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Luzzago S, Mistretta FA, Mauri G, Vaccaro C, Ghilardi G, Maiettini D, Marmiroli A, Varano G, Di Trapani E, Camisassi N, Bianchi R, Della Vigna P, Ferro M, Bonomo G, de Cobelli O, Orsi F, Musi G. Thermal ablation for small renal masses: Identifying the most appropriate tumor size cut-off for predicting perioperative and oncological outcomes. Urol Oncol 2022; 40:537.e1-537.e9. [PMID: 36224057 DOI: 10.1016/j.urolonc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/11/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To test TRIFECTA achievement [1) absence of CLAVIEN-DINDO ≥3 complications; 2) complete ablation; 3) absence of ≥30% decrease in eGFR] and local recurrence rates, according to tumor size, in patients treated with thermal ablation (TA: radiofrequency [RFA] and microwave ablation [MWA]) for small renal masses. METHODS Retrospective analysis (2008-2020) of 432 patients treated with TA (RFA: 162 vs. MWA: 270). Tumor size was evaluated as: 1) continuously coded variable (cm); 2) tumor size strata (0.1-2 vs. 2.1-3 vs. 3.1-4 vs. >4 cm). Multivariable logistic regression models and a minimum P-value approach were used for testing TRIFECTA achievement. Kaplan-Meier plots depicted local recurrence rates over time. RESULTS Overall, 162 (37.5%) vs. 140 (32.4%) vs. 82 (19.0%) vs. 48 (11.1%) patients harboured, respectively, 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. >4 cm tumors. In multivariable logistic regression models, increasing tumor size was associated with higher rates of no TRIFECTA achievement (OR:1.11; P< 0.001). Using a minimum P-value approach, an optimal tumor size cut-off of 3.2 cm was identified (P< 0.001). In multivariable logistic regression models, 3.1 to 4 cm tumors (OR:1.27; P< 0.001) and >4 cm tumors (OR:1.49; P< 0.001), but not 2.1 to 3 cm tumors (OR:1.05; P= 0.3) were associated with higher rates of no TRIFECTA achievement, relative to 0.1 to 2 cm tumors. The same results were observed in separate analyses of RFA vs. MWA patients. After a median (IQR) follow-up time of 22 (12-44) months, 8 (4.9%), 8 (5.7%), 11 (13.4%), and 5 (10.4%) local recurrences were observed in tumors sized 0.1 to 2 vs. 2.1 to 3 vs. 3.1 to 4 vs. >4 cm, respectively (P= 0.01). CONCLUSION A tumor size cut-off value of ≤3 cm is associated with higher rates of TRIFECTA achievement and lower rates of local recurrence over time in patients treated with TA for small renal masses.
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Affiliation(s)
- Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy.
| | - Francesco A Mistretta
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy
| | - Giovanni Mauri
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy; Department of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Vaccaro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gaia Ghilardi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Daniele Maiettini
- Department of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Andrea Marmiroli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gianluca Varano
- Department of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Camisassi
- Department of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Paolo Della Vigna
- Department of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Guido Bonomo
- Department of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy
| | - Franco Orsi
- Department of Interventional Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122, Milan, Italy
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Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3 cm or larger: a prospective study. Int J Clin Oncol 2022; 27:1589-1595. [PMID: 35945389 DOI: 10.1007/s10147-022-02224-7] [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: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We prospectively evaluated the safety and efficacy of percutaneous cryoablation combined with transcatheter renal arterial embolization for the treatment of tumors ≥ 3 cm in diameter. METHODS We included patients aged ≥ 20 years with histologically proven renal cell carcinoma with a tumor diameter ≥ 3 cm who were inoperable or refused surgery. Prior to ablation, transcatheter arterial embolization was performed using a mixture of absolute ethanol and iodized oil. All cryoablation procedures were performed percutaneously under computed tomography fluoroscopy guidance. The primary endpoint was safety, which was evaluated for adverse events using CTCAE version 4.0. The secondary endpoint was survival; overall survival, progression-free survival, and cancer-specific survival were calculated. RESULTS From October 2013 to March 2016, 19 patients (mean age, 75 ± 13 years; 5 women, 14 men) were prospectively enrolled. The mean tumor diameter was 3.9 ± 0.7 (range 3.1-5.3) cm. Four grade 3 hematologic adverse events occurred, while no symptomatic grade ≥ 3 events occurred. The median follow-up period was 68 (range 52-84) months. During the follow-up period, two patients developed local tumor progression at 3 and 42 months after the initial ablative procedure; no patient showed distant metastasis. Two patients died from causes other than RCC. Overall survival, progression-free survival, and cause-specific survival were 100%, 95%, and 100% at 3 years, and 95%, 84%, and 100% at 5 years, respectively. CONCLUSION Percutaneous cryoablation combined with prior TAE for the treatment of tumors ≥ 3 cm in diameter was safe and achieved favorable survival.
