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Terauchi M, Yamashiro T, Sawamura S, Koyama S, Nakaigawa N, Kondo K, Hasumi H, Makiyama K, Utsunomiya D. Combining Transarterial Embolization and Percutaneous Cryoablation for Early-Stage Renal Cell Carcinoma: Embolization Materials and Impacts of Tumor Size. Tomography 2024; 10:1767-1779. [PMID: 39590939 PMCID: PMC11598556 DOI: 10.3390/tomography10110130] [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: 09/19/2024] [Revised: 10/30/2024] [Accepted: 11/03/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Our aim was to compare the complication rates of different embolization materials (absolute ethanol and gelatin sponges) used for combined transarterial embolization (TAE) and to investigate the impact of tumor size on operative time and cryoneedle use during percutaneous cryoablation (PCA). METHODS We treated 27 patients (9 women and 18 men; mean age, 74 years) with 28 early-stage (T1a) renal cell carcinoma (RCC) lesions using combined TAE and PCA between September 2018 and January 2021. During TAE, 15 lesions in 14 patients were embolized using mixed absolute ethanol and iodized oil. The remaining 13 lesions (in 13 patients) were embolized using a gelatin sponge followed by iodized oil. The PCA was performed within 3 to 21 days of the TAE. We compared complications between the TAE subgroups (i.e., absolute ethanol and gelatin sponge) and assessed potential correlations between tumor size and the operative time of the PCA. RESULTS All patients were successfully treated by combined TAE-PCA. Local control was achieved for all patients (monitoring period, 1-48 months; median, 28 months). Although the effect of TAE did not differ between subgroups, a significantly higher number of patients in the absolute ethanol group experienced intraprocedural pain than in the gelatin sponge group (p < 0.05). The operative time of the PCA was significantly correlated with the size of the RCC lesion (p < 0.01). The number of cryoneedles used for the PCA was also correlated with the size of the RCC lesion (p < 0.0001). CONCLUSIONS For TAE prior to PCA for early-stage RCC, gelatin sponges can replace absolute ethanol to reduce intraprocedural pain. Tumor size correlates with operative time and the number of cryoneedles needed for PCA, which suggests the total medical cost for PCA therefore varies based on the tumor's size.
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Affiliation(s)
- Miki Terauchi
- Department of Interventional Radiology, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211 Kozukuechou, Kohoku-ku, Yokohama 222-0036, Japan
| | - Tsuneo Yamashiro
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Shungo Sawamura
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Shingo Koyama
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
| | - Noboru Nakaigawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
- Department of Urology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
| | - Keiichi Kondo
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
- Kanazawa-Hakkei Kondo Urology Clinic, 19-14 Seto, Kanazawa-ku, Yokohama 236-0027, Japan
| | - Hisashi Hasumi
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (N.N.); (K.K.); (H.H.); (K.M.)
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (T.Y.); (S.S.); (S.K.); (D.U.)
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Karamık K, Anıl H, Yıldız A, Güzel A, Akdemir S, Arslan M. Perioperative, Oncological, and Functional Outcomes after Retroperitoneal Laparoscopic Partial Nephrectomy in Elderly Patients: A Propensity Score Matching Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:915-920. [PMID: 39206537 DOI: 10.1089/lap.2024.0234] [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] [Indexed: 09/04/2024] Open
Abstract
Purpose: We aimed to assess the perioperative, oncological, and functional outcomes of patients aged 70 years or older following retroperitoneal laparoscopic partial nephrectomy (LPN) and compare their results with younger patients. Materials and Methods: A retrospective review of our prospectively maintained database identified 329 patients who underwent retroperitoneal LPN from January 2013 to October 2022. The patients divided into 2 groups defined by age ≥70 or <70 years at the time of surgery. A propensity score matching analysis was conducted to obtain two balanced groups. The groups were compared for safety (perioperative outcomes) and efficacy (oncological and functional outcomes). Results: After matching, all variables were well balanced with no differences between the two cohorts. No significant differences were found in perioperative outcomes, including operative time, warm ischemia time, blood loss, hospital stay, and complications (P values >.05). Concerning functional outcomes, postoperative glomerular filtration rate and decrease in glomerular filtration rate were significantly better in the younger group compared with the elderly groups (P = .003 and P = .001, respectively). Although margin, ischemia, complications rates were similar between the cohorts (P = .068), Pentafecta rates were lower in the elderly patients (P = .029). In terms of oncological outcomes, recurrence-free survival and cancer-specific survival were comparable between the groups. Conclusion: Retroperitoneal LPN can be performed safely and with adequate oncological efficacy in elderly patients.
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Affiliation(s)
- Kaan Karamık
- Department of Urology, Kemer State Hospital, Antalya, Turkey
| | - Hakan Anıl
- Department of Urology, Medical Park Seyhan Hospital, Adana, Turkey
| | - Ali Yıldız
- Department of Urology, Faculty of Medicine, Okan University, Istanbul, Turkey
| | - Ahmet Güzel
- Department of Urology, Aydın State Hospital, Aydın, Turkey
| | - Serkan Akdemir
- Department of Urology, Tınaztepe Hospital, İzmir, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Okan University, Istanbul, Turkey
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Gao H, Zhou L, Zhang J, Wang Q, Luo Z, Xu Q, Tan Y, Shuai H, Zhou J, Cai X, Zheng Y, Shan W, Duan X, Wu T. Comparative efficacy of cryoablation versus robot-assisted partial nephrectomy in the treatment of cT1 renal tumors: a systematic review and meta-analysis. BMC Cancer 2024; 24:1150. [PMID: 39285347 PMCID: PMC11403780 DOI: 10.1186/s12885-024-12917-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE This study utilizes a meta-analytic approach to investigate the effects of cryoablation and robot-assisted partial nephrectomy on perioperative outcomes, postoperative renal function, and oncological results in patients. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library database) were systematically searched to identify relevant studies published in English up to November 2023. The primary outcomes were perioperative results, complications, postoperative renal function and oncologic outcomes. Review Manager 5.4 was used for this analysis. RESULTS This study included a total of 10 studies comprising 2,011 patients. Compared to RAPN (Robot-Assisted Partial Nephrectomy), the CA (Cryoablation) group had a shorter hospital stay [MD -1.76 days; 95% CI -3.12 to -0.41; p = 0.01], less blood loss [MD -104.60 ml; 95% CI -152.58 to -56.62; p < 0.0001], and fewer overall complications [OR 0.62; 95% CI 0.45 to 0.86; p = 0.004], but a higher recurrence rate [OR 7.83; 95% CI 4.32 to 14.19; p < 0.00001]. There were no significant differences between the two groups in terms of operative time, minor complications (Clavien-Dindo Grade 1-2), major complications (Clavien-Dindo Grade 3-5), changes in renal function at 12 months post-operation, RFS (Recurrence-Free Survival), and OS (Overall Survival). CONCLUSION The evidence provided by this meta-analysis indicates that the therapeutic effects of Cryoablation (CA) are similar to those of Robot-Assisted Partial Nephrectomy (RAPN) in terms of perioperative outcomes and renal function. However, the recurrence rate of tumors treated with CA is significantly higher. SYSTEMATIC REVIEW REGISTRATION The study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023465846).
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Affiliation(s)
- HuiYu Gao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - Lin Zhou
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - JiaBin Zhang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - Qiang Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - ZiYuan Luo
- Department of Clinical Medicine, North Sichuan Medical College, No. 234 Fujiang Road Shunqing, Nanchong, Sichuan, 637000, P.R. China
| | - Qian Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - Ying Tan
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - Hui Shuai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - JunJie Zhou
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - Xiang Cai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - YongBo Zheng
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China
| | - Wang Shan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xi Duan
- Department of Dermatology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road Shunqing, Nanchong, Sichuan, 637000, P.R. China.
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Shunqing district, Nanchong, Sichuan, 637000, P.R. China.
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Chlorogiannis DD, Chlorogiannis A, Filippiadis DK, Kelekis A, Makris GC, Georgiades C. Impact of Percutaneous Cryoablation on Renal Function in Patients with Stage I Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2024; 35:1278-1287.e3. [PMID: 38914159 DOI: 10.1016/j.jvir.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/26/2024] Open
Abstract
PURPOSE To assess the effect of cryoablation on renal function (measured by estimated glomerular filtration rate [eGFR] or serum creatinine) for treating Stage I renal cancer. MATERIALS AND METHODS The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were systematically searched from inception to May 1, 2023. Cohort studies that included data on change of eGFR and serum creatinine increase were included. Meta-analysis was performed by measuring the weighted mean difference and by fitting random-effect models. RESULTS Overall, 38 studies were included, comprising 3,202 participants. Percutaneous cryoablation was associated with an absolute eGFR reduction of -3.06 mL/min/1.73 m2 (95% CI, -4.12 to -2.01; P < .001) and serum creatinine increase of 0.05 mg/dL (95% CI, -0.02 to 0.11; P > .05). The weighted absolute mean difference of percutaneous cryoablation for treating Stage T1b renal cell carcinoma was estimated at -5.19 mL/min/1.73 m2 (95% CI, -11.1 to 0.72; P > .05). Lastly, when analyzing studies that included cohorts with solitary kidneys, the pooled weighted mean difference was estimated as -3.27 mL/min/1.73 m2 (95% CI, -6.79 to 0.25; P > .05). CONCLUSIONS Percutaneous cryoablation for Stage 1 renal cell carcinoma has minimal significant impact on renal function (measured by eGFR or serum creatinine). The same outcome was observed in patients with larger tumors (T1b) and those with solitary kidneys.
