1
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Acosta Ruiz V, Dahlman P, Brekkan E, Lönnemark M, Magnusson A. Microwave ablation of 105 T1 renal tumors: technique efficacy with a mean follow-up of two years. Acta Radiol 2024; 65:294-301. [PMID: 32910687 DOI: 10.1177/0284185120956283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Thermal ablation (TA) with radiofrequency (RFA) or cryoablation (CA) are established treatments for small renal masses (≤4 cm). Microwave ablation (MWA) has several potential benefits (decreased ablation time, less susceptibility to heat-sink, higher lesion temperatures than RFA) but is still considered experimental considering the available small-sample studies with short follow-up. PURPOSE To evaluate technique efficacy and complications of our initial experience of renal tumors treated using percutaneous MWA with a curative intent. MATERIAL AND METHODS A total of 105 renal tumors (in 93 patients) were treated between April 2014 and August 2017. MWA was performed percutaneously with computed tomography (CT) guidance under conscious sedation (n=82) or full anesthesia. Patients were followed with contrast-enhanced CT scans at six months and yearly thereafter for a minimum of five years. The mean follow-up time was 2.1 years. The percentage of tumors completely ablated in a single session (primary efficacy rate) and those successfully treated after repeat ablation (secondary efficacy rate) were recorded. Patient and tumor characteristics as well as complications were collected retrospectively. RESULTS The median patient age was 70 years and median tumor size was 25 mm. Primary efficacy rate was 96.2% (101/105 tumors). After including two residual tumors for a second ablation session, secondary efficacy was 97.1% (102/105). Periprocedural complications were found in 5.2% (5/95) sessions: four Clavien-Dindo I and one Clavien-Dindo IIIa. One postprocedural Clavien-Dindo II complication was found. CONCLUSION MWA has high efficacy rates and few complications compared to other TA methods at a mean follow-up of two years.
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Affiliation(s)
- Vanessa Acosta Ruiz
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Pär Dahlman
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Einar Brekkan
- Department of Surgical Sciences - Urology, Uppsala University, Uppsala Sweden
| | - Maria Lönnemark
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Anders Magnusson
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
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2
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Del Cura Rodríguez JL, Zabala-Landa R, Korta-Gomez I. Percutaneous ablation of renal tumors: Long-term outcomes. RADIOLOGIA 2023; 65:492-501. [PMID: 38049248 DOI: 10.1016/j.rxeng.2021.12.003] [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: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To evaluate the long-term outcomes of renal tumor ablation, analyzing efficacy, long-term survival, and factors associated with complications and therapeutic success. MATERIAL AND METHODS We retrospectively reviewed 305 ablations (generally done with expandable electrodes) of 273 renal tumors between May 2005 and April 2019. We analyzed survival, primary and secondary efficacy, and complications according to various patient factors and tumor characteristics. RESULTS Mean blood creatinine was 1.14 mg/dL before treatment and 1.30 mg/dL after treatment (p < 0.0001). Complications were observed in 13.25% of the ablations, including major complications in in 4.97%. Complications were associated with age (p = 0.013) and tumor diameter (p < 0.0001). Primary efficacy was 96.28%. Incomplete ablation was more common in lesions measuring > 4 cm in diameter (p = 0.002). Secondary efficacy was 95.28%. The only factor associated with the risk of recurrence was the size of the tumor (p = 0.02). Overall survival was 95.26% at 1 year, 77.01% at 5 years, and 51.78% at 10 years, with no differences between patients with malignant and benign lesions. Mortality was higher in patients with creatinine >1 (p = 0.05) or ASA > 2 (p = 0.0001). CONCLUSIONS Percutaneous ablation is extremely efficacious for renal tumors; it improves the prognosis of renal carcinoma to the point where it does not differ from that of benign lesions. Complications are rare. Like survival, complications are associated with age and overall health status.
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Affiliation(s)
- J L Del Cura Rodríguez
- Servicio de Radiodiagnóstico, Hospital Universitario Donostia, Donostia-San Sebastián, Spain.