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Scharll Y, Letrari S, Laimer G, Schullian P, Bale R. Puncture accuracy of an optical tracked robotic aiming device-a phantom study. Eur Radiol 2022; 32:6769-6776. [PMID: 35678863 PMCID: PMC9474375 DOI: 10.1007/s00330-022-08915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the targeting accuracy of stereotactic punctures based on a hybrid robotic device in combination with optical tracking-a phantom study. METHODS CT data sets of a gelatin-filled plexiglass phantom with 1-, 3-, and 5-mm slice thickness were acquired. An optical navigation device served for planning of a total of 150 needle trajectories. All punctures were carried out semi-automatically with help of the trackable iSYS-1 robotic device. Conically shaped targets inside the phantom were punctured using Kirschner wires. Up to 8 K-wires were positioned sequentially based on the same planning CT and placement accuracy was assessed by taking control CTs and measuring the Euclidean (ED) and normal distances (NDs) between the wire and the entry and target point. RESULTS Using the StealthStation S7, the accomplished mean ND at the target for the 1-mm, 3-mm, and 5-mm slice thickness was 0.89 mm (SD ± 0.42), 0.93 mm (SD ± 0.45), and 0.73 mm (SD ± 0.50), respectively. The corresponding mean ED was 1.61 mm (SD ± 0.36), 2.04 mm (SD ± 0.59), and 1.76 mm (SD ± 0.45). The mean duration of the total procedure was 27.9 min, including image acquisition, trajectory planning, registration, placement of 8 wires, and the control-CT. CONCLUSIONS The optically tracked iSYS-1 robot allows for precise punctures in a phantom. The StealthStation S7 provided acceptable results and may be helpful for interventions in difficult anatomical regions and for those requiring complex multi-angle trajectories. In combination with our optical navigation tool, the trackable robot unit allows to cover a large treatment field and the compact design facilitates placement of needle-like instruments. KEY POINTS • The use of a robotic targeting device in combination with optical tracking (hybrid system) allows for accurate placement of needle-like instruments without repeated control imaging. • The compact robotic positioning unit in combination with a camera for optical tracking facilitates sequential placement of multiple K-wires in a large treatment volume.
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Affiliation(s)
- Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sofia Letrari
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Applications of Focused Ultrasound in the Treatment of Genitourinary Cancers. Cancers (Basel) 2022; 14:cancers14061536. [PMID: 35326687 PMCID: PMC8945954 DOI: 10.3390/cancers14061536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Cancer is a prevalent disease globally, and conventional treatment options have been associated with substantial morbidity for patients. The unique acoustic properties and biological effects of focused ultrasound have been investigated for use as an alternative treatment option for various forms of cancer with lower associated morbidity than standard treatments. The objective of our review was to assess the current state and various applications of focused ultrasound for the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular malignancies. Current research demonstrates that focused ultrasound-based focal therapy shows promise for the treatment of localized prostate and kidney cancer, and the effect of ultrasound on cell membranes may increase the efficacy of chemotherapeutics and radiotherapy. Focused ultrasound-based treatment modalities should continue to be investigated as an alternative or complementary treatment option for cancer patients. Abstract Traditional cancer treatments have been associated with substantial morbidity for patients. Focused ultrasound offers a novel modality for the treatment of various forms of cancer which may offer effective oncological control and low morbidity. We performed a review of PubMed articles assessing the current applications of focused ultrasound in the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular cancer. Current research indicates that high-intensity focused ultrasound (HIFU) focal therapy offers effective short-term oncologic control of localized prostate and kidney cancer with lower associated morbidity than radical surgery. In addition, studies in mice have demonstrated that focused ultrasound treatment increases the accuracy of chemotherapeutic drug delivery, the efficacy of drug uptake, and cytotoxic effects within targeted cancer cells. Ultrasound-based therapy shows promise for the treatment of genitourinary cancers. Further research should continue to investigate focused ultrasound as an alternative cancer treatment option or as a complement to increase the efficacy of conventional treatments such as chemotherapy and radiotherapy.
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Richard PO, Violette PD, Bhindi B, Breau RH, Kassouf W, Lavallée LT, Jewett M, Kachura JR, Kapoor A, Noel-Lamy M, Ordon M, Pautler SE, Pouliot F, So AI, Rendon RA, Tanguay S, Collins C, Kandi M, Shayegan B, Weller A, Finelli A, Kokorovic A, Nayak J. Canadian Urological Association guideline: Management of small renal masses - Full-text. Can Urol Assoc J 2022; 16:E61-E75. [PMID: 35133268 PMCID: PMC8932428 DOI: 10.5489/cuaj.7763] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Patrick O. Richard
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Philippe D. Violette
- Departments of Health Research Methods Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada
| | - Bimal Bhindi
- Southern Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada
| | - Rodney H. Breau
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | - Luke T. Lavallée
- Department of Surgery, Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Michael Jewett
- Department of Surgical Oncology, Division of Urology, Princess Margaret Hospital, Toronto, ON, Canada
| | - John R. Kachura
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- McMaster Institute of Urology, St. Joseph Healthcare, Hamilton, ON, Canada
| | - Maxime Noel-Lamy
- Department of Medical Imaging, Division of Interventional Radiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Michael Ordon
- Department of Surgery, Division of Urology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Stephen E. Pautler
- Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Frédéric Pouliot
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada
| | - Alan I. So
- Division of Urology, British Columbia Cancer Care, Vancouver, BC, Canada
| | - Ricardo A. Rendon
- Department of Surgery, Division of Urology, Capital Health - QEII, Halifax, NS, Canada
| | - Simon Tanguay
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Maryam Kandi
- Departments of Health Research Methods Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, ON, Canada
| | - Bobby Shayegan
- McMaster Institute of Urology, St. Joseph Healthcare, Hamilton, ON, Canada
| | | | - Antonio Finelli
- Department of Surgical Oncology, Division of Urology, Princess Margaret Hospital, Toronto, ON, Canada
| | - Andrea Kokorovic
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Jay Nayak
- Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Dai JC, Morgan TN, Moody D, McLaughlin J, Cadeddu JA. Radiofrequency Ablation of Small Renal Masses. J Endourol 2021; 35:S38-S45. [PMID: 34499555 DOI: 10.1089/end.2020.1041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although the incidence of localized renal cell carcinoma has increased in recent decades due to greater use of imaging, the treatment has shifted to less invasive, nephron-sparing approaches. Radiofrequency ablation (RFA) is one accepted treatment modality for patients with small renal masses, and it has the advantage of being minimally invasive and highly nephron sparing, with the additional benefits of reduced blood loss and complication rates. We describe our experience with RFA with an accompanying instructional video outlining the procedure's key components.