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Affiliation(s)
| | - Anargyros Chlorogiannis
- Department of Health Economics, Policy and Management, Karolinska Institutet, Stockholm, Sweden
| | - Dimitrios K Filippiadis
- 2nd Department of Radiology, University General Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, University General Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory C Makris
- Department of Vascular and Interventional Radiology, Guy's and St Thomas Hospital, NHS Foundation Trust, London, United Kingdom
| | - Christos Georgiades
- Department of Vascular and Interventional Radiology, Johns Hopkins University, Baltimore, Maryland
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Campbell WA, Makary MS. Advances in Image-Guided Ablation Therapies for Solid Tumors. Cancers (Basel) 2024; 16:2560. [PMID: 39061199 PMCID: PMC11274819 DOI: 10.3390/cancers16142560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Image-guided solid tumor ablation methods have significantly advanced in their capability to target primary and metastatic tumors. These techniques involve noninvasive or percutaneous insertion of applicators to induce thermal, electrochemical, or mechanical stress on malignant tissue to cause tissue destruction and apoptosis of the tumor margins. Ablation offers substantially lower risks compared to traditional methods. Benefits include shorter recovery periods, reduced bleeding, and greater preservation of organ parenchyma compared to surgical intervention. Due to the reduced morbidity and mortality, image-guided tumor ablation offers new opportunities for treatment in cancer patients who are not candidates for resection. Currently, image-guided ablation techniques are utilized for treating primary and metastatic tumors in various organs with both curative and palliative intent, including the liver, pancreas, kidneys, thyroid, parathyroid, prostate, lung, breast, bone, and soft tissue. The invention of new equipment and techniques is expanding the criteria of eligible patients for therapy, as now larger and more high-risk tumors near critical structures can be ablated. This article provides an overview of the different imaging modalities, noninvasive, and percutaneous ablation techniques available and discusses their applications and associated complications across various organs.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Bertolo R, Amparore D, Muselaers S, Marchioni M, Wu Z, Campi R, Antonelli A. Thermal ablation for T1b renal cancer: an "I wish I could, but I cannot?". Minerva Urol Nephrol 2024; 76:254-259. [PMID: 38742559 DOI: 10.23736/s2724-6051.24.05842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Riccardo Bertolo
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy -
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands -
| | - Daniele Amparore
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stijn Muselaers
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michele Marchioni
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Zhenjie Wu
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Shanghai Hospital, Naval Medical University, Shanghai, China
| | - Riccardo Campi
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Antonelli
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy
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Barjolle I, Ah-Thiane L, Frampas E, Karam G, Rigaud J, David A. Efficacy and safety of cryoablation for localized renal tumor as an alternative approach to partial nephrectomy. Front Oncol 2023; 13:1235705. [PMID: 37860181 PMCID: PMC10584313 DOI: 10.3389/fonc.2023.1235705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Renal cryoablation displays a profile of high tolerance, including in a frail population. Cryoablation appears as a validated alternative treatment to surgery for renal tumors smaller than 4 cm. However, evidence is lacking for larger tumors, despite encouraging data for tumors up to 7 cm. Material and methods This retrospective descriptive study of a population with a stage T1b renal tumor treated by cryoablation was conducted at the Nantes University Hospital between January 2009 and July 2021. Primary endpoint was 3-year rate of local recurrence. Secondary endpoints included technical efficacy, overall and cancer-specific survivals, and safety assessment. Results A total of 63 patients were analyzed. Three-year rate of local recurrence was 11.1%. Primary and secondary technical efficacies were achieved in 88.9% and 96.8% of patients, respectively, and 3-year overall and cancer-specific survival were 87.3% and 95.2%, respectively. Most patients (73%) experienced no complications, 13% of patients had minor (CIRSE grades 1 or 2) adverse effects, and 13% had severe but non-lethal (CIRSE grade 3) adverse effects. One patient died following cryoablation due to colic perforation. The most common AE (all grades) was hemorrhage (9.5%). Discussion This study showed a good efficacy and safety of cryoablation for renal tumors up to 7 cm (T1b). Our results were consistent with a rather sparse literature and contributed to guide future recommendations about cryoablation as an alternative to surgery for T1b renal tumors.
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Affiliation(s)
- Irène Barjolle
- Department of Radiology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Loic Ah-Thiane
- Department of Radiotherapy, Western Cancer institute (ICO) René Gauducheau 44805 St-Herblain, Nantes University, Nantes, France
| | - Eric Frampas
- Department of Radiology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Georges Karam
- Department of Urology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Arthur David
- Department of Radiology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
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Klein C, Cazalas G, Margue G, Piana G, DE Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Michiels C, Jegonday MA, Rouviere O, Grenier N, Marcelin C, Bernhard JC. Percutaneous tumor ablation versus image guided robotic-assisted partial nephrectomy for cT1b renal cell carcinoma: a comparative matched-pair analysis (UroCCR 80). Minerva Urol Nephrol 2023; 75:559-568. [PMID: 37728492 DOI: 10.23736/s2724-6051.23.05274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm). METHODS Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization. RESULTS A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS 3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France -
| | - Grégoire Cazalas
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | | | - Afshin Gangi
- Department of Interventional Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Phillipe Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers University Hospital, Angers, France
| | - Remi Grange
- Department of Radiology, Saint-Etienne University Hospital, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Bergonié Institute, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | | | - Nicolas Grenier
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Clément Marcelin
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
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Hannan R, McLaughlin MF, Pop LM, Pedrosa I, Kapur P, Garant A, Ahn C, Christie A, Zhu J, Wang T, Robles L, Durakoglugil D, Woldu S, Margulis V, Gahan J, Brugarolas J, Timmerman R, Cadeddu J. Phase 2 Trial of Stereotactic Ablative Radiotherapy for Patients with Primary Renal Cancer. Eur Urol 2023; 84:275-286. [PMID: 36898872 PMCID: PMC10440291 DOI: 10.1016/j.eururo.2023.02.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Most renal cell carcinomas (RCCs) are localized and managed by active surveillance, surgery, or minimally invasive techniques. Stereotactic ablative radiation (SAbR) may provide an innovative non-invasive alternative although prospective data are limited. OBJECTIVE To investigate whether SAbR is effective in the management of primary RCCs. DESIGN, SETTING, AND PARTICIPANTS Patients with biopsy-confirmed radiographically enlarging primary RCC (≤5 cm) were enrolled. SAbR was delivered in either three (12 Gy) or five (8 Gy) fractions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was local control (LC) defined as a reduction in tumor growth rate (compared with a benchmark of 4 mm/yr on active surveillance) and pathologic evidence of tumor response at 1 yr. Secondary endpoints included LC by the Response Evaluation Criteria in Solid Tumors (RECIST 1.1), safety, and preservation of kidney function. Exploratory tumor cell-enriched spatial protein and gene expression analysis were conducted on pre- and post-treatment biopsy samples. RESULTS AND LIMITATIONS Target accrual was reached with the enrollment of 16 ethnically diverse patients. Radiographic LC at 1 yr was observed in 94% of patients (15/16; 95% confidence interval: 70, 100), and this was accompanied by pathologic evidence of tumor response (hyalinization, necrosis, and reduced tumor cellularity) in all patients. By RECIST, 100% of the sites remained without progression at 1 yr. The median pretreatment growth rate was 0.8 cm/yr (interquartile range [IQR]: 0.3, 1.4), and the median post-treatment growth rate was 0.0 cm/yr (IQR: -0.4, 0.1, p < 0.002). Tumor cell viability decreased from 4.6% to 0.7% at 1 yr (p = 0.004). With a median follow-up of 36 mo for censored patients, the disease control rate was 94%. SAbR was well tolerated with no grade ≥2 (acute or late) toxicities. The average glomerular filtration rate declined from a baseline of 65.6 to 55.4 ml/min at 1 yr (p = 0.003). Spatial protein and gene expression analyses were consistent with the induction of cellular senescence by radiation. CONCLUSIONS This clinical trial adds to the growing body of evidence suggesting that SAbR is effective for primary RCC supporting its evaluation in comparative phase 3 clinical trials. PATIENT SUMMARY In this clinical trial, we investigated a noninvasive treatment option of stereotactic radiation therapy for the treatment of primary kidney cancer and found that it was safe and effective.
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Affiliation(s)
- Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Mark F McLaughlin
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Laurentiu M Pop
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Ivan Pedrosa
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Payal Kapur
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Pathology, University of Texas Southwestern, Dallas, TX, USA
| | - Aurelie Garant
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chul Ahn
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, University of Texas Southwestern, Dallas, TX, USA
| | - Alana Christie
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Zhu
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tao Wang
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Liliana Robles
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Deniz Durakoglugil
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Solomon Woldu
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Vitaly Margulis
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Jeffrey Gahan
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - James Brugarolas
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Cadeddu
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
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10
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Fourniol C, Dariane C, Correas J, Audenet F, Pinar U, Anract J, Hostettler A, Panthier F, Timsit MO, Mejean A. Volumetric and functional outcomes at 1-year between percutaneous-ablation and partial-nephrectomy for T1b renal tumors. Prog Urol 2023; 33:509-518. [PMID: 37633733 DOI: 10.1016/j.purol.2023.08.019] [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: 04/13/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Indication for percutaneous-ablation (PA) is gradually expanding to renal tumors T1b (4-7cm). Few data exist on the alteration of renal functional volume (RFV) post-PA. Yet, it is a surrogate marker of post partial-nephrectomy (PN) glomerular filtration rate (GFR) impairment. The objective was to compare RFV and GFR at 1-year post-PN or PA, in this T1b population. METHODS Patients with unifocal renal tumor≥4cm treated between 2014 and 2019 were included. Tumor, homolateral (RFVh), contralateral RFV, and total volumes were assessed by manual segmentation (3D Slicer) before and at 1 year of treatment, as was GFR. The loss of RFV, contralateral hypertrophy, and preservation of GFR were compared between both groups (PN vs. PA). RESULTS 144 patients were included (87PN, 57PA). Preoperatively, PA group was older (74 vs. 59 years; P<0.0001), had more impaired GFR (73 vs. 85mL/min; P=0.0026) and smaller tumor volume(31.1 vs. 55.9cm3; P=0.0007) compared to PN group. At 1 year, the PN group had significantly more homolateral RFV loss (-19 vs. -14%; P=0.002), and contralateral compensatory hypertrophy (+4% vs. +1,8%; P=0.02, respectively). Total-RFV loss was similar between both (-21.7 vs. -19cm3; P=0.07). GFR preservation was better in the PN group (95.9 vs. 90.7%; P=0.03). In multivariate analysis, age and tumor size were associated with loss of RFVh. CONCLUSION For renal tumors T1b, PN is associated with superior compensatory hypertrophy compared with PA, compensating for the higher RFVh loss, resulting in similar ΔRFV-total between both groups. The superior post-PN GFR preservation suggests that the preserved quantitative RFV factor is insufficient. Therefore, the underlying quality of the parenchyma would play a major role in postoperative GFR.