| | - R Zabala-Landa
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - I Korta-Gomez
- Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
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3
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Qiu J, Ballantyne C, Yeaman C, Lange M, Morgan J, Mershon JP, Richie I, DeNovio A, Clements MB, Krupski TL, Schenkman N, Lobo JM. Microwave ablation of the T1a small renal mass: expanding beyond 3 cm. Abdom Radiol (NY) 2023; 48:2695-2704. [PMID: 37212853 DOI: 10.1007/s00261-023-03935-9] [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: 02/10/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE To compare the oncological and renal function outcomes for patients receiving microwave ablation (MWA) in tumors < 3 and 3-4 cm. METHODS Retrospective analysis of a prospectively maintained database identified patients with < 3 or 3-4 cm renal cancers undergoing MWA. Radiographic follow-up occurred at approximately 6 months post-procedure and annually thereafter. Serum creatinine and estimated glomerular filtration rate (eGFR) were calculated before and 6-months post-MWA. Local recurrence-free survival (LRFS) was estimated using the Kaplan-Meier method. Tumor size was evaluated as a prognostic factor using Cox proportional-hazards regression. Predictors for change in eGFR and chronic kidney disease (CKD) stage were modeled using linear and ordinal logistic regression. RESULTS A total of 126 patients fit the inclusion criteria. Overall recurrences were 2/62 (3.2%) and 6/64 (9.4%) for < 3 versus 3-4 cm. Both recurrences in the < 3 cm group were local, 4/6 in the 3-4 cm group were local and 2/6 were metastatic without local progression. For < 3 versus 3-4 cm, cumulative LRFS at 36 months was 94.6% versus 91.4%. Tumor size was not a significant prognostic factor for LRFS. Renal function did not change significantly after MWA. Patient comorbidities and RENAL nephrometry score significantly affected change in CKD. CONCLUSION With comparable oncological outcomes, complication rates, and renal function preservation, MWA is a promising management strategy for renal masses of 3-4 cm in select patients. Our findings suggest that current AUA guidelines, which recommend thermal ablation for tumors < 3 cm, may need review to include T1a tumors for MWA, regardless of size.
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Affiliation(s)
- Jessica Qiu
- University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA
| | | | - Clint Yeaman
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Moritz Lange
- University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA
| | - John Morgan
- University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA
| | - J Patrick Mershon
- University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA
| | - Iman Richie
- University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA
| | - Anthony DeNovio
- University of Virginia School of Medicine, 1300 Jefferson Park Avenue, P.O. Box 800717, Charlottesville, VA, 22908-0717, USA
| | - Matthew B Clements
- Department of Urology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Noah Schenkman
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Jennifer M Lobo
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA.
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4
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Jin X, Liu W, Li Y, Qian L, Zhu Q, Li W, Qian Z. Evaluation method of ex vivo porcine liver reduced scattering coefficient during microwave ablation based on temperature. BIOMED ENG-BIOMED TE 2022; 67:491-501. [DOI: 10.1515/bmt-2022-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/01/2022] [Indexed: 11/15/2022]
Abstract
Abstract
The principle of microwave ablation (MWA) is to cause irreversible damage (protein coagulation, necrosis, etc.) to tumor cells at a certain temperature by heating, thereby destroying the tumor. We have long used functional near-infrared spectroscopy (fNIRs) to monitor clinical thermal ablation efficacy. After a lot of experimental verification, it can be found that there is a clear correlation between the reduced scattering coefficient and the degree of tissue damage. During the MWA process, the reduced scattering coefficient has a stable change. Therefore, both temperature (T) and reduced scattering coefficient (
μ
s
′
${\mu }_{s}^{\prime }$
) are related to the thermal damage of the tissue. This paper mainly studies the changing law of T and
μ
s
′
${\mu }_{s}^{\prime }$
during MWA and establishes a relationship model. The two-parameter simultaneous acquisition system was designed and used to obtain the T and
μ
s
′
${\mu }_{s}^{\prime }$
of the ex vivo porcine liver during MWA. The correlation model between T and
μ
s
′
${\mu }_{s}^{\prime }$
is established, enabling the quantitative estimation of
μ
s
′
${\mu }_{s}^{\prime }$
of porcine liver based on T. The maximum and the minimum relative errors of
μ
s
′
${\mu }_{s}^{\prime }$
are 79.01 and 0.39%, respectively. Through the electromagnetic simulation of the temperature field during MWA, 2D and 3D fields of reduced scattering coefficient can also be obtained using this correlation model. This study contributes to realize the preoperative simulation of the optical parameter field of microwave ablation and provide 2D/3D therapeutic effect for clinic.
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Affiliation(s)
- Xiaofei Jin
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Wenwen Liu
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Yiran Li
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Lu Qian
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Qiaoqiao Zhu
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Weitao Li
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
| | - Zhiyu Qian
- Department of Biomedical Engineering , College of Automation Engineering, Nanjing University of Aeronautics and Astronautics , Nanjing , China
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del Cura Rodríguez J, Zabala-Landa R, Korta-Gomez I. Ablación percutánea de tumores renales: resultados a largo plazo. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Tan S, Yu X, Cheng Z, Zhang J, Yu J, Liu F, Gao Y, Linghu R, Han Z, Liang P. Cause Analysis and Diagnosis and Treatment of Intestinal Fistulas After Ultrasound-Guided Microwave Ablation of Abdominopelvic Lesions. Front Surg 2021; 8:675585. [PMID: 34869548 PMCID: PMC8639506 DOI: 10.3389/fsurg.2021.675585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the cause and high-risk factors for the development of intestinal fistulas (IFs) after ultrasound-guided microwave ablation (MA) of abdominopelvic lesions, and to identify effective prophylactic and therapeutic actions. Methods: Clinical data were collected from patients with an IF after ultrasound-guided MA of abdominopelvic lesions in our hospital from January 1, 2010 to December 31, 2018. The cause, diagnosis, and treatment of IFs in these patients were analyzed. Results: Among 8,969 patients who underwent ultrasound-guided MA of abdominopelvic lesions, eight patients developed IF after MA, Seven patients were discharged after being cured and one died. Conclusion: Abdominopelvic lesions are close to the intestines, so histories of surgery, radiotherapy, and abdominopelvic infection are high-risk factors for IF development after MA of these lesions. Surgical treatment should be provided as soon as an IF is identified.