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Affiliation(s)
- Jessica C Dai
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tara Nikonow Morgan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Devan Moody
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph McLaughlin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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7
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Dai JC, Morgan TN, Steinberg RL, Johnson BA, Garbens A, Cadeddu JA. Irreversible Electroporation for the Treatment of Small Renal Masses: 5-Year Outcomes. J Endourol 2021; 35:1586-1592. [PMID: 33926224 DOI: 10.1089/end.2021.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Introduction: Irreversible electroporation (IRE) is a nonthermal ablative technology that applies high-voltage short-pulse electrical current to create cellular membrane nanopores and ultimately results in apoptosis. This is thought to overcome thermal limitations of other ablative technologies. We report 5-year oncologic outcomes of percutaneous IRE for small renal masses. Patients and Methods: A single-institution retrospective review of cT1a renal masses treated with IRE from April 2013 to December 2019 was performed. Those with <1 month follow-up were excluded. IRE was performed with the NanoKnife© System (Angiodynamics, Latham, NY). Renal mass biopsy was obtained before or during ablation in most circumstances; biopsy was excluded in some patients because of concern for IRE probe displacement. Postablation guideline-based surveillance imaging was performed. Initial treatment failure was defined as persistent tumor enhancement on first post-treatment imaging. Survival analysis was performed through the Kaplan-Meier method for effectively treated tumors (SPSS; IBM, Armonk, NY). Results: IRE was used to treat 48 tumors in 47 patients. Twenty-two per 48 tumors (45.8%) were biopsy-confirmed renal cell carcinoma (RCC). No complications ≥ Clavien Grade III occurred and 36 patients (76.6%) were discharged the same day. Initial treatment success rate was 91.7% (n = 44/48); three treatment failures were managed with salvage radiofrequency ablation and one with robotic partial nephrectomy. Median follow-up was 50.4 months (interquartile range 29.0-65.5). The 5-year local recurrence-free survival was 81.4% in biopsy-confirmed RCC patients and 81.0% in all patients. Five-year metastasis-free survival was 93.3% and 97.1%, respectively, and 5-year overall survival was 92.3% and 90.6%, respectively. Five-year cancer-specific survival was 100% for both biopsy-confirmed RCC and all patient groups. Conclusions: IRE has low morbidity, but suboptimal intermediate-term oncologic outcomes compared with conventional thermal ablation techniques for small low-complexity tumors. Use of IRE should be restricted to select cases.
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Affiliation(s)
- Jessica C Dai
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | - Tara N Morgan
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | | | - Brett A Johnson
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | - Alaina Garbens
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
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Abou Elkassem AM, Lo SS, Gunn AJ, Shuch BM, Dewitt-Foy ME, Abouassaly R, Vaidya SS, Clark JI, Louie AV, Siva S, Grosu AL, Smith AD. Role of Imaging in Renal Cell Carcinoma: A Multidisciplinary Perspective. Radiographics 2021; 41:1387-1407. [PMID: 34270355 DOI: 10.1148/rg.2021200202] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the expansion in cross-sectional imaging over the past few decades, there has been an increase in the number of incidentally detected renal masses and an increase in the incidence of renal cell carcinomas (RCCs). The complete characterization of an indeterminate renal mass on CT or MR images is challenging, and the authors provide a critical review of the best imaging methods and essential, important, and optional reporting elements used to describe the indeterminate renal mass. While surgical staging remains the standard of care for RCC, the role of renal mass CT or MRI in staging RCC is reviewed, specifically with reference to areas that may be overlooked at imaging such as detection of invasion through the renal capsule or perirenal (Gerota) fascia. Treatment options for localized RCC are expanding, and a multidisciplinary group of experts presents an overview of the role of advanced medical imaging in surgery, percutaneous ablation, transarterial embolization, active surveillance, and stereotactic body radiation therapy. Finally, the arsenal of treatments for advanced renal cancer continues to grow to improve response to therapy while limiting treatment side effects. Imaging findings are important in deciding the best treatment options and to monitor response to therapy. However, evaluating response has increased in complexity. The unique imaging findings associated with antiangiogenic targeted therapy and immunotherapy are discussed. An invited commentary by Remer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Asser M Abou Elkassem
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Simon S Lo
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew J Gunn
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Brian M Shuch
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Molly E Dewitt-Foy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Robert Abouassaly
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Sandeep S Vaidya
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Joseph I Clark
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Alexander V Louie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Shankar Siva
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Anca-Ligia Grosu
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew D Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
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9
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Gümüş BH, Albaz AC, Düzgün F, Üçer O, Temeltaş G, Müezzinoğlu T, Tarhan S. Long term follow-up results of ablation treatment for patients with small renal mass. Int J Clin Pract 2021; 75:e14130. [PMID: 33660394 DOI: 10.1111/ijcp.14130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the outcome of ablation therapy in our clinic for the treatment of patients with a small renal mass Materials and Methods: We retrospectively evaluated the technic and follow-up data of 30 patients with 36 tumours who underwent Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) in our clinic. Demographic data, ablation type, tumour characteristics, peroperative and postoperative complications and treatment success of the patients were evaluated. RESULTS A total of 36 tumours who underwent ablation treatments, 23 were treated with RFA, 13 with MWA. The mean tumour size was 28.9 ± 6.92 mm in RFA and 29.3 ± 7.70 mm in MWA. The mean follow-up period was 49.6 ± 24.7 months in patients with RFA and mean follow-up was 16 ± 8.05 months in MWA treatments. The overall success in MWA administration was calculated as 76.9%, while the overall success in RFA was 80%. CONCLUSION Long-term oncologic efficacy of RFA appears to be successful in the treatment of T1a renal carcinomas. Further studies can be conducted to elucidate the influence of MWA on long-term oncological outcomes.
