiology, University of Amsterdam, Amsterdam, Netherlands
| | - Ton G van Leeuwen
- Academic Medical Center, Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, Netherlands
| | - Jean Jmch de la Rosette
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
| | - M Pilar Laguna
- Academic Medical Center, Department of Urology, University of Amsterdam, Amsterdam, Netherlands
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