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Affiliation(s)
- C Fourniol
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - C Dariane
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J Correas
- Service de radiologie adulte, hôpital Necker-Enfants-Malades, AP-HP, centre, université de Paris, 245, rue de Sèvres, 75015 Paris, France
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - U Pinar
- Service d'urologie, hôpital Pitié-Salpêtrière, AP-HP-centre, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Anract
- Service d'urologie, hôpital Cochin, AP-HP-centre, université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Hostettler
- Département de recherche et développement, IRCAD France, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - F Panthier
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Mejean
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
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11
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Castellana R, Natrella M, Fanelli G, Lancellotta V, Cornacchione P, Castellana M, Filippiadis D, Tagliaferri L, Iezzi R. Efficacy and safety of MWA versus RFA and CA for renal tumors: A systematic review and meta-analysis of comparison studies. Eur J Radiol 2023; 165:110943. [PMID: 37392547 DOI: 10.1016/j.ejrad.2023.110943] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Thermal ablation procedures represent an alternative treatment option for patients with T1a renal tumors. Radiofrequency ablation (RFA) and cryoablation (CA) are the most used and studied techniques, while microwave ablation (MWA) has progressively emerged in recent years. Our aim was to assess the effectiveness and safety of MWA in comparison to RFA and CA for the treatment of primary renal tumors. METHOD Pubmed, CENTRAL, Web of Science and Scopus were searched until March 2023 to identify studies aimed at comparing the efficacy and safety of MWA with those of RFA and CA for the treatment of patients with primary renal tumors. We compared MWA and RFA/CA primary technique efficacy, local recurrences, overall and cancer-specific survival, major and overall complications, and eGFR changes. Moreover, subgroup analyses were conducted (MWA vs RFA; MWA vs CA; MWA vs RFA/CA in T1a renal tumors). RESULTS Ten retrospective studies with 2258 thermal ablations were included (508 MWA and 1750 RFA /CA). MWA had fewer local recurrences (OR = 0.31; 95% CI, 0.16, 0.62; p = 0.0008) than RFA/CA; the other outcomes were not significantly different. In subgroup analyses, MWA resulted to have fewer overall complications than RFA (OR = 0.60; 95% CI, 0.38, 0.97; p = 0.04) and CA (OR = 0.49; 95% CI, 0.28, 0.85; p = 0.01); moreover, MWA was associated with fewer recurrences than CA (OR = 0.30; 95% CI, 0.11, 0.84; p = 0.02). In T1a renal tumors subgroup analysis, the outcomes were not significantly different. CONCLUSIONS MWA is an ablative procedure as effective and safe as RFA or CA for the treatment of renal tumors.
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Affiliation(s)
- Roberto Castellana
- Radiologia Diagnostica ed Interventistica, Ospedale Regionale "U. Parini", viale Ginevra 3, 11100 Aosta, Italy.
| | - Massimiliano Natrella
- Radiologia Diagnostica ed Interventistica, Ospedale Regionale "U. Parini", viale Ginevra 3, 11100 Aosta, Italy
| | - Gianluca Fanelli
- Radiologia Diagnostica ed Interventistica, Ospedale Regionale "U. Parini", viale Ginevra 3, 11100 Aosta, Italy
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Patrizia Cornacchione
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Dimitrios Filippiadis
- Diagnostic and Interventional Radiology 2nd Radiology Dpt, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, 1 Rimini str, 12462 Haidari/Athens, Greece
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia-Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A Gemelli 8, 00168 Rome, Italy
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12
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Vrabel MR, Schulman JA, Gillam FB, Mantooth SM, Nguyen KG, Zaharoff DA. Focal Cryo-Immunotherapy with Intratumoral IL-12 Prevents Recurrence of Large Murine Tumors. Cancers (Basel) 2023; 15:2210. [PMID: 37190138 PMCID: PMC10137033 DOI: 10.3390/cancers15082210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Focal ablation technologies are routinely used in the clinical management of inoperable solid tumors but they often result in incomplete ablations leading to high recurrence rates. Adjuvant therapies, capable of safely eliminating residual tumor cells, are therefore of great clinical interest. Interleukin-12 (IL-12) is a potent antitumor cytokine that can be localized intratumorally through coformulation with viscous biopolymers, including chitosan (CS) solutions. The objective of this research was to determine if localized immunotherapy with a CS/IL-12 formulation could prevent tumor recurrence after cryoablation (CA). Tumor recurrence and overall survival rates were assessed. Systemic immunity was evaluated in spontaneously metastatic and bilateral tumor models. Temporal bulk RNA sequencing was performed on tumor and draining lymph node (dLN) samples. In multiple murine tumor models, the addition of CS/IL-12 to CA reduced recurrence rates by 30-55%. Altogether, this cryo-immunotherapy induced complete durable regression of large tumors in 80-100% of treated animals. Additionally, CS/IL-12 prevented lung metastases when delivered as a neoadjuvant to CA. However, CA plus CS/IL-12 had minimal antitumor activity against established, untreated abscopal tumors. Adjuvant anti-PD-1 therapy delayed the growth of abscopal tumors. Transcriptome analyses revealed early immunological changes in the dLN, followed by a significant increase in gene expression associated with immune suppression and regulation. Cryo-immunotherapy with localized CS/IL-12 reduces recurrences and enhances the elimination of large primary tumors. This focal combination therapy also induces significant but limited systemic antitumor immunity.
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Affiliation(s)
- Maura R. Vrabel
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
| | - Jacob A. Schulman
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - Francis B. Gillam
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - Siena M. Mantooth
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
| | - Khue G. Nguyen
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - David A. Zaharoff
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
- Lineberger Comprehensive Cancer Center, UNC-Chapel Hill, Chapel Hill, NC 27599, USA
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13
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Aikawa K, Yanagisawa T, Fukuokaya W, Shimizu K, Miyajima K, Nakazono M, Iwatani K, Matsukawa A, Obayashi K, Kimura S, Tsuzuki S, Sasaki H, Abe H, Sadaoka S, Miki J, Kimura T. Percutaneous cryoablation versus partial nephrectomy for cT1b renal tumors: An inverse probability weight analysis. Urol Oncol 2023; 41:150.e11-150.e19. [PMID: 36604229 DOI: 10.1016/j.urolonc.2022.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/13/2022] [Accepted: 11/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate differential clinical outcomes in patients treated with partial nephrectomy (PN) vs. percutaneous cryoablation (PCA) for cT1b renal tumors. MATERIALS AND METHODS We retrospectively analyzed the records of 119 patients who had undergone PN (n = 90) or PCA (n = 29) for cT1b renal tumors. Inverse probability weighting (IPW) was used for balancing patient demographics, including renal function and tumor complexity. Perioperative complications, renal function preservation rates, and oncological outcomes such as local recurrence-free, metastasis-free, cancer-specific, and overall survival were compared using IPW-adjusted restricted mean survival times (RMSTs). RESULTS PCA was more likely to be selected for octogenarians (odds ratio: 11.4, 95% confidence interval [CI]: 3.33-45.1). During the median follow-up of 43 months in the PCA group and 36.5 months in the PN group, unablated local residue or local recurrence was noted in 6 patients in the PCA group and local recurrence was noted in 4 patients in the PN groups. Of the 6 patients in the PCA group, 4 underwent salvage PCA, and local control had been achieved at the last visit. In the IPW-adjusted population, PCA had significantly worse local recurrence-free survival compared with PN (IPW-adjusted RMST difference: -22.7 months, 95% CI: -45.3 to -0.4, P = 0.046). IPW-adjusted RMST for metastasis-free survival (P = 0.23), cancer-specific survival (P = 0.77), and overall survival (P = 0.11) did not differ between PCA and PN. In addition, PN was not a predictor for local control failure at the last visit (odds ratio: 0.30, 95%CI: 0.05-1.29). There were no statistically significant differences between PN and PCA in renal function preservation or overall/severe complication rates. CONCLUSIONS In patients with cT1b renal tumor, although the local recurrence rate is higher for PCA than for PN, PCA provides comparable distant oncologic outcomes. PCA can be an alternative treatment option for elderly, comorbid patients, even those with cT1b renal tumors.
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Affiliation(s)
- Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kanichiro Shimizu
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koki Obayashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Shunichi Sadaoka
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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14
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Yanagisawa T, Mori K, Kawada T, Motlagh RS, Mostafaei H, Quhal F, Laukhtina E, Rajwa P, Aydh A, König F, Pallauf M, Pradere B, Miki J, Kimura T, Egawa S, Shariat SF. Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: A systematic review and meta-analysis. Urol Oncol 2022; 40:315-330. [PMID: 35562311 DOI: 10.1016/j.urolonc.2022.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/21/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors. MATERIALS AND METHODS Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors. RESULTS Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28-0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23-0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32-1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23-0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors. CONCLUSIONS AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Hospital Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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15
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Dong L, Liang WY, Ya L, Yang L, Qiang W. A Systematic Review and Meta-Analysis of Minimally Invasive Partial Nephrectomy Versus Focal Therapy for Small Renal Masses. Front Oncol 2022; 12:732714. [PMID: 35692758 PMCID: PMC9178090 DOI: 10.3389/fonc.2022.732714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 04/15/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundMinimally invasive partial nephrectomy (MIPN) and focal therapy (FT) are popular trends for small renal masses (SRMs). However, there is currently no systematic comparison between MIPN and FT of SRMs. Therefore, we systematically study the perioperative, renal functional, and oncologic outcomes of MIPN and FT in SRMs.MethodsWe have searched the Embase, Cochrane Library, and PubMed for articles between MIPN (robot-assisted partial nephrectomy and laparoscopic partial nephrectomy) and FT {radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), irreversible electroporation, non-thermal [irreversible electroporation (IRE)] ablation, and stereotactic body radiation therapy (SBRT)}. We calculated pooled mean difference (MD), odds ratios (ORs), and 95% confidence intervals (CIs) (CRD42021260787).ResultsA total of 26 articles (n = 4,420) were included in the study. Compared with MIPN, the operating time (OP) of FT had significantly lower (SMD, −1.20; CI, −1.77 to −0.63; I2 = 97.6%, P < 0.0001), estimated blood loss (EBL) of FT had significantly less (SMD, −1.20; CI, −1.77 to −0.63; I2 = 97.6%, P < 0.0001), length of stay (LOS) had shorter (SMD, −0.90; CI, −1.26 to −0.53; I2 = 92.2%, P < 0.0001), and estimated glomerular filtration rate (eGFR) of FT was significantly lower decrease (SMD, −0.90; CI, −1.26 to −0.53; I2 = 92.2%, P < 0.0001). However, FT possessed lower risk in minor complications (Clavien 1–2) (OR, 0.69; CI, 0.45 to 1.07; I2 = 47%, P = 0.023) and overall complications (OR, 0.71; CI, 0.51 to 0.99; I2 = 49.2%, P = 0.008). Finally, there are no obvious difference between FT and MIPN in local recurrence, distant metastasis, and major complications (P > 0.05).ConclusionFT has more advantages in protecting kidney function, reducing bleeding, shortening operating time, and shortening the length of stay. There is no difference in local recurrence, distant metastasis, and major complications. For the minimally invasive era, we need to weigh the advantages and disadvantages of all aspects to make comprehensive choices.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier PROSPERO (CRD42021260787).