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Affiliation(s)
- Bilali Habeş Gümüş
- Department of Urology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Ali Can Albaz
- Department of Urology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Fatih Düzgün
- Department of Radiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Oktay Üçer
- Department of Urology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Gökhan Temeltaş
- Department of Urology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Talha Müezzinoğlu
- Department of Urology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
| | - Serdar Tarhan
- Department of Radiology, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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10
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A 25 year perspective on the evolution and advances in an understanding of the biology, evaluation and treatment of kidney cancer. Urol Oncol 2021; 39:548-560. [PMID: 34092483 DOI: 10.1016/j.urolonc.2021.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
The diagnosis, evaluation and management of patients with renal cell carcinoma has transformed in the 21st century. Utilizing biological discoveries and technological advances, the field has moved from blunt surgical and largely ineffective medical treatments, to nuanced and fine-tuned approaches based on biology, extent of disease and patient preferences. In this review we will summarize the last 25 years of progress in kidney cancer.
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11
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Wang Z, Lu J, Huang W, Wu Z, Gong J, Wang Q, Liu Q, Wang C, Zhu Y, Ding X, Wang Z. A retrospective study of CT-guided percutaneous irreversible electroporation (IRE) ablation: clinical efficacy and safety. BMC Cancer 2021; 21:124. [PMID: 33546635 PMCID: PMC7866876 DOI: 10.1186/s12885-021-07820-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background To evaluate the clinical efficacy and safety of ablating renal cell carcinoma (RCC) by irreversible electroporation (IRE). Methods Fifteen patients (19 lesions) with RCC who underwent IRE were retrospectively reviewed. Seven patients had solitary kidneys. Two lesions were located in the renal hilus. One patient had chronic renal insufficiency. Percutaneous biopsy for histopathology was performed. The best puncture path plan was evaluated before CT-guided IRE. The estimated glomerular filtration rate (eGFR) was compared vs baseline at 1–2 months after the ablation. Contrast-enhanced computed tomography imaging changes were evaluated immediately after IRE. Contrast-enhanced computed tomography/magnetic resonance was performed 1 month, 3 months, 6 months, 12 months and every year thereafter. The complications after treatment were also reviewed. Results The success rate of the procedure was 100%. The median tumor size was 2.4 (IQR 1.3–2.9) cm, with an median score of 6 (IQR 5.5–8) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). Two cases (3 lesions) were punctured through the liver. In other cases, puncture was performed through the perirenal space. There were no severecomplications in interventional therapy. Transient gross hematuria occurred in 2 patients (centrally located). Self-limiting perinephric hematomas occurred in 1 patient. Needle puncture path metastasis was found in 1 patient 2.5 years after IRE. The subcutaneous metastasis was surgically removed, and there was no evidence of recurrence. There was no significant change in eGFR levels in terms of short- term clinical outcomes (t = 0.348, P = 0.733). At 6 months, all 15 patients with imaging studies available had no evidence of recurrence. At 1 year, 1 patient (1 of 15) was noted to have experienced needle tract metastasis and accepted salvage radiofrequency ablation (RFA) therapy. Conclusions IRE appears to be a safe and effective treatment for RCC that may offer a tissue-sparing method and complete ablation as an alternative therapy for RCC.
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Affiliation(s)
- Ziyin Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Jian Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Wei Huang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Ju Gong
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Qingbing Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Qin Liu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China
| | - Cangyi Wang
- Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China
| | - Yu Zhu
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China.
| | - Xiaoyi Ding
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China.
| | - Zhongmin Wang
- Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 197#, Rui Jin Er Road, Shanghai, 200025, People's Republic of China. .,Department of Radiology, Ruijin Hospital Luwan Branch, School of Medicine, Shanghai Jiao Tong University, 149#, South Chongqing Road, Shanghai, 200020, People's Republic of China.