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Affiliation(s)
- Shuilian Tan
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jing Zhang
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuanjin Gao
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Runze Linghu
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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7
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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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8
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Yu J, Yu XL, Cheng ZG, Hu B, Han ZY, Liu FY, Hu ZQ, Wang H, Dong J, Pan J, Yang B, Sai X, Guo AT, Liang P. Percutaneous microwave ablation of renal cell carcinoma: practice guidelines of the ultrasound committee of Chinese medical association, interventional oncology committee of Chinese research hospital association. Int J Hyperthermia 2021; 37:827-835. [PMID: 32635839 DOI: 10.1080/02656736.2020.1779356] [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] [Indexed: 12/29/2022] Open
Abstract
Imaging-guided percutaneous microwave ablation (MWA) with high thermal efficiency comprises rapid, successful management of small renal cell carcinomas (RCCs) in selected patients. Ultrasound Committee of Chinese Medical Association, Interventional Oncology Committee of Chinese Research Hospital Association developed evidence-based guidelines for MWA of RCCs after systematically reviewing the 1969-2019 literature. Systematic reviews, meta-analyses, randomized controlled trials, cohort, and case-control studies reporting MWA of RCCs were included and levels of evidence assessed. Altogether, 146 articles were identified, of which 35 reported percutaneous MWA for T1a RCCs and 5 articles for T1b RCCs. Guidelines were established based on indications, techniques, safety, and effectiveness of MWA for RCCs, with the goal of standardizing imaging-guided percutaneous MWA treatment of RCCs. Key points Microwave ablation is recommended for managing small renal cell carcinoma in selected patients. Imaging protocols are tailored based on the procedural plan, guidance, and evaluation. Patient's selection evaluation, updated technique information, clinical efficacy, and complications are recommended to standardize management. A joint task force (multidisciplinary team) summarized the key elements of the standardized report.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Bing Hu
- Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Ultrasound in Med, 6th People's Hospital of Shanghai Jiaotong, University, Shanghai, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Zhi-Quan Hu
- Department of Ultrasound, Medical Imaging Union Hospital of Tongji Medical College of HUST Wuhan, China
| | - Hui Wang
- Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jun Dong
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Jie Pan
- Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Yang
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyong Sai
- Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Institute of Geriatrics, Beijing, China
| | - Ai-Tao Guo
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
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9
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Wu J, Yu J, Cheng Z, Han Z, Yu X, Li K, Hu P, Liu F, Liang P. Risk Factors of Ureteral Stenosis After Percutaneous Microwave Ablation of Renal Tumor, a Single-Center Experience. Front Oncol 2020; 10:521349. [PMID: 33072565 PMCID: PMC7531279 DOI: 10.3389/fonc.2020.521349] [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: 01/07/2020] [Accepted: 08/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background Ureteral stenosis after percutaneous microwave ablation (MWA) of renal tumor is a rare but severe complication, and its risk factors are not apparent. Purpose This study aimed to investigate the risk factors for stenosis of ureter after MWA treatment of the renal tumor that is a rare complication. Materials and Methods Data of 211 patients who underwent MWA for the treatment of renal tumor were retrospectively analyzed from September 2006 to August 2019. Demographic characteristics, clinical features, ablation parameters, and outcomes were analyzed to find out the potential risk factors of this complication. P < 0.05 is considered significant. Results Six of 211 patients developed ureter stenosis, and the rate of this complication is 2.84%. The median time of emergence of hydronephrosis was 226 (range, 3-390) days. Univariate analysis shows the distance between ureter and tumor (P = 0.225) or ablation zone (P = 0.089) is not related to this complication. Postoperative urine routine (red blood cell, P = 0.001; white blood cell, P = 0.035) and R.E.N.A.L. score (P < 0.001) is related to this complication. But after multivariate logistic analysis, only R.E.N.A.L. score (P = 0.004) is associated with this complication. The location and growth pattern of tumor and the energy of ablation were not related to this complication independently. Conclusion The stenosis of the ureter after MWA of renal tumor is not associated with the tumor size, location, or the distance between the ureter and tumor and ablation site independently. But R.E.N.A.L. score is associated with ureter stenosis after MWA for the treatment of renal tumor, which combines the information of location, depth, and size of tumor. Preoperative evaluation of the tumor is necessary for avoiding ureter stenosis. Further studies should focus on these risk factors of this complication.