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Affiliation(s)
- Lin Dong
- Department of Urology, Pengzhou People’s Hospital, Chengdu, China
| | - Wang You Liang
- Department of Laboratory, Pengzhou People’s Hospital, Chengdu, China
| | - Lu Ya
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Liu Yang
- Department of Urology, Pengzhou People’s Hospital, Chengdu, China
- *Correspondence: Liu Yang,
| | - Wei Qiang
- Department of Urology, West China Fourth Hospital of Sichuan University, Chengdu, China
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16
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Shi H, Li J, Fan Z, Yang J, Fu S, Wang H, Wang J, Zhang J. Comparison of Radiofrequency Ablation Versus Cryoablation For T1 Renal Tumors: An Evidence-Based Analysis of Comparative Outcomes. Front Oncol 2022; 12:802437. [PMID: 35530360 PMCID: PMC9072730 DOI: 10.3389/fonc.2022.802437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/24/2022] [Indexed: 12/16/2022] Open
Abstract
Objective To discuss the differences in the effectiveness and security for T1 renal tumors by radiofrequency ablation (RFA) and cryoablation (CA). Methods We systematically searched the Cochrane Library, PubMed, Embase, CNKI databases, and Science databases, and the date was from the above database establishment to August 2021. Controlled trials on RFA and CA for T1 renal tumors were included. The meta-analysis was conducted with the Review Manager 5.4 software. Results A total of ten studies with 2,367 patients were included in the analysis. There were no significant differences in complications (odds ratio [OR], 1.23; 95% CI, 0.80 to 1.90; p=0.35), primary technique efficacy rate (OR, 1.01; 95% CI, 0.33 to 3.14; p=0.98), changes in serum creatinine (weighted mean difference [WMD], 0.53; 95% CI, -0.50 to 1.57; p=0.31), or 5-year survival rate (hazard ratio [HR], 1.11; 95% CI, 0.41 to 3.00; p=0.84) among patients undergoing RFA and CA. However, compared with patients who underwent RFA, patients who underwent CA had a lower Local recurrence (OR: 2.25; 95% CI: 1.38 to 3.67; p = 0.001). Conclusion The analysis demonstrated that in the treatment of T1 renal tumors, CA may be associated with lower local recurrence rates. However, no differences were observed in terms of primary technique efficacy rate, 5-year survival rate, changes in serum creatinine, and complication rate between groups. Systematic Review Registration [https://www.crd.york.ac.uk/PROSPERO/], identifier PROSPERO (CRD42021295160).
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Affiliation(s)
- Hongjin Shi
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Jinze Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhinan Fan
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Jing Yang
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Shi Fu
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
| | - Jinsong Zhang
- Department of Urology, The Second Affiliated Hospital, Kunming Medical University, Kunming, China
- *Correspondence: Jinsong Zhang,
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17
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Chan VWS, Abul A, Osman FH, Ng HHL, Wang K, Yuan Y, Cartledge J, Wah TM. Ablative therapies versus partial nephrectomy for small renal masses - A systematic review and meta-analysis. Int J Surg 2022; 97:106194. [PMID: 34958968 DOI: 10.1016/j.ijsu.2021.106194] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND High quality studies and reviews on the management of small renal masses (SRM) are lacking. This review aims to compare oncological outcomes in patients undergoing ablative therapies (AT) or partial nephrectomy (PN) for T1a or T1b SRM. MATERIAL AND METHODS Medline, EMBASE, Cochrane CENTRAL and conference proceedings were searched on the 15th July 2020 for comparative studies respective to our research question. The ROBINS-I tool and the GRADE approach were used to assess any risk of biases and certainty of evidence in the included studies. The review is registered on PROSPERO. RESULTS 1,748 records were retrieved. 32 observational studies and 1 RCT integrating 74,946 patients were included. Patients undergoing AT patients are significantly older than PN patients (MD 5.70, 95%CI 3.83-7.58). In T1a patients, AT patients have significantly worse overall survival (HR 1.64, 95%CI 1.39-1.95). Local recurrence-free survival is similar with PN in patients with longer than five-years follow up (HR 1.54, 95%CI 0.88-2.71). AT patients also have similar cancer-specific survival (CSS), metastasis-free survival, disease-free survival, significantly fewer post-operative complications (RR 0.72, 95%CI 0.55-0.94), and a smaller decline in estimated glomerular filtration rate post-operatively (MD: -7.42, 95%CI -13.1 to -1.70) compared to those undergoing PN. Evidence contradicts in T1b patients for oncological outcomes. CONCLUSIONS AT have similar long-term oncological durability; lower rates of complications and superior kidney function preservation compared to PN. Given the low quality of evidence, AT is a reasonable alternative to PN in frail and co-morbid patients. Long-term high-quality studies are needed to confirm the potential benefits of AT, especially in T1b patients. PROSPERO REGISTRATION CRD42020199099.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK Department of Medicine, McMaster University, Hamilton, Canada Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK Department of Diagnostic and Interventional Radiology, Institute of Oncology, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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18
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Bianchi L, Chessa F, Piazza P, Ercolino A, Mottaran A, Recenti D, Serra C, Gaudiano C, Cappelli A, Modestino F, Golfieri R, Bertaccini A, Marcelli E, Porreca A, Celia A, Schiavina R. Percutaneous ablation or minimally invasive partial nephrectomy for cT1a renal masses? A propensity score-matched analysis. Int J Urol 2021; 29:222-228. [PMID: 34894001 DOI: 10.1111/iju.14758] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Local tumor ablation to treat small renal mass is increasing. The aim of the present study was to compare oncologic outcomes among patients with T1 renal mass treated with partial nephrectomy and local tumor ablation. METHODS To reduce the inherent differences between patients undergoing laparoscopic or robot-assisted partial nephrectomy (n = 405) and local tumor ablation (n = 137), we used a 1:1 propensity score-matched analysis. Local tumor ablation consisted of radiofrequency ablation and cryoablation. Disease-free survival, overall survival and other causes mortality-free survival rates were estimated using the Kaplan-Meier method. Multivariable logistic regression and competing-risk regression models were used to identify predictors of complications, recurrence and other causes mortality, respectively. RESULTS Partial nephrectomy had higher disease-free survival estimates, as compared with local tumor ablation (92.8% vs 80.4% at 5 years, P = 0.02), with no significant difference between radiofrequency ablation and cryoablation (P = 0.9). Ablation showed comparable overall survival estimates to partial nephrectomy (91% vs 95.8% at 5 years, P = 0.6). The 5-year recurrence rates were 7.9% versus 23.8% for patients aged ≤70 years, and 2.5% versus 11.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively; the 5-year other causes mortality rates were 0% and 2.2% for patients treated with partial nephrectomy and ablation aged ≤70 years, and 3% versus 10.9% for patients aged >70 years treated with partial nephrectomy and ablation, respectively. At multivariable analysis, ablation was associated with fewer complications (odds ratio 0.41; P = 0.01). At competing risks analysis, age (hazard ratio 0.96) and ablation (hazard ratio 4.56) were independent predictors of disease recurrence (all P ≤ 0.008). CONCLUSIONS Local tumor ablation showed a higher risk of recurrence and lower risk of complications compared with partial nephrectomy, with comparable overall survival rates.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dario Recenti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Carla Serra
- Interventional Ultrasound Unit, Department of Organ Failure and Transplantations, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Emanuela Marcelli
- Department of Experimental, Diagnostic and Specialty Medicine, Laboratory of Bioengineering, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology, Padua, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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Lopez O, Chevallier O, Guillen K, Comby PO, Pellegrinelli J, Tinel C, Falvo N, Midulla M, Mourey E, Loffroy R. Selective Arterial Embolization with N-Butyl Cyanoacrylate Prior to CT-Guided Percutaneous Cryoablation of Kidney Malignancies: A Single-Center Experience. J Clin Med 2021; 10:jcm10214986. [PMID: 34768506 PMCID: PMC8584960 DOI: 10.3390/jcm10214986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
The study’s purpose was to assess the safety, feasibility and efficiency of selective arterial embolization (SAE) using N-butyl cyanoacrylate (NBCA) glue before percutaneous cryoablation (PCA) of renal malignancies in patients whose tumor characteristics and/or comorbidities resulted in an unacceptable risk of bleeding. In this single-center retrospective study of 19 consecutive high-risk patients (median age, 74 years) with renal malignancies managed in 2017–2020 by SAE with NBCA followed by PCA, data about patients, tumor and procedures characteristics, complications, renal function and hemoglobin concentration before and after treatment, as well as recurrence were collected. Charlson comorbidity index was ≥4 in 89.5% of patients. Ten patients were treated by antiplatelet and/or anticoagulant therapy. Median tumor largest diameter was 3.75 cm (range, 1–6.5 cm) and R.E.N.A.L. nephrometry score was ≥7 in 80%, indicating substantial tumor complexity. No major complications were recorded and minor complications occurred in 7 patients. No residual tumor was found at 6-week imaging follow-up in 18/19 patients. Tumor recurrence was visible in 1/16 patients at 6-month imaging follow-up. No significant difference was found for renal function after treatment (p = 0.07), whereas significant decrease in hemoglobin concentration was noted (p = 0.00004), although it was relevant for only one patient who required only blood transfusion and no further intervention. SAE prior to PCA is safe and effective for managing renal malignancies in high-risk patients.