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12
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Management of Residual or Recurrent Disease Following Thermal Ablation of Renal Cortical Tumors. J Kidney Cancer VHL 2020; 7:1-5. [PMID: 32665886 PMCID: PMC7331942 DOI: 10.15586/jkcvhl.2020.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022] Open
Abstract
Management of residual or recurrent disease following thermal ablation of renal cortical tumors includes surveillance, repeat ablation, or surgical extirpation. We present a multicenter experience with regard to the management of this clinical scenario. Prospectively maintained databases were reviewed to identify 1265 patients who underwent cryoablation (CA) or radiofrequency ablation (RFA) for enhancing renal masses. Disease persistence or recurrence was classified into one of the three categories: (i) residual disease in ablation zone; (ii) recurrence in the ipsilateral renal unit; and (iii) metastatic/extra-renal disease. Seventy seven patients (6.1%) had radiographic evidence of disease persistence or recurrence at a median interval of 13.7 months (range, 1–65 months) post-ablation. Distribution of disease included 47 patients with residual disease in ablation zone, 29 with ipsilateral renal unit recurrences (all in ablation zone), and one with metastatic disease. Fourteen patients (18%) elected for surveillance, and the remaining underwent salvage ablation (n = 50), partial nephrectomy (n = 5), or radical nephrectomy (n = 8). Salvage ablation was successful in 38/50 (76%) patients, with 12 failures managed by observation (3), tertiary ablation (6), and radical nephrectomy (3). At a median follow-up of 28 months, the actuarial cancer-specific survival and overall survival in this select cohort of patients was 94.8 and 89.6%, respectively.
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13
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Lam CJ, Wong NC, Voss M, Mironov O, Connolly M, Matsumoto ED, Kapoor A. Surveillance post-radiofrequency ablation for small renal masses: Recurrence and followup. Can Urol Assoc J 2020; 14:398-403. [PMID: 32574144 DOI: 10.5489/cuaj.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Small renal masses (SRMs), enhancing tumors <4 cm in diameter, are suspicious for renal cell carcinoma (RCC). The incidence of SRMs have risen with the increased quality and frequency of imaging. Partial nephrectomy is widely accepted as a nephron-sparing approach for the management of clinically localized RCC, with a greater than 90% disease-specific survival for stage T1a. Radiofrequency ablation (RFA) has been emerging as an alternative management strategy, with evidence suggesting RFA as a safe alternative for SRMs. We aimed to evaluate the time to recurrence and recurrence rates of SRMs treated with RFA at our institution. METHODS A retrospective review between October 2011 and May 2019 identified 141 patients with a single SRM treated with RFA at Hamilton Health Sciences and St. Joseph's Healthcare Hamilton. Patients with familial syndromes and distant metastases were excluded. Repeat RFAs of the ipsilateral kidney for incomplete ablation were not considered a new procedure. The primary variable measured was time from initial ablation to recurrence. A Cox proportional hazard regression model was used to identify possible prognostic variables for tumor recurrence defined a priori, including age, gender, mass size, RENAL nephrometry, and PADUA scores. RESULTS The overall average age of our patients was 69.0±11.1 years, with 71.6% being male. Average tumor size was 2.6±0.8 cm. There were 22/154 total recurrences (15.6%) post-RFA. Median followup time was 67 (18-161) months. Those with new recurrences had median time to recurrence of 15 months and no recurrence beyond 53 months. Thirteen of 141 patients had residual disease (9.2%) and were identified within the first eight months post-RFA. The only prognostic variable identified as a predictor of residual disease was tumor size (hazard ratio 2.265; p<0.001). CONCLUSIONS This study shows the risk of a new recurrence following RFA for SRMs is 6.4%. Most recurrences (9.2%) were a result of residual tumor at the ablation site identified within the first eight months post-RFA. No recurrences were identified beyond 53 months, with a total median followup time of 67 months. Tumor size alone, without need for complex scoring systems, may serve as a predictor of incomplete ablation following RFA and could be used to assist in shared decision-making on management strategies.
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Affiliation(s)
- Cameron J Lam
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Nathan C Wong
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Maurice Voss
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Oleg Mironov
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Michael Connolly
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Edward D Matsumoto
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
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14
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Guo J, Arellano RS. Percutaneous Microwave Ablation of Stage T1b Renal Cell Carcinoma: Short-Term Assessment of Technical Feasibility, Short-Term Oncologic Outcomes, and Safety. J Endourol 2020; 34:1021-1027. [PMID: 32498630 DOI: 10.1089/end.2020.0382] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To report on the safety, technical results, and oncologic outcomes of computed tomography guided percutaneous microwave ablation of stage cT1b renal cell carcinoma. Materials and Methods: This single-center retrospective study investigated consecutive patients with T1b renal cell carcinoma who were treated with CT guided percutaneous microwave ablation between December 2015 and May 2019. Patient baseline characteristics, tumor biologic features, technical parameters, clinical outcomes, and complications were recorded and evaluated. Local tumor progression-free survival and overall survival rates were estimated using the Kaplan-Meier methods. Results: This study included 23 patients (18 men [mean age ± standard deviation, 74.6 years ±10.2; range 58-89 years] and 5 women [mean age, 71.6 years ±10.1; range 62-86 years]; overall mean age, 74.0 years ±10.0; range 58-89 years) with 23 T1b renal cell carcinomas. Primary technical success was achieved in 20/23 (87%) patients. Secondary technical success was achieved in 3/3 (100%) patients. Local tumor progression-free survival was 100.0%, 90.9%, and 90.9% at 1, 2, and 3 years, respectively. Overall survival was 95.2%, 85.7%, and 71.4% at 1, 2, and 3 years, respectively. There were 2 (8.7%) complications; both were classified as minor complications according to the Society of Interventional Radiology grading system. Conclusions: Computed tomography guided percutaneous microwave ablation for T1b renal cell carcinoma is associated with high rates of technical success, excellent local tumor progression-free survival, short-term survival and overall survival, and low complication rates.