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Affiliation(s)
- Jiapeng Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Kai Li
- Ultrasonic Department, The Second Affiliated Hospital of Chengdu Medical College, Nuclear Industry 416 Hospital, Chengdu, China
| | - Ping Hu
- Department of Ultrasound, First People's Hospital of Datong, Datong, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China
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10
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An TJ, Arellano RS. Comparison of Safety and Efficacy of Percutaneous Microwave Ablation of Central Versus Peripheral Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2020; 44:281-288. [PMID: 33078234 DOI: 10.1007/s00270-020-02674-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Thermal ablation of central renal cell carcinoma has been associated with increased risk of incomplete tumor necrosis and adverse events due to the proximity of tumors to the central collecting system and hilar vessels. The purpose of this study was to compare the safety and efficacy of computed tomography-guided percutaneous microwave ablation of central versus peripheral renal cell carcinoma. MATERIALS AND METHODS An institutional database was used to retrospectively identify 114 patients with renal cell carcinoma who were treated with computed tomography-guided percutaneous microwave ablation between January 2015 and December 2019. Patients were divided into two cohorts based on tumor location: central versus peripheral. Central renal tumors were defined as being within 4 mm of renal pelvis and/or ureter and peripheral tumors were defined as tumors beyond 4 mm the renal pelvis and/or ureter. Patient demographics, tumor type, technical success, primary technique efficacy and adverse events were recorded from the medical record. Technical success, primary technique efficacy and adverse events were compared between the two cohorts. RESULTS There were 44 patients in the central group and 70 patients in the peripheral group. Technical success was 100% for both groups. There was no significant difference in primary technique efficacy rates for peripheral compared to central tumors (93% vs. 89%, p = 0.49). There was no significant difference in overall adverse event rate (17.7% vs. 11.7%, p = 0.34) or Grade II or higher adverse event rate (7.8% vs. 2.6%, p = 0.17) following microwave ablation of central versus peripheral lesions. Adjunctive maneuvers of hydrodissection and/or pyeloperfusion were performed significantly more frequently for treatment for central tumors compared to peripheral tumors (53% vs. 29%, p = 0.006). CONCLUSION When adjunctive procedures were utilized more frequently for central compared to peripheral tumors, there was no significant difference in primary technique efficacy or adverse event rate following CT-guided percutaneous microwave ablation of central compared to peripheral renal cell carcinoma. The data suggest that MWA can be successfully applied to select central renal masses and adjunctive maneuvers such as pyeloperfusion should be strongly considered for patient safety. LEVEL OF EVIDENCE III Non-randomized controlled cohort study/follow-up study.
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Affiliation(s)
- Thomas J An
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ronald S Arellano
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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Guo J, Arellano RS. Percutaneous Microwave Ablation of Stage T1b Renal Cell Carcinoma: Short-Term Assessment of Technical Feasibility, Short-Term Oncologic Outcomes, and Safety. J Endourol 2020; 34:1021-1027. [PMID: 32498630 DOI: 10.1089/end.2020.0382] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To report on the safety, technical results, and oncologic outcomes of computed tomography guided percutaneous microwave ablation of stage cT1b renal cell carcinoma. Materials and Methods: This single-center retrospective study investigated consecutive patients with T1b renal cell carcinoma who were treated with CT guided percutaneous microwave ablation between December 2015 and May 2019. Patient baseline characteristics, tumor biologic features, technical parameters, clinical outcomes, and complications were recorded and evaluated. Local tumor progression-free survival and overall survival rates were estimated using the Kaplan-Meier methods. Results: This study included 23 patients (18 men [mean age ± standard deviation, 74.6 years ±10.2; range 58-89 years] and 5 women [mean age, 71.6 years ±10.1; range 62-86 years]; overall mean age, 74.0 years ±10.0; range 58-89 years) with 23 T1b renal cell carcinomas. Primary technical success was achieved in 20/23 (87%) patients. Secondary technical success was achieved in 3/3 (100%) patients. Local tumor progression-free survival was 100.0%, 90.9%, and 90.9% at 1, 2, and 3 years, respectively. Overall survival was 95.2%, 85.7%, and 71.4% at 1, 2, and 3 years, respectively. There were 2 (8.7%) complications; both were classified as minor complications according to the Society of Interventional Radiology grading system. Conclusions: Computed tomography guided percutaneous microwave ablation for T1b renal cell carcinoma is associated with high rates of technical success, excellent local tumor progression-free survival, short-term survival and overall survival, and low complication rates.