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Affiliation(s)
- Olivier Lopez
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.L.); (O.C.); (K.G.); (J.P.); (N.F.); (M.M.)
| | - Olivier Chevallier
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.L.); (O.C.); (K.G.); (J.P.); (N.F.); (M.M.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
| | - Kévin Guillen
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.L.); (O.C.); (K.G.); (J.P.); (N.F.); (M.M.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
| | - Pierre-Olivier Comby
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
- Department of Neuroradiology and Emergency Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France
| | - Julie Pellegrinelli
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.L.); (O.C.); (K.G.); (J.P.); (N.F.); (M.M.)
| | - Claire Tinel
- Department of Nephrology and Renal Transplantation, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France;
| | - Nicolas Falvo
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.L.); (O.C.); (K.G.); (J.P.); (N.F.); (M.M.)
| | - Marco Midulla
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.L.); (O.C.); (K.G.); (J.P.); (N.F.); (M.M.)
| | - Eric Mourey
- Department of Urology and Andrology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France;
| | - Romaric Loffroy
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (O.L.); (O.C.); (K.G.); (J.P.); (N.F.); (M.M.)
- Imaging and Artificial Vision (ImViA) Laboratory-EA 7535, University of Bourgogne/Franche-Comté, 9 Avenue Alain Savary, BP 47870, 21078 Dijon, France;
- Correspondence: ; Tel.: +33-380-293-677
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20
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Park BK, Shen SH, Fujimori M, Wang Y. Thermal Ablation for Renal Cell Carcinoma: Expert Consensus from the Asian Conference on Tumor Ablation. Korean J Radiol 2021; 22:1490-1496. [PMID: 34448380 PMCID: PMC8390817 DOI: 10.3348/kjr.2020.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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21
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Uemura T, Kato T, Nagahara A, Kawashima A, Hatano K, Ujike T, Ono Y, Higashihara H, Fujita K, Fukuhara S, Kiuchi H, Imamura R, Tomiyama N, Nonomura N, Uemura M. Therapeutic and Clinical Outcomes of Robot-assisted Partial Nephrectomy Versus Cryoablation for T1 Renal Cell Carcinoma. In Vivo 2021; 35:1573-1579. [PMID: 33910838 DOI: 10.21873/invivo.12413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND In cT1 renal cell carcinoma (RCC), very few studies have compared oncological outcomes and renal function preservation rates in nephron-sparing robot-assisted partial nephrectomy (RAPN) and percutaneous cryoablation (PCA). PATIENTS AND METHODS We retrospectively analysed 126 patients with cT1 RCC treated with RAPN (n=78) and computed tomography-guided PCA (n=48) between March 2016 and November 2019. Clinical data and outcomes were compared for the two groups. RESULTS There were no significant differences in the 3-year overall survival and relapse-free survival rates in the two groups (p=0.17 and p=0.093, respectively). The median percentage of estimated glomerular filtration rate preservation at 6 months after surgery was 91.8% and 91.4% in the RAPN and PCA groups, respectively (p=0.9). CONCLUSION In patients with cT1a RCC, oncological outcomes and renal function appear similar following RAPN and PCA.
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Affiliation(s)
- Toshihiro Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan;
| | - Akira Nagahara
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Hatano
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Ujike
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yusuke Ono
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Higashihara
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Fukuhara
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kiuchi
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoichi Imamura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
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22
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Kamran SC, Efstathiou JA. Current State of Personalized Genitourinary Cancer Radiotherapy in the Era of Precision Medicine. Front Oncol 2021; 11:675311. [PMID: 34026653 PMCID: PMC8139515 DOI: 10.3389/fonc.2021.675311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022] Open
Abstract
Radiation therapy plays a crucial role for the management of genitourinary malignancies, with technological advancements that have led to improvements in outcomes and decrease in treatment toxicities. However, better risk-stratification and identification of patients for appropriate treatments is necessary. Recent advancements in imaging and novel genomic techniques can provide additional individualized tumor and patient information to further inform and guide treatment decisions for genitourinary cancer patients. In addition, the development and use of targeted molecular therapies based on tumor biology can result in individualized treatment recommendations. In this review, we discuss the advances in precision oncology techniques along with current applications for personalized genitourinary cancer management. We also highlight the opportunities and challenges when applying precision medicine principles to the field of radiation oncology. The identification, development and validation of biomarkers has the potential to personalize radiation therapy for genitourinary malignancies so that we may improve treatment outcomes, decrease radiation-specific toxicities, and lead to better long-term quality of life for GU cancer survivors.
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Affiliation(s)
- Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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23
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Liu HY, Kang CH, Wang HJ, Chen CH, Luo HL, Chen YT, Cheng YT, Chiang PH. Comparison of Robot-Assisted Laparoscopic Partial Nephrectomy with Laparoscopic Cryoablation in the Treatment of Localised Renal Tumours: A Propensity Score-Matched Comparison of Long-Term Outcomes. Diagnostics (Basel) 2021; 11:diagnostics11050759. [PMID: 33922727 PMCID: PMC8146293 DOI: 10.3390/diagnostics11050759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 01/20/2023] Open
Abstract
Preserving renal function and controlling oncological outcomes are pertinent when managing renal neoplasms. Cryoablation is the recommended treatment only for clinical T1a stage renal tumour. Here, we compared the outcomes of robot-assisted laparoscopic partial nephrectomy (RaPN) and laparoscopic cryoablation (LCA) in the treatment of patients with localised T1-T2 renal tumours. Overall, 86 patients who received RaPN and 78 patients underwent LCA were included in this study. The intraoperative, postoperative, and oncological outcomes in the LCA group were non-inferior to the RaPN group. Moreover, LCA demonstrated shorter operative time (267.45 ± 104.53 min vs. 138.56 ± 45.28 min, p < 0.001), lower blood loss (300.56 ± 360.73 mL vs. 30.73 ± 50.31 mL, p < 0.001), and slight renal function deterioration because of the reduced invasiveness, without compromising on the oncological outcomes.
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Affiliation(s)
- Hui-Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
| | - Chih-Hsiung Kang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
| | - Hung-Jen Wang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
| | - Chien-Hsu Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
| | - Hao-Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 83301, Taiwan
| | - Yen-Ta Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
| | - Yuan-Tso Cheng
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
| | - Po-Hui Chiang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan; (H.-Y.L.); (C.-H.K.); (H.-J.W.); (C.-H.C.); (H.-L.L.); (Y.-T.C.); (Y.-T.C.)
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 83301, Taiwan
- Correspondence: ; Tel.: +886-77-317-123 (ext. 8094)
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Chandrasekar T, Boorjian SA, Capitanio U, Gershman B, Mir MC, Kutikov A. Collaborative Review: Factors Influencing Treatment Decisions for Patients with a Localized Solid Renal Mass. Eur Urol 2021; 80:575-588. [PMID: 33558091 DOI: 10.1016/j.eururo.2021.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT With the addition of active surveillance and thermal ablation (TA) to the urologist's established repertoire of partial (PN) and radical nephrectomy (RN) as first-line management options for localized renal cell carcinoma (RCC), appropriate treatment decision-making has become increasingly nuanced. OBJECTIVE To critically review the treatment options for localized, nonrecurrent RCC; to highlight the patient, renal function, tumor, and provider factors that influence treatment decisions; and to provide a framework to conceptualize that decision-making process. EVIDENCE ACQUISITION A collaborative critical review of the medical literature was conducted. EVIDENCE SYNTHESIS We identify three key decision points when managing localized RCC: (1) decision for surveillance versus treatment, (2) decision regarding treatment modality (TA, PN, or RN), and (3) decision on surgical approach (open vs minimally invasive). In evaluating factors that influence these treatment decisions, we elaborate on patient, renal function, tumor, and provider factors that either directly or indirectly impact each decision point. As current nomograms, based on preselected patient datasets, perform poorly in prospective settings, these tools should be used with caution. Patient decision aids are an underutilized tool in decision-making. CONCLUSIONS Localized RCC requires highly nuanced treatment decision-making, balancing patient- and tumor-specific clinical variables against indirect structural influences to provide optimal patient care. PATIENT SUMMARY With expanding treatment options for localized kidney cancer, treatment decision is highly nuanced and requires shared decision-making. Patient decision aids may be helpful in the treatment discussion.
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Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Boris Gershman
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Maria Carmen Mir
- Department of Urology, Fundación Instituto Valenciano Oncologia, Valencia, Spain
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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25
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Park BK, Shen SH, Fujimori M, Wang Y. Asian Conference on Tumor Ablation guidelines for renal cell carcinoma. Investig Clin Urol 2021; 62:378-388. [PMID: 34190433 PMCID: PMC8246015 DOI: 10.4111/icu.20210168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 01/20/2023] Open
Abstract
Thermal ablation has been established as an alternative treatment for renal cell carcinoma (RCC) in patients who are poor candidates for surgery. However, while American and European guidelines have been established for American and European patients, respectively, no ablation guidelines for Asian patients with RCCs have been established many years after the Asian Conference on Tumor Ablation (ACTA) had been held. Given that Western guidelines are difficult to apply to Asian patients due to differences in body habitus, economic status, and insurance systems, the current review sought to establish the first version of the ACTA guidelines for treating a RCC with thermal ablation.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Mie Prefecture, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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26
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Bianchi L, Mineo Bianchi F, Chessa F, Barbaresi U, Casablanca C, Piazza P, Mottaran A, Droghetti M, Roveroni C, Balestrazzi E, Gentile G, Gaudiano C, Bertaccini A, Marcelli E, Porreca A, DE Concilio B, Serra C, Celia A, Brunocilla E, Schiavina R. Percutaneous tumor ablation versus partial nephrectomy for small renal mass: the impact of histologic variant and tumor size. Minerva Urol Nephrol 2020; 73:581-590. [PMID: 33256358 DOI: 10.23736/s2724-6051.20.03983-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim, of this study was to investigate recurrence rates in patients with T1 renal cell carcinoma (RCC) undergone partial nephrectomy (PN), radiofrequency ablation (RFA) or cryoablation (Cryo). METHODS We retrospectively evaluated data from 665 (81.4%), 68 (8.3%) and 83 (10.3%) patients who underwent PN, RFA and Cryo, respectively. Kaplan-Meier curves depict recurrence-free survival (RFS) rates in the overall population and after stratifying according to tumor's histology (namely, clear cell RCC and non-clear RCC) and size (namely <2 cm and 2-4 cm). Multivariable Cox regression model was used to identify predictors of recurrence. Cumulative-incidence plots evaluated disease recurrence and other causes of mortality (OCM). RESULTS Patients referred to PN experienced higher RFS rate compared to those treated with RFA and Cryo at 60-month in the overall population (96.4% vs. 79.4% vs. 87.8%), in patients with clear cell RCC (93.3% vs. 75% vs. 80.4%) and in those with tumor of 2-4 cm (97.3% vs. 78% and 84.4%; all P≤0.01). In patients with non-clear cell RCC and with tumor <2cm, PN showed higher RFS rate at 60-month as compared to RFA (97.9% vs. 84.4% and 95.1% vs. 78.1%, respectively: all P≤0.02). At multi-variate analysis, ablative techniques (RFA [HR=4.03] and Cryo [HR=3.86]) were independent predictors of recurrence (all P<0.03). At competing risks analysis, recurrence rate and OCM were 7.3% and 1.3% vs. 25% and 7.2% vs. 19.9% and 19.9% for PN, RFA and Cryo, respectively. CONCLUSIONS PN and Cryo showed similar RFS rates in patients with non-clear cell RCC and with renal mass <2cm.