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Affiliation(s)
- Jianhai Guo
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Interventional Therapy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, China
| | - Ronald S Arellano
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Papa M, Suardi N, Losa A, Agostini G, Maga T, Ierardi AM, Carrafiello G, Gaboardi F, Cardone G. ABLATE: a score to predict complications and recurrence rate in percutaneous treatments of renal lesions. Med Oncol 2020; 37:26. [PMID: 32166542 DOI: 10.1007/s12032-020-01351-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 01/20/2023]
Abstract
RENAL score has been validated on predicting adverse events and relapses in percutaneous treatments of renal lesions. To better fit interventional issues a modified score (mRENAL) has been introduced, but the only difference from the RENAL score is on the dimensional parameter. However, it remains of surgical derivation while a specific interventional score is missing. This study aims to obtain a specific score (ABLATE) to better quantify the risk of complications and relapses in percutaneous kidney ablation procedures compared to the existing surgical scores. Taking inspiration from previous papers, a score was built to quantify the real difficulties faced in percutaneous treatment of renal lesions. The ABLATE score was used on 71 cryoablations to evaluate its predictivity of complications and relapses. Logistic regression was used to predict complication incidence; Cox-regression was used for relapses; ROC analysis was used to evaluate the accuracy of the different scores. Between January 2014 and November 2019, 71 lesions in 68 patients were treated. Overall, malignant histology was found in 62 lesions (87.3%). Mean and median RENAL, mRENAL, and ABLATE scores were 7.04 and 7, 7.19 and 7, and 5.11 and 4, respectively. Out of 71 treatments, we experienced 3 bleeding with anemia (4.2%), only 2 of which needed further treatment (2.82%). The mean and median RENAL, mRENAL, and ABLATE scores in those with complications were 7.66 and 7.01 (p = 0.69), 8.0 and 7.1 (p = 0.54), and 6.6 and 5.0 (p = 0.38), respectively. Out of 62 malignant lesions, we experienced 2 persistent and 6 recurrent lesions (3.2% and 8.4%, respectively). At Cox-regression analyses, mABLATE score outperformed both RENAL and mRENAL scores in predicting recurrences (HR 1.48; p < 0.001 vs. 1.41; p = 0.1 vs. 1.38: p = 0.07, respectively). The ABLATE score showed to be a better predictor of relapses than RENAL and mRENAL. The small number of complications conditioned a lack of statistic power on complications for all the scores. At the moment to quantify the risks in percutaneous kidney ablation procedures, surgical scores are used. A specific score better performs this task.
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Affiliation(s)
- Maurizio Papa
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy.
| | - Nazareno Suardi
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Andrea Losa
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Giulia Agostini
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy
| | - Tommaso Maga
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | | | | | - Franco Gaboardi
- Ospedale San Raffaele Sede di Ville Turro - UOC Urology, Milan, Italy
| | - Gianpiero Cardone
- Ospedale San Raffaele Sede di Ville Turro - UOC Radiology, Milan, Italy
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16
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Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2020; 43:1025-1033. [PMID: 32052093 PMCID: PMC7300114 DOI: 10.1007/s00270-020-02423-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 01/20/2023]
Abstract
Objectives To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC). Methods We analysed patients with a histologically proven RCC (≤ 7 cm) treated by MWA from April 2012–April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien–Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications. Results In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4–4.0). Primary efficacy was 89% (95%CI 0.81–0.94) for T1a lesions and 52% (95%CI 0.31–0.73) for T1b lesions (p < 0.001). Fifteen lesions (7 T1a) were re-ablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10–60 months. Six (4%) AEs grade > 3–5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012). Conclusion Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.
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17
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Dreyfuss LD, Wells SA, Best SL, Hedican SP, Ziemlewicz TJ, Lubner MG, Hinshaw JL, Lee FT, Nakada SY, Abel EJ. Development of a Risk-stratified Approach for Follow-up Imaging After Percutaneous Thermal Ablation of Sporadic Stage One Renal Cell Carcinoma. Urology 2019; 134:148-153. [DOI: 10.1016/j.urology.2019.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 01/20/2023]
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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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Shakeri S, Raman SS. Trends in Percutaneous Thermal Ablation Therapies in the Treatment of T1a Renal Cell Carcinomas Rather than Partial Nephrectomy/Radical Nephrectomy. Semin Intervent Radiol 2019; 36:183-193. [PMID: 31435126 DOI: 10.1055/s-0039-1694714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
With the increased incidence of stage T1a renal cell carcinoma (RCC) has come the recognition that these lesions tend to be low grade and slow growing, with low probability of metastasis not necessarily requiring surgery. As alternatives to surgery, both active surveillance and ablation have been advocated for the management of selected patients with stage T1a renal cancers due to slow rate of tumor growth and low metastatic potential based on recent epidemiological studies. Thermal ablation also has consistently reported favorable complication and renal preservation rates compared with surgical approaches. However, most studies are single-center case series and meta-analysis of these series and comparative prospective series with long-term follow-up are lacking. The purpose of this article is to review the principal thermal ablation modalities and oncological outcomes for the treatment of stage T1 RCCs with long-term follow-up.