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Affiliation(s)
- Jianhai Guo
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Interventional Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Ronald S Arellano
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, 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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Welch BT, Shah PH, Thompson RH, Atwell TD. The current status of thermal ablation in the management of T1b renal masses. Int J Hyperthermia 2019; 36:31-36. [DOI: 10.1080/02656736.2019.1605097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- BT Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - PH Shah
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - RH Thompson
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - TD Atwell
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Percutaneous image-guided renal ablations: Current evidences for long-term oncologic efficacy. Presse Med 2019; 48:e233-e243. [PMID: 31445699 DOI: 10.1016/j.lpm.2019.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/24/2019] [Accepted: 07/17/2019] [Indexed: 01/20/2023] Open
Abstract
The rise in incidentally discovered small renal neoplasms has focused attention on nephron-sparing treatment strategies including partial nephrectomy and percutaneous ablation as well as active surveillance. As all treatment modality, renal ablation has matured technically. Radiofrequency ablation, microwave ablation or cryoablation are now performed in many institutions under imaging guidance. The long-term results allow them to be now recommended as a therapeutic option whatever the patients' condition if complete ablation can reliably be achieved.
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Cronan J, Dariushnia S, Bercu Z, Ermentrout RM, Majdalany B, Findeiss L, Newsome J, Kokabi N. Systematic Review of Contemporary Evidence for the Management of T1 Renal Cell Carcinoma: What IRs Need to Know for Kidney Cancer Tumor Boards. Semin Intervent Radiol 2019; 36:194-202. [PMID: 31435127 DOI: 10.1055/s-0039-1693119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal cell carcinoma is a relatively common malignancy, with 60 to 70 thousand cases a year in the United States alone. Increased utilization of cross-sectional imaging has led to an increase in the number of early renal cell cancers seen by the medical establishment. In addition, certain patient populations have an increased risk of developing kidney cancers which may mandate aggressive screening protocols. This article discusses the epidemiology of renal cell cancers; discusses the current management guidelines from multiple specialty societies; discusses some of the surgical and interventional techniques used in the treatment of such lesions; and provides a review of the literature regarding treatments of early-stage renal cell cancers.
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Affiliation(s)
- Julie Cronan
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sean Dariushnia
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary Bercu
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Mitchell Ermentrout
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Bill Majdalany
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Laura Findeiss
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Janice Newsome
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nima Kokabi
- Division of Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Shakeri S, Afshari Mirak S, Mohammadian Bajgiran A, Pantuck A, Sisk A, Ahuja P, Lu DS, Raman SS. The effect of tumor size and location on efficacy and safety of US- and CT- guided percutaneous microwave ablation in renal cell carcinomas. Abdom Radiol (NY) 2019; 44:2308-2315. [PMID: 30847565 DOI: 10.1007/s00261-019-01967-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the effect of size and central location of the tumor on safety and efficacy of percutaneous CEUS- and CT-guided MWA in biopsy-proven renal cell carcinomas (RCCs). MATERIALS AND METHODS In this IRB-approved retrospective study, 69 biopsy-proven renal tumors in 56 patients, who underwent MWA in our institution from January 2013 to March 2017, were evaluated. Data collection included demographics, tumor characteristics, procedural protocols, and follow-up visits within 6 months post procedure. Primary outcomes were assessed by technical success (TS), local tumor progression (LTP), and complications. The Kaplan-Meier analysis was used for survival rate. RESULTS Overall technical success was achieved for all 69 lesions (92.8% primary TS, 100% overall). Median nephrometry score was 8 (4-11) and median tumor size was 2.5 cm (0.8-7). Five lesions which required second ablation had significantly higher median tumor size 4 cm (P = 0.039) with the same nephrometry score. Renal function remained stable with no significant change in eGFR before or after ablation. The LTP rate was 5.8%. The most recurrent tumors were clear cell (50%) followed by papillary tumors (25%). The complication rate was 5.8% with minor complications (hematoma and pain) and no major issues. There was no significant association between nephrometry score and technical success, recurrence, or complication rates. Overall and tumor-specific survival rates were 96.7% and 100% at 11.9 months. CONCLUSIONS Image-guided MWA appears to be a safe and effective treatment regardless of nephrometry score and tumor location with high technical success, low recurrence, and complication rates.