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Affiliation(s)
- Lorenzo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy - .,University of Bologna, Bologna, Italy -
| | - Federico Mineo Bianchi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Francesco Chessa
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Umberto Barbaresi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Angelo Mottaran
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Carlo Roveroni
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giorgio Gentile
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Caterina Gaudiano
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Alessandro Bertaccini
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | | | - Angelo Porreca
- Department of Radiology, IRCCS University Hospital of Bologna, Bologna, Italy
| | | | - Carla Serra
- Unit of Interventional Ultrasound, Department of Organ Failure and Transplantations, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Eugenio Brunocilla
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Division of Urology, Department of Urology, IRCCS University Hospital of Bologna, Bologna, Italy.,University of Bologna, Bologna, Italy
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27
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Gobara H, Hiraki T, Iguchi T, Matsui Y, Sakurai J, Uka M, Tomita K, Komaki T, Kobayasi Y, Araki M, Watanabe T, Kanazawa S. Oncologic outcomes and safety of percutaneous cryoablation for biopsy-proven renal cell carcinoma up to 4 cm in diameter: a prospective observational study. Int J Clin Oncol 2020; 26:562-568. [PMID: 33174078 DOI: 10.1007/s10147-020-01825-4] [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] [Received: 07/22/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Percutaneous cryoablation is widely used for the treatment of renal cell carcinoma. We prospectively evaluated the oncologic outcomes and safety of percutaneous cryoablation for the treatment of tumors ≤ 4 cm in diameter. METHODS We included patients aged ≥ 20 years, who had histologically proven renal cell carcinoma, tumor diameter ≤ 4 cm, a performance status of ≤ 1, acceptable laboratory parameters, were inoperable or refused to undergo surgery, and had signed a written informed consent. The primary endpoint was the cause-specific survival rate. The secondary endpoints were overall and progression-free survival, and adverse event frequency and grade. All procedures were percutaneously performed under computed tomography fluoroscopy guidance. RESULTS From October 2013 to October 2015, 33 patients (mean age: 68 ± 14 years; sex: six women, 27 men) were enrolled. The mean tumor diameter was 2.1 ± 0.6 (range 1.0-3.4) cm. The median follow-up period was 60.1 (range 18.4-76.6) months. One patient died of non-renal cell carcinoma-related disease 46 months after percutaneous cryoablation. The cause-specific and overall survival rates were 100% and 96.8% at 3 years, and 100% and 96.8% at 5 years, respectively. There was no local tumor progression or distant metastasis. The incidence of severe urological (urinary fistula and perinephric infection) and non-urological adverse events (increased creatine kinase and skin ulceration) was 6% each. CONCLUSION Percutaneous cryoablation for renal cell carcinoma ≤ 4 cm in diameter achieved good tumor control with a low complication frequency.
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Affiliation(s)
- Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Toshiyuki Komaki
- Department of Radiology, Okayama University School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Yasuyuki Kobayasi
- Department of Urology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Hospital, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, Japan
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28
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Yanagisawa T, Miki J, Shimizu K, Fukuokaya W, Urabe F, Mori K, Sasaki H, Kimura T, Miki K, Egawa S. Functional and oncological outcome of percutaneous cryoablation versus laparoscopic partial nephrectomy for clinical T1 renal tumors: A propensity score-matched analysis. Urol Oncol 2020; 38:938.e1-938.e7. [PMID: 33036899 DOI: 10.1016/j.urolonc.2020.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/07/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the clinical trifecta of percutaneous cryoablation (PCA) vs. laparoscopic partial nephrectomy (LPN) for cT1 renal tumors. PATIENTS AND METHODS We retrospectively analyzed the records of patients who had undergone 2 types of nephron sparing surgeries (NSS) PCA or LPN for cT1 renal tumors between November 2011 and December 2019. The cohorts were matched by one-to-one propensity scores based on patient demographics, renal function, and tumor complexity. Perioperative and oncological outcomes and preservation of renal function following surgery were compared. RESULTS After matching, a total of 180 patients who had undergone NSS for de novo renal tumors were evaluable: 90 for PCA and 90 for LPN. No statistically significant differences were noted among the measured baseline characteristics in the propensity score-matched cohorts. Overall perioperative complication rates were 5.5% in the PCA and 11.1% in the LPN groups (P = 0.28). The rate of eGFR preservation 1 to 3 months after surgery was significantly higher for PCA than for LPN (92.8 ± 11.5% vs. 88.5 ± 14.6%, P = 0.03). Median follow-up was 33 months for PCA and 18 months for LPN (P < 0.001). Three residual and 4 recurrent tumors were later diagnosed in the PCA group and 1 recurrent tumor in the LPN group. The 5-year local recurrence-free survival was lower for PCA than LPN (90.2% vs. 98.5%, P = 0.36). The 5-year metastasis-free survival rate was similar in both groups (98.4% vs. 100%, P = 0.38). The 5-year overall and cancer-specific survival rates were comparable in both groups (91.7% vs. 98.9%, P = 0.53, and 95% vs. 100%, P = 0.55, respectively). CONCLUSIONS Clinical T1 RCC patients are better treated with LPN if technically possible. Though PCA had a higher local recurrence rate, medium-term local control was not inferior to LPN. Additionally, PCA patients tended to retain renal function without severe complications. PCA appears to be a reasonable option for patients with high comorbidity at presentation.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kanichiro Shimizu
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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29
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John JB, Anderson M, Dutton T, Stott M, Crundwell M, Llewelyn R, Gemmell A, Bufacchi R, Spiers A, Campain N. Percutaneous microwave ablation of renal masses in a UK cohort. BJU Int 2020; 127:486-494. [PMID: 32871034 DOI: 10.1111/bju.15224] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To report a tertiary referral centre's experience of microwave ablation (MWA) for suspected renal cell carcinoma (RCC), describing complications and oncological outcomes. PATIENTS AND METHODS Consecutive MWA procedures (n = 113) for renal masses (October 2016 to September 2019) were maintained on a prospective database. Data describing patient, disease, procedure, complications, and oncological outcomes were analysed. RESULTS The median (range) age was 68 (33-85) years, 73% were male, and the median Charlson Comorbidity Index was 0. The median (interquartile range [IQR]) tumour diameter was 25 (20-32) mm. In all, 95% had renal mass biopsy, with histologically confirmed cancer in 75%. The median (IQR) R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score was 7 (6-8). The median ablation time was 6 min and length of stay was 1 day for 95% of the patients. Clavien-Dindo complication Grades I, II, IIIb and IV occurred in 18%, 1.8%, 0.9% and 0.9%, respectively. The median follow-up was 12 months and the median (IQR) renal function change was -4 (-18 to 0)%. One patient (0.9%) had local recurrence, treated with re-ablation; two developed metastatic progression; and two (1.8%) had indeterminate findings on follow-up (one lung nodule and one possible local recurrence), managed with ongoing protocolised computed tomography surveillance. Post-procedure complications were associated with total ablation time (odds ratio [OR] 1.152/min, 95% confidence interval [CI] 1.040-1.277) and total ablation energy (OR 1.017/kJ, 95% CI 1.001-1.033). CONCLUSIONS We describe the largest UK series of MWA treatment for T1a/small T1b renal masses to date. MWA was well tolerated, with 95% discharged the following day and low complication/re-admission rates. Current follow-up demonstrates favourable disease control. MWA appears to be safe and effective and should be considered in future prospective comparisons of treatments for T1a/small T1b renal masses.
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Affiliation(s)
- Joseph B John
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Moira Anderson
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Thomas Dutton
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Mark Stott
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Rhys Llewelyn
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew Gemmell
- The Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rory Bufacchi
- Department of Neuroscience, Physiology and Pharmacology, University College London (UCL), London, UK
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30
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Shi L, He Y, Liu C, Qian X, Wang Z. Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis. Cancer Med 2020; 9:7988-8003. [PMID: 32888392 PMCID: PMC7643644 DOI: 10.1002/cam4.3433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
Objective To compare the survival outcomes of local ablation (LA) and partial nephrectomy (PN) for T1N0M0 renal cell carcinoma (RCC). Method We identified 38,155 T1N0M0 RCC patients treated with PN or LA in 2004‐2016 from the retrospective Surveillance, Epidemiology, and End Results databases. Among them, there were 4656 LA and 33,499 PN. A Cox proportional hazards regression model, cause‐specific Cox regression and Fine and Gray sub‐distribution hazard ratio (sHR) with inverse probability of treatment weighting (IPTW) adjusting was utilized to compare the effects of LA vs PN on all‐, RCC‐, and non‐RCC–caused mortality. Results Within the IPTW analysis, patients who underwent PN experienced a better overall survival (OS) (HR, 1.56; 95% CI, 1.40‐1.74; P < .001) and cancer‐specific survival (CSS) (HR, 2.21; 95% CI, 1.62‐2.98; P < .001) than LA patients. In the subgroup of patients >85 years (HR, 1.14; 95% CI, 0.73‐1.79, P = .577), chromophobe RCC (HR, 1.68; 95% CI, 0.94‐3.00, P = .078), and tumor size <2 cm (HR, 1.21; 95% CI, 0.95‐1.53, P = .126), the OS showed no significant difference between LA and PN. No significant difference in CSS between LA and PN was observed in the subgroup of chromophobe RCC (HR, 0.34; 95% CI, 0.03‐3.97, P = .389), and tumor size <2 cm (HR, 1.83; 95% CI, 0.92‐3.64, P = .084). For patients >85 years (sHR, 0.89; 95% CI, 0.52‐1.27, P = .520) and tumor size <2 cm (sHR, 1.14; 95% CI, 0.94‐1.38, P = .200), the non‐RCC–specific mortality was not significantly different in PN and LA cohorts, however, for the chromophobe RCC, the LA showed a worse non‐RCC mortality than PN (HR, 1.72; 95% CI, 1.06‐2.79, P = .028). Conclusion PN showed a better prognosis than LA in T1N0M0 RCC treatment, but LA and PN showed a comparable OS in elderly patients (>85), small RCC (<2 cm) and chromophobe RCC.