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Affiliation(s)
- Sepideh Shakeri
- Department of Radiology, University of California, Los Angeles
| | - Steven S Raman
- Department of Radiology, University of California, Los Angeles.,Department of Urology, University of California, Los Angeles
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Abstract
Renal cell cancer is nowadays predominantly diagnosed in early stages due to the widespread use of sectional imaging for unrelated symptoms. Small renal masses (<4 cm) feature a largely indolent biology with a very low risk for metastasis or even a benign biology in up to 30% of the cases. Consequently, there is a need for less invasive therapeutic alternatives to nephron-sparing surgery. Meanwhile, there is a broad portfolio of local ablation techniques to treat small renal tumors. These include the extensively studied radiofrequency ablation and cryoablation techniques as well as newer modalities like microwave ablation and irreversible electroporation as more experimental techniques. Tumor ablation can be performed percutaneously under image guidance or laparoscopically. In particular, the percutaneous approach is a less invasive alternative to nephron-sparing surgery with lower risk for complications. Comparative studies and meta-analyses report a higher risk for local recurrence after renal tumor ablation compared to surgery. However, long-term oncological results after treatment of small renal masses are promising and do not seem to differ from partial nephrectomy. The possibility for salvage therapy in case of recurrence also accounts for this finding. Especially old patients with an increased risk of surgical and anesthesiological complications as well as patients with recurrent and multiple hereditary renal cell carcinomas may benefit from tumor ablation. Tumor biopsy prior to intervention is associated with very low morbidity rates and is oncologically safe. It can help to assess the biology of the renal mass and prevent therapy of benign lesions.
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Abstract
PURPOSE OF REVIEW With this review, we describe the most recent advances in active surveillance as well as diagnosis and management of small renal masses (SRMs). RECENT FINDINGS We discuss diagnosis, differentiation of solid from cystic lesions, risk prediction and treatment of the SRM. A better understanding of the disease facilitates the use of more conservatory treatments, such as active surveillance. Active surveillance has been increasingly accepted not only for SRM, but also for larger tumors and even metastatic patients. Exiting advances in risk prediction will help us define which patients can be safely managed with active surveillance and which require immediate treatment. Meanwhile, the use of renal tumor biopsies is still an important tool for these cases. SUMMARY Active surveillance is an option for many patients with renal masses. Noninvasive methods for diagnosis and risk prediction are being developed, but meanwhile, renal tumor biopsy is a useful tool. A better understanding of the disease increases the number of patients who can undergo active surveillance fully certain of the safety of their management.
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Palumbo C, Cyr SJ, Mazzone E, Mistretta FA, Knipper S, Pecoraro A, Tian Z, Shariat SF, Saad F, Simeone C, Briganti A, Kapoor A, Antonelli A, Karakiewicz PI. Impact of Tumor Size on Cancer-Specific Mortality Rate After Local Tumor Ablation in T1a Renal-Cell Carcinoma. J Endourol 2019; 33:606-613. [DOI: 10.1089/end.2019.0179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Sarah-Jeanne Cyr
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco A. Mistretta
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | | | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Anil Kapoor
- Division of Urology, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
- Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
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Shakeri S, Afshari Mirak S, Mohammadian Bajgiran A, Pantuck A, Sisk A, Ahuja P, Lu DS, Raman SS. The effect of tumor size and location on efficacy and safety of US- and CT- guided percutaneous microwave ablation in renal cell carcinomas. Abdom Radiol (NY) 2019; 44:2308-2315. [PMID: 30847565 DOI: 10.1007/s00261-019-01967-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the effect of size and central location of the tumor on safety and efficacy of percutaneous CEUS- and CT-guided MWA in biopsy-proven renal cell carcinomas (RCCs). MATERIALS AND METHODS In this IRB-approved retrospective study, 69 biopsy-proven renal tumors in 56 patients, who underwent MWA in our institution from January 2013 to March 2017, were evaluated. Data collection included demographics, tumor characteristics, procedural protocols, and follow-up visits within 6 months post procedure. Primary outcomes were assessed by technical success (TS), local tumor progression (LTP), and complications. The Kaplan-Meier analysis was used for survival rate. RESULTS Overall technical success was achieved for all 69 lesions (92.8% primary TS, 100% overall). Median nephrometry score was 8 (4-11) and median tumor size was 2.5 cm (0.8-7). Five lesions which required second ablation had significantly higher median tumor size 4 cm (P = 0.039) with the same nephrometry score. Renal function remained stable with no significant change in eGFR before or after ablation. The LTP rate was 5.8%. The most recurrent tumors were clear cell (50%) followed by papillary tumors (25%). The complication rate was 5.8% with minor complications (hematoma and pain) and no major issues. There was no significant association between nephrometry score and technical success, recurrence, or complication rates. Overall and tumor-specific survival rates were 96.7% and 100% at 11.9 months. CONCLUSIONS Image-guided MWA appears to be a safe and effective treatment regardless of nephrometry score and tumor location with high technical success, low recurrence, and complication rates.