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Affiliation(s)
- Sepideh Shakeri
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Sohrab Afshari Mirak
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | | | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Anthony Sisk
- Department of Pathology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Preeti Ahuja
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - David S Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
- Department of Urology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Samadi K, Arellano RS. Ureteral protection during microwave ablation of renal cell carcinoma: combined use of pyeloperfusion and hydrodissection. ACTA ACUST UNITED AC 2019; 24:388-391. [PMID: 30406764 DOI: 10.5152/dir.2018.18137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A 56-year-old female with past medical history of thrombotic microangiopathy presented to her physician with nonspecific abdominal pain. A magnetic resonance imaging scan was obtained, which revealed a 3.1 cm mass arising from medial lower pole of the left kidney that was subsequently shown to be renal cell carcinoma by percutaneous biopsy. Because of her history of thrombotic microangiopathy and other comorbidities, she was deemed a nonsurgical candidate and was therefore referred to interventional radiology for thermal ablation. Computed tomography (CT)-guided microwave ablation was performed with the combined use of pyeloperfusion and hydrodissection for maximal ureteral protection. Follow-up unenhanced CT scan obtained one month after ablation showed a normal collecting system without evidence of hydronephrosis or urinoma.
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Affiliation(s)
- Katayoun Samadi
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronald S Arellano
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Introduction of Microwave Ablation Into a Renal Ablation Practice: Valuable Lessons Learned. AJR Am J Roentgenol 2018; 211:1381-1389. [PMID: 30247980 DOI: 10.2214/ajr.18.19775] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the early outcomes of percutaneous microwave ablation (MWA) for clinical stage T1 (cT1) renal masses when performed within a high-volume ablation practice with critical emphasis on procedural safety. MATERIALS AND METHODS A retrospective review of a percutaneous renal ablation registry identified 26 patients with a total of 27 cT1 renal masses treated with MWA between 2011 and 2017. Mean patient age was 63.8 years and 16 (61.5%) patients were male. Mean renal mass size ± SD was 2.3 ± 0.8 cm (range, 1.1-4.7 cm). The main outcome parameters investigated were technical success, local tumor progression, survival rates, and complications. Complications were categorized using the Clavien-Dindo classification system. Rates of local progression-free and cancer-specific survival (PFS and CSS, respectively) were estimated using the Kaplan-Meier method. RESULTS Technical success was 100% on contrast-enhanced CT or MRI performed immediately after renal MWA. Twenty-four patients (92%) with 25 tumors had follow-up imaging for 3 months or longer (mean, 20.6 ± 11.6 months), with no local tumor recurrences identified. Estimated 3-year local PFS and CSS were 96% and 94%, respectively. The overall complication rate was 19.2%; two patients (7.7%) experienced minor complications (grade I or II) and three patients (11.5%) experienced major bleeding or urinary-related complications (grade III or higher), including one death. CONCLUSION This study suggests that percutaneous MWA is a promising minimally invasive treatment option for cT1 renal masses. Nonetheless, major bleeding and urinary-related complications can occur, and further studies are needed to determine optimal patient and tumor selection for renal MWA.
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Choi SH, Kim JW, Kim JH, Kim KW. Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012. Korean J Radiol 2018; 19:938-949. [PMID: 30174484 PMCID: PMC6082757 DOI: 10.3348/kjr.2018.19.5.938] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/10/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To systematically determine the treatment outcomes of percutaneous microwave ablation (MWA) in patients with malignant renal tumor. Materials and Methods Original studies that reported the clinical outcomes of MWA in patients with malignant renal tumors were identified in MEDLINE and EMBASE from 2012 to June 30, 2017. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic summary estimates of various clinical outcomes, including technical outcomes (technical success rate [TSR] and technical efficacy rate [TER]), oncologic outcomes (local tumor recurrence rate [LRR], cancer-specific survival rate [CSSR], and overall survival rate [OSR]), and complications. Results Among the 145 articles screened, 13 articles including 567 patients carrying 616 malignant renal tumors were included in the meta-analysis. The meta-analytic pooled TSR and TER were 97.3% (95% confidence interval, 94.3-99.4%; I2 = 0.0%) and 97.6% (95.0-99.4%, I2 = 48.5%), respectively. The meta-analytic pooled LRR was 2.1% (0.3-4.7%, I2 = 54.1%). At 1-, 2-, 3-, and 5-year follow-up time points, the meta-analytic pooled CSSRs were 99.1% (97.2-100.0%; I2 = 0.0%), 98.4% (95.1-100.0%; I2 = 31.2%), 97.6% (93.4-99.9%; I2 = 52.3%), and 96.9% (93.3-99.2%; I2 = 0.0%) respectively, while the OSRs were 98.3% (96.1-99.8%; I2 = 0.0%), 94.9% (91.7-97.5%; I2 = 0.0%), 86.8% (81.9-91.1%; I2 = 22.1%), and 81.9% (75.4-87.6%; I2 = 0.0%). In terms of major complications, a 1.8% (0.6-3.3%; I2 = 0.0%) rate of meta-analytic pooled incidence was found. Conclusion Microwave ablation showed favorable technical and oncologic outcomes with a low incidence of major complications. Hence, image-guided percutaneous MWA can be considered as a safe and effective treatment for malignant renal tumors.