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Affiliation(s)
- Lei Shi
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yan He
- Department of Urology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang, China
| | - Chang Liu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyuan Qian
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhixian Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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31
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Abstract
Based on Surveillance, Epidemiology, and End Results studies, most renal cancers are low grade and slow growing. Long-term, single-center studies show excellent outcomes for T1a renal cell carcinoma (RCC), comparable to partial nephrectomy without affecting renal function and with much lower rates of complications. However, there are no multicenter randomized controlled trials of multiple ablative modalities or comparison with partial nephrectomy, and most studies are single-arm observational studies with short-term and intermediate follow-up. For treatment of stage T1a RCC, percutaneous TA is an effective alternative to surgery with preservation of renal function, low risk, and comparable overall and disease-specific survival.
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32
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Siva S, Correa RJM, Warner A, Staehler M, Ellis RJ, Ponsky L, Kaplan ID, Mahadevan A, Chu W, Gandhidasan S, Swaminath A, Onishi H, Teh BS, Lo SS, Muacevic A, Louie AV. Stereotactic Ablative Radiotherapy for ≥T1b Primary Renal Cell Carcinoma: A Report From the International Radiosurgery Oncology Consortium for Kidney (IROCK). Int J Radiat Oncol Biol Phys 2020; 108:941-949. [PMID: 32562838 DOI: 10.1016/j.ijrobp.2020.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Patients with larger (T1b, >4 cm) renal cell carcinoma (RCC) not suitable for surgery have few treatment options because thermal ablation is less effective in this setting. We hypothesize that SABR represents an effective, safe, and nephron-sparing alternative for large RCC. METHODS AND MATERIALS Individual patient data from 9 institutions in Germany, Australia, USA, Canada, and Japan were pooled. Patients with T1a tumors, M1 disease, and/or upper tract urothelial carcinoma were excluded. Demographics, treatment, oncologic, and renal function outcomes were assessed using descriptive statistics. Kaplan-Meier estimates and univariable and multivariable Cox proportional hazards regression were generated for oncologic outcomes. RESULTS Ninety-five patients were included. Median follow-up was 2.7 years. Median age was 76 years, median tumor diameter was 4.9 cm, and 81.1% had Eastern Cooperative Oncology Group performance status of 0 to 1 (or Karnofsky performance status ≥70%). In patients for whom operability details were reported, 77.6% were defined as inoperable as determined by the referring urologist. Mean baseline estimated glomerular filtration rate (eGFR) was 57.2 mL/min (mild-to-moderate dysfunction), with 30% of the cohort having moderate-to-severe dysfunction (eGFR <45mL/min). After SABR, eGFR decreased by 7.9 mL/min. Three patients (3.2%) required dialysis. Thirty-eight patients (40%) had a grade 1 to 2 toxicity. No grade 3 to 5 toxicities were reported. Cancer-specific survival, overall survival, and progression-free survival were 96.1%, 83.7%, and 81.0% at 2 years and 91.4%, 69.2%, 64.9% at 4 years, respectively. Local, distant, and any failure at 4 years were 2.9%, 11.1%, and 12.1% (cumulative incidence function with death as competing event). On multivariable analysis, increasing tumor size was associated with inferior cancer-specific survival (hazard ratio per 1 cm increase: 1.30; P < .001). CONCLUSIONS SABR for larger RCC in this older, largely medically inoperable cohort, demonstrated efficacy and tolerability and had modest impact on renal function. SABR appears to be a viable treatment option in this patient population.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - Rohann J M Correa
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | | | - Rodney J Ellis
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Penn State Cancer Institute, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Lee Ponsky
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | - William Chu
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Senthilkumar Gandhidasan
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Anand Swaminath
- Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, Texas
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | | | - Alexander V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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33
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Grange R, Tradi F, Izaaryene J, Daidj N, Brunelle S, Walz J, Gravis G, Piana G. Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes. Int J Hyperthermia 2020; 36:1065-1071. [PMID: 31648584 DOI: 10.1080/02656736.2019.1675913] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: To evaluate the safety, functional and oncological outcomes associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). Materials and methods: Institutional database was reviewed to identify patients treated by percutaneous CT-guidance cryoablation between 2013 and 2018 for biopsy-proven RCC tumors measuring 4.1-7.0 cm. The main outcome parameters analyzed were primary and secondary technique efficacy, progression-free survival (PFS), cancer-specific survival (CSS), loss of estimated glomerular filtration rate (eGFR) and complications. PFS and CSS were estimated by the Kaplan-Meier method. Complications were graded by the Clavien-Dindo system. Results: Twenty-three consecutive patients were included (mean tumor diameter: 45.6 ± 6.2 mm; mean RENAL score: 8.1 ± 1.8). The technical success rate was 95.7%. Primary and secondary technique efficacy rates were 86.3 and 100%, respectively. Three patients found to have incomplete ablations at 3 months were successfully treated by repeat cryoablation. Median duration follow-up was 11 months (range: 3-33). Imaging showed PFS to be 85.7% at 6 months, 66.7% at 12 months and 66.7% at 24 months. One patient with a local recurrence at 12 months was treated by radical nephrectomy. One patient died from progression of disease within 12 months. One patient reported a complication grade ≥ II (4.3%). Mean eGFR loss was 4.4 ± 8.5 ml/min/1.73m2, which was significantly higher among those treated for central tumors (p < .05). Conclusion: Cryoablation for stage T1b renal tumors is technically feasible, with favorable oncological and perioperative outcomes. Longer-term studies are needed to verify our findings.
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Affiliation(s)
- Rémi Grange
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Farouk Tradi
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Jean Izaaryene
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Nassima Daidj
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes , Marseille , France
| | - Gwenaëlle Gravis
- Department of Oncology, Institut Paoli-Calmettes , Marseille , France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
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Mershon JP, Tuong MN, Schenkman NS. Thermal ablation of the small renal mass: a critical analysis of current literature. MINERVA UROL NEFROL 2020; 72:123-134. [DOI: 10.23736/s0393-2249.19.03572-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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35
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Klatte T, Stewart GD. Partial nephrectomy versus thermal ablation for clinical T1 renal tumours. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:S363. [PMID: 32016081 DOI: 10.21037/atm.2019.09.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK.,Department of Surgery, University of Cambridge, Cambridge, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Cambridge University Hospitals, Cambridge, UK
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Yu J, Zhang X, Liu H, Zhang R, Yu X, Cheng Z, Han Z, Liu F, Hao G, Mu MJ, Liang P. Percutaneous Microwave Ablation versus Laparoscopic Partial Nephrectomy for cT1a Renal Cell Carcinoma: A Propensity-matched Cohort Study of 1955 Patients. Radiology 2020; 294:698-706. [PMID: 31961239 DOI: 10.1148/radiol.2020190919] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Percutaneous microwave ablation (MWA) and laparoscopic partial nephrectomy (LPN) are two modalities indicated for early-stage renal cell carcinoma (RCC) with low extent of invasion. Purpose To compare the long-term results of percutaneous MWA and LPN in the treatment of cT1a RCC. Materials and Methods This retrospective study included 1955 patients with cT1a RCC treated with percutaneous MWA or LPN between April 2006 and November 2017. Propensity score matching was used. Oncologic outcomes were analyzed by using the Fine-and-Gray competing risk models. Results A total of 185 patients underwent percutaneous MWA (mean age, 63.2 years ± 15.2 [standard deviation]) and 1770 underwent LPN (mean age, 50.9 years ± 13.2). During the follow-up (median, 40.6 months), after propensity score matching, no difference was observed between local tumor progression (3.2% vs 0.5%, P = .10), cancer-specific survival (2.2% vs 3.8%, P = .24), and distant metastases (4.3% vs 4.3%, P = .76). Patients who underwent percutaneous MWA had worse overall survival (hazard ratio, 2.4; 95% confidence interval: 1.0, 5.7; P = .049 vs LPN) and disease-free survival (82.9% vs 91.4%, P = .003). Percutaneous MWA led to smaller drop in estimated glomerular filtration rate at discharge (6.2% vs 16.4%, P < .001), smaller estimated blood loss (4.5 mL ± 1.3 vs 54.2 mL ± 69.2), lower cost ($3150 ± 2970 vs $6045 ± 1860 U.S. dollars), shorter operative time (0.5 minute ± 0.1 vs 1.8 minutes ± 0.6), and shorter postoperative hospitalization time (5.1 days ± 2.6 vs 6.9 days ± 2.8) (all P < .001 vs LPN). There were fewer cases of fever in the percutaneous MWA group (16.2% vs 73.0%, P < .001). Conclusion There were no significant differences regarding oncologic outcomes and complications between percutaneous microwave ablation and laparoscopic partial nephrectomy for patients with cT1a renal cell carcinoma. Percutaneous microwave ablation led to smaller renal function change and lower blood loss. For patients who cannot be subjected to the risks of more invasive laparoscopic partial nephrectomy, percutaneous microwave ablation could be an alternative less invasive treatment option. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Jie Yu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Xu Zhang
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Hong Liu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Ruiming Zhang
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Xiaoling Yu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Zhigang Cheng
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Zhiyu Han
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Fangyi Liu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Guoliang Hao
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Meng-Juan Mu
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
| | - Ping Liang
- From the Department of Interventional Ultrasound (J.Y., X.Y., Z.C., Z.H., F.L., G.H., M.M., P.L.), State Key Laboratory of Kidney Disease (J.Y., P.L), and Department of Urology Surgery (X.Z.), Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China; Department of Cardiovascular Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (H.L.); and Department of Urology, the Fourth Hospital of Baotou, Baotou, Inner Mongolia, China (R.Z.)
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Morris CS, Baerlocher MO, Dariushnia SR, McLoney ED, Abi-Jaoudeh N, Nelson K, Cura M, Abdel Aal AK, Mitchell JW, Madassery S, Partovi S, McClure TD, Tam AL, Patel S. Society of Interventional Radiology Position Statement on the Role of Percutaneous Ablation in Renal Cell Carcinoma: Endorsed by the Canadian Association for Interventional Radiology and the Society of Interventional Oncology. J Vasc Interv Radiol 2020; 31:189-194.e3. [PMID: 31917025 DOI: 10.1016/j.jvir.2019.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 12/15/2022] Open
Affiliation(s)
- Christopher S Morris
- Department of Radiology, Larner College of Medicine at the University of Vermont, Division of Interventional Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT, 05401.
| | | | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Eric D McLoney
- Department of Radiology, University Hospitals of Cleveland, Cleveland, Ohio
| | - Nadine Abi-Jaoudeh
- Department of Radiological Sciences, University of California Irvine, Orange, California
| | - Kari Nelson
- Department of Radiological Sciences, UC Irvine Medical Center, Orange, California
| | - Marco Cura
- Department of Radiology, Baylor University Medical Center, Dallas, Texas
| | | | - Jason W Mitchell
- Department of Radiology, Capital Regional Medical Center, Tallahassee, Florida
| | - Sreekumar Madassery
- Division of Vascular and Interventional Radiology, Rush University Medical Center, Chicago, Illinois
| | - Sasan Partovi
- Imaging Institute, Section of Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Timothy D McClure
- Departments of Urology and Radiology, Weill Cornell Medicine, Lefrak Center for Robotic Surgery, New York, New York
| | - Alda L Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virgina
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Gunn AJ, Parikh NS, Bhatia S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma. J Vasc Interv Radiol 2020; 31:195-201.e3. [PMID: 31917026 DOI: 10.1016/j.jvir.2019.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Nainesh S Parikh
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Chen YA, Hsu JS, Chow PM, Liang PC. A case with small renal tumor complicated with pulmonary oil embolism after transcatheter arterial embolization. UROLOGICAL SCIENCE 2020. [DOI: 10.4103/uros.uros_84_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fujimori M, Yamanaka T, Sugino Y, Matsushita N, Sakuma H. Percutaneous Image-guided Thermal Ablation for Renal Cell Carcinoma. INTERVENTIONAL RADIOLOGY 2020; 5:32-42. [PMID: 36284654 PMCID: PMC9550385 DOI: 10.22575/interventionalradiology.2020-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/17/2020] [Indexed: 11/05/2022]
Abstract
Nephrectomy is the gold standard for the treatment of renal cell carcinoma (RCC). However, some patients are not suitable candidates for nephrectomy because of high surgical risk, reduced renal function, or the presence of multiple renal tumors. Percutaneous image-guided thermal ablation, including cryoablation and radiofrequency ablation, is a minimally invasive and highly effective treatment and can be used to treat RCC in patients who are not good candidates for surgery. This article will review percutaneous image-guided thermal ablation for RCC, covering treatment indications, ablation modalities and techniques, oncologic outcomes, and possible complications. In addition, the characteristics of each ablation modality and its comparison with nephrectomy are also presented.
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Affiliation(s)
| | | | - Yuichi Sugino
- Department of Radiology, Mie University School of Medicine
| | | | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine
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41
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Comparing Outcomes for Patients with Clinical T1b Renal Cell Carcinoma Treated With Either Percutaneous Microwave Ablation or Surgery. Urology 2020; 135:88-94. [DOI: 10.1016/j.urology.2019.09.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/22/2022]
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42
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Renal Mass Biopsy. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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43
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Mano R, Hakimi AA. Are the long-term outcomes of percutaneous ablation for clinical stage T1 renal tumors similar to those of partial nephrectomy? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S370. [PMID: 32016088 PMCID: PMC6976441 DOI: 10.21037/atm.2019.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/28/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A. Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Mongiat-Artus P, Paillaud E, Caillet P, Albrand G, Neuzillet Y. [Geriatric specificities of localized renal cell carcinoma]. Prog Urol 2019; 29:865-873. [PMID: 31771769 DOI: 10.1016/j.purol.2019.08.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe the epidemiology of renal cell carcinoma (RCC) and its natural history in the elderly patient. To propose adaptations of geriatric evaluation specific to RCC. Recall therapeutic options and the treatment options specific to elderly patients. METHOD Bibliographic research from the Medline bibliographic database (NLM Pubmed tool) and Embase, as well as on the websites of scientific societies of geriatrics, from the National Cancer Institute using the following keywords: elderly, geriatrics, renal cell carcinoma, small renal mass, diagnosis, treatment. RESULTS The incidence of RCC increases in France and peaks between 70 and 80 years. This increase in incidence is mainly due to the diagnosis of small renal masses (SMR). The specific mortality of RCC increases with age (at least between 75 and 95 years). Tumor biopsy, especially of SMR, should be considered in the elderly patient. The geriatric assessment of patients with CaR has no specificity apart from specific evaluation of renal function and operative risk. There is no prospective therapeutic trials dedicated to elderly patients with localized RCC. Surgical treatment requires the use of fast track protocol (the modalities of which are being elaborated) in which geriatricians play a key role throughout the process. The role of percutaneous ablative treatment should be better defined in elderly patients. However, given their low specific mortality, surveillance of SRM (at least initially) is probably an interesting option, certainly under-used, although its impact on quality of life remains to be clarified. The overarching goal of geriatric oncology must guide the decisions of care in the older patient with CaR: first, the respect of patient-specific expectations and secondly the search for an overall clinical benefit; objectives that have no reason to be restricted to elderly patients. CONCLUSION RCC is becoming a predominantly elderly cancer. It responds to the current general diagnostic and therapeutic guidelines. It is desirable that clinical research help to better define the respective roles of percutaneous biopsy and treatment of localized RCC.
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Affiliation(s)
- P Mongiat-Artus
- Inserm UMR_S1165, service d'urologie et unité de chirurgie et d'anesthésie ambulatoires, hôpital Saint-Louis, université Paris Diderot, université de Paris, Assistance publique-Hôpitaux de Paris, 75010 Paris, France.
| | - E Paillaud
- EA 7376 épidémiologie clinique et vieillissement, service de gériatrie - unité d'onco-gériatrie et UCOG - Paris-Ouest, hôpital européen Georges-Pompidou, université René Descartes, université de Paris, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - P Caillet
- Service de gériatrie, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, 94000 Créteil, France
| | - G Albrand
- Service de gériatrie et UCOG - IR, AuRA Ouest-Guyane, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles, Saint-Quentin-en-Yvelines, 92150 Suresnes, France
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Sundelin MO, Lagerveld B, Ismail M, Keeley FX, Nielsen TK. Repeated Cryoablation as Treatment Modality After Failure of Primary Renal Cryoablation: A European Registry for Renal Cryoablation Multinational Analysis. J Endourol 2019; 33:909-913. [DOI: 10.1089/end.2019.0444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | - Brunolf Lagerveld
- Department of Urology, Onze lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Mohamed Ismail
- Department of Urology, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
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The Emerging Role of Stereotactic Ablative Radiotherapy for Primary Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. Eur Urol Focus 2019; 5:958-969. [DOI: 10.1016/j.euf.2019.06.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/17/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022]
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Rembeyo G, Correas JM, Jantzen R, Audenet F, Dariane C, Delavaud C, Mejean A, Timsit MO. Percutaneous Ablation Versus Robotic Partial Nephrectomy in the Treatment of cT1b Renal Tumors: Oncologic and Functional Outcomes of a Propensity Score-weighted Analysis. Clin Genitourin Cancer 2019; 18:138-147. [PMID: 31982346 DOI: 10.1016/j.clgc.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The purpose of this study was to assess oncologic and functional outcomes of both percutaneous ablation (cryoablation and radiofrequency ablation) and robot-assisted partial nephrectomy (RAPN) in the treatment of renal tumors larger than 4 cm. MATERIALS AND METHODS We retrospectively analyzed prospectively collected data from 102 consecutive patients, who underwent minimally invasive treatment for cT1b renal tumors at our institution. Primary renal function outcome was assessed by estimated glomerular filtration rate preservation at baseline and 1 year postoperatively. Perioperative data and functional and oncologic outcome were collected. Multivariate regression models were used to compare functional outcomes between groups. Cancer-specific survival and recurrence-free survival were estimated at 2 years using the Kaplan-Meier method and compared with Cox proportional hazards regression model to calculate hazard ratios (HRs). To control for selection bias between the different treatments, we adjusted our models with an inverse probability of treatment weighting propensity score. RESULTS There was no significant difference in renal preservation between the groups (P = .664). Multivariate analysis did not show a statistically significant difference in terms of renal function outcomes between the RAPN and percutaneous thermal ablation groups. The adjusted HR regarding the local recurrence-free survival was significantly shorter for the cryoablation group (HR, 4.3; 95% confidence interval, 1.78-10.37; P = .001). CONCLUSIONS Our study demonstrated the equivalence between RAPN and percutaneous ablative techniques for the preservation of renal function in the treatment of T1b tumors. RAPN offers a better local control than percutaneous ablation, in terms of primary success rate.
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Affiliation(s)
- Gregory Rembeyo
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France.
| | - Jean-Michel Correas
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Rodolphe Jantzen
- Université Paris Descartes, Faculté de Médecine, Paris, France; Medical Informatics, Biostatistics and Public Health Department, HEGP, Paris, France
| | - François Audenet
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Charles Dariane
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Christophe Delavaud
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Arnaud Mejean
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
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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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50
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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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