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Affiliation(s)
- Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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21
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Kim E, Zschiedrich S. Renal Cell Carcinoma in von Hippel-Lindau Disease-From Tumor Genetics to Novel Therapeutic Strategies. Front Pediatr 2018; 6:16. [PMID: 29479523 PMCID: PMC5811471 DOI: 10.3389/fped.2018.00016] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/16/2018] [Indexed: 01/05/2023] Open
Abstract
von Hippel-Lindau (VHL) disease is an autosomal dominant syndrome caused by mutations in the VHL tumor-suppressor gene, leading to the dysregulation of many hypoxia-induced genes. Affected individuals are at increased risk of developing recurrent and bilateral kidney cysts and dysplastic lesions which may progress to clear cell renal cell carcinoma (ccRCC). Following the eponymous VHL gene inactivation, ccRCCs evolve through additional genetic alterations, resulting in both intratumor and intertumor heterogeneity. Genomic studies have identified frequent mutations in genes involved in epigenetic regulation and phosphoinositide 3-kinase-AKT-mechanistic target of rapamycin (mTOR) pathway activation. Currently, local therapeutic options include nephron-sparing surgery and alternative ablative procedures. For advanced metastatic disease, systemic treatment, including inhibition of vascular endothelial growth factor pathways and mTOR pathways, as well as immunotherapy are available. Multimodal therapy, targeting multiple signaling pathways and/or enhancing the immune response, is currently being investigated. A deeper understanding of the fundamental biology of ccRCC development and progression, as well as the development of novel and targeted therapies will be accelerated by new preclinical models, which will greatly inform the search for clinical biomarkers for diagnosis, prognosis, and response to treatment.
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Affiliation(s)
- Emily Kim
- Department of Radiation Oncology, Faculty of Medicine, Albert Ludwigs University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Stefan Zschiedrich
- Renal Division, Department of Medicine IV, Faculty of Medicine, Albert Ludwigs University of Freiburg, Freiburg, Germany
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Duodenorenal Fistula after Microwave Ablation Presenting as Melena. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805100-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Filippiadis DK, Gkizas C, Chrysofos M, Siatelis A, Velonakis G, Alexopoulou E, Kelekis A, Brountzos E, Kelekis N. Percutaneous microwave ablation of renal cell carcinoma using a high power microwave system: focus upon safety and efficacy. Int J Hyperthermia 2017; 34:1077-1081. [DOI: 10.1080/02656736.2017.1408147] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- D. K. Filippiadis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - C. Gkizas
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - M. Chrysofos
- Urology Clinic, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Siatelis
- Urology Clinic, University General Hospital “ATTIKON”, Athens, Greece
| | - G. Velonakis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - E. Alexopoulou
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - E. Brountzos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - N. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
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An C, Hu ZL, Liang P, Cheng ZG, Han ZY, Yu J, Liu FY. Ultrasound-guided percutaneous microwave ablation vs. surgical resection for thoracoabdominal wall implants from hepatocellular carcinoma: intermediate-term results. Int J Hyperthermia 2017; 34:1067-1076. [PMID: 29161924 DOI: 10.1080/02656736.2017.1402131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The aims of this study were to compare the clinical outcomes between ultrasound (US)-guided percutaneous microwave ablation (MWA) and surgical resection (SR) in patients with thoracoabdominal wall implants from hepatocellular carcinom (HCC) and to identify the prognostic factors associated with the two treatment methods. MATERIALS AND METHODS A total of 47 patients (mean age, 56.7 ± 15.9 years, range, 18-78 years; 34 men and 13 women) with 61 thoracoabdominal wall HCC seeding were included from April 2007 to May 2017. Twenty-five patients underwent US-guided MWA and 22 patients underwent SR. Survival, recurrence and liver function were compared between the two groups. Effect of changes in key parameters (i.e. overall survival (OS), disease-free survival (DFS) and local tumour reoccurrence-free (LTRF)) was statistically analysed with the log-rank test. Univariate and multivariate analyses were performed on several clinicopathological variables to identify factors affecting long-term outcome and recurrence. RESULTS The OS, DFS and LTRF after MWA were comparable to those of SR (p =0.493, p = 0.578 and p =0.270, respectively). Estimated 5-year overall survival rates were 63% after MWA and 48.1% after SR; for disease-free survival, estimated 5-year rates were 67.5% after MWA and 48.8% after SR; estimated 24-month LTRF rates were 71.3% after MWA and 87.8% after SR. The MWA group had less surgical time (p = <0.001), estimated blood loss (p = <0.001) and post-operative hospitalisation (p = 0.032) and cost (p = 0.015). Multivariate analysis showed remnant intrahepatic tumour (p =0.007), Child Pugh grade (p = 0.009) and metastasis (p= <0.001), were predictors for survival rate. CONCLUSIONS Ultrasound-guided percutaneous MWA is a safe and effective treatment method for metastatic HCC on the thoracoabdominal wall with similar outcomes to SR. Residual intrahepatic HCC, Child Pugh grade and distant metastasis are predictors for survival.
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Affiliation(s)
- Chao An
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zi-Long Hu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Ping Liang
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhi-Gang Cheng
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Zhi-Yu Han
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Jie Yu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
| | - Fang-Yi Liu
- a Department of Interventional Ultrasound , Chinese PLA General Hospital , Beijing , China
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Prins FM, Kerkmeijer LGW, Pronk AA, Vonken EJPA, Meijer RP, Bex A, Barendrecht MM. Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review. J Endourol 2017; 31:963-975. [PMID: 28741377 DOI: 10.1089/end.2017.0382] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments. MATERIALS AND METHODS Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy. RESULTS The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4. CONCLUSION Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.
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Affiliation(s)
- Fieke M Prins
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Linda G W Kerkmeijer
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Anne A Pronk
- 2 Department of Urology, Tergooi Hospital , Hilversum, The Netherlands
| | - Evert-Jan P A Vonken
- 3 Department of Radiology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Richard P Meijer
- 4 Department of Urology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Axel Bex
- 5 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands
| | - Maurits M Barendrecht
- 6 Department of Urology, Tergooi Hospital, Hilversum and University Medical Center Utrecht , Utrecht, The Netherlands
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Dai Y, Covarrubias D, Uppot R, Arellano RS. Image-Guided Percutaneous Radiofrequency Ablation of Central Renal Cell Carcinoma: Assessment of Clinical Efficacy and Safety in 31 Tumors. J Vasc Interv Radiol 2017; 28:1643-1650. [PMID: 28673657 DOI: 10.1016/j.jvir.2017.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess clinical efficacy and safety of image-guided percutaneous radiofrequency (RF) ablation of central renal cell carcinoma with adjunctive pyeloperfusion. MATERIALS AND METHODS Patients with central renal tumors who underwent percutaneous RF ablation between 2005 and 2010 were retrospectively evaluated. Thirty patients with 31 central renal tumors underwent 39 RF ablation sessions. Mean tumor diameter was 3.7 cm (range, 2-7 cm). Median distance between tumor and renal pelvis was 5 mm (range, 0-15 mm). Pyeloperfusion was performed in 27 patients (27/30; 90%). Contrast-enhanced CT or MR imaging was performed to evaluate treatment response. RESULTS Technical success of RF ablation was achieved in 38/39 (97.4%) ablation sessions. Primary efficacy was 83.9% (26/31) on first follow-up imaging. One (3.2%) case of local tumor progression was detected 6 months after initial ablation. Secondary efficacy was 96.8% (30/31) after repeat RF ablation for residual tumor or local tumor progression. Median follow-up was 88 months (mean 82.6 mo ± 30.7; range, 9-121 mo). Major complications occurred in 5/39 (12.8%) RF ablation sessions. Complications were significantly higher for tumors located within 5 mm of the renal pelvis or 0 mm of a major calyx (28.6% vs 4.0%; P < .05). Overall survival was 96.0% (95% CI, 88.4%-100.0%), and progression-free survival at 5 years was 80.9% (95% CI, 65.8%-95.9%). CONCLUSION Image-guided percutaneous RF ablation combined with pyeloperfusion has satisfactory clinical efficacy in treating central renal tumors. Although clinically effective, RF ablation of central tumors may also be associated with significant major complications.
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Affiliation(s)
- Ying Dai
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA 02114; Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Minister of Education), Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, Beijing, China
| | - Diego Covarrubias
- Department of Radiology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
| | - Raul Uppot
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA 02114
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA 02114.
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Park BK. Ultrasound-guided genitourinary interventions: principles and techniques. Ultrasonography 2017; 36:336-348. [PMID: 28736429 PMCID: PMC5621800 DOI: 10.14366/usg.17026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 12/30/2022] Open
Abstract
Ultrasound (US) is often used to guide various interventional procedures in the genitourinary (GU) tract because it can provide real-time imaging without any radiation hazard. Moreover, US can clearly visualize the pathway of an aspiration or biopsy needle to ensure the safety of the intervention. US guidance also helps clinicians to access lesions via the transabdominal, transhepatic, transvaginal, transrectal, and transperineal routes. Hence, US-guided procedures are useful for radiologists who wish to perform GU interventions. However, US-guided procedures and interventions are difficult for beginners because they involve a steep initial learning curve. The purpose of this review is to describe the basic principles and techniques of US-guided GU interventions.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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