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Affiliation(s)
- Sepideh Shakeri
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Sohrab Afshari Mirak
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | | | - Allan Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Anthony Sisk
- Department of Pathology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Preeti Ahuja
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - David S Lu
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
- Department of Urology, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
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Leshen M, Butani D. Management of small renal masses: An interventional radiologist's perspective. Eur J Intern Med 2019; 64:15-20. [PMID: 31029546 DOI: 10.1016/j.ejim.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/16/2019] [Accepted: 04/18/2019] [Indexed: 11/25/2022]
Abstract
Renal cell carcinoma is relatively common malignancy. Its imaging features are often non-specific and can present a diagnostic dilemma for clinicians. Historically, all patients with a renal mass underwent radical nephrectomy. Advances in technology have allowed for an increase in partial nephrectomies and percutaneous ablations. This essay briefly describes some of the imaging findings of renal cell carcinoma and several of its mimics followed by an in-depth review of procedural management with a particular focus on recent advancements.
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Affiliation(s)
- Michael Leshen
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Devang Butani
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Percutaneous Cryoablation of Stage T1b Renal Cell Carcinoma: Safety, Technical Results, and Clinical Outcomes. Cardiovasc Intervent Radiol 2019; 42:970-978. [PMID: 31044292 DOI: 10.1007/s00270-019-02226-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The use of percutaneous cryoablation for T1b (4.1-7.0 cm) renal cell carcinoma, has not yet been widely adopted. The purpose of this study was to describe our experience in the cryoablation of stage T1b tumors with an emphasis on safety, technical results, and clinical outcomes. MATERIALS AND METHODS A retrospective review of hospital records identified 37 patients who underwent cryoablation for T1b lesions from 2008 to 2018. Patient demographics, comorbidities, tumor characteristics, technical parameters, and outcomes were recorded and analyzed. Recurrence-free, overall, and cancer-specific survival rates were estimated using the Kaplan-Meier method. RESULTS Thirty-seven patients (22 males, 15 females; mean age 66.5 ± 11.3) with 37 T1b tumors (mean diameter 47.3 ± 6.3 mm) were included. A median of 3 probes were used (range: 1-7). Angio-embolization was used in 3/37 (8.1%) and 2/37 patients (5.4%) required hydrodissection. The mean number of total cryoablation procedures for each patient was 1.5 (median 1; range: 1-4). Technical success was achieved in 88.2% of patients. Recurrence-free survival was 96.5%, 86.1%, and 62.6% at 1, 2, and 3 years respectively. Cancer-specific survival was 100% at 1, 2, and 3 years respectively. Overall survival was 96.7%, 91.8%, and 77.6% at 1, 2, and 3 years respectively. Complications classified as CIRSE grade 2 or higher occurred in 6/37 (16.2%) patients. CONCLUSION T1b cryoablation is associated with high rates of technical success, excellent cancer-specific survival, and an acceptable safety profile. LEVEL OF EVIDENCE Level 4, Case Series.
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Salagierski M, Wojciechowska A, Zając K, Klatte T, Thompson RH, Cadeddu JA, Kaouk J, Autorino R, Ahrar K, Capitanio U. The Role of Ablation and Minimally Invasive Techniques in the Management of Small Renal Masses. Eur Urol Oncol 2018; 1:395-402. [PMID: 31158078 DOI: 10.1016/j.euo.2018.08.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/14/2018] [Accepted: 08/31/2018] [Indexed: 12/25/2022]
Abstract
CONTEXT Nephron-sparing approaches are increasingly recommended for incidental small renal masses. Herein, we review the current literature regarding the safety and efficacy of focal therapy, including percutaneous ablation, for small renal masses. OBJECTIVE To summarize the application of ablative therapy in the management of small renal masses. EVIDENCE ACQUISITION PubMed and Medline database search was performed to look for findings published since 2000 on focal therapy for small renal masses. After literature review, 64 articles were selected and discussed. EVIDENCE SYNTHESIS Radiofrequency ablation and cryotherapy are the most widely used procedures with intermediate-term oncological outcome comparable with surgical series. Cost effectiveness seems excellent and side effects appear acceptable. To date, no randomized trial comparing percutaneous focal therapy with standard surgical approach or active surveillance has been performed. CONCLUSIONS Focal ablative therapies are now accepted as effective treatment for small renal tumors. For tumors <3cm, oncological effectiveness of ablative therapies is comparable with that of partial nephrectomy. Percutaneous ablation has fewer complications and a better postoperative profile when compared with minimally invasive partial nephrectomy. PATIENT SUMMARY Focal ablative therapies are now accepted as effective treatment for small renal tumors. For tumors <3cm, oncological effectiveness of ablative therapies is comparable with that of partial nephrectomy.
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Affiliation(s)
- Maciej Salagierski
- Urology Department, The Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland.
| | - Adrianna Wojciechowska
- Urology Department, The Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Kinga Zając
- Urology Department, The Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK
| | | | | | - Jihad Kaouk
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Kamran Ahrar
- Interventional Radiology, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Umberto Capitanio
- Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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Kuklik E, Światłowski Ł, Sojka M, Szczerbo-Trojanowska M. Endovascular Embolization of Renal Cell Carcinoma in a Patient with Solitary Kidney. Pol J Radiol 2018; 82:494-497. [PMID: 29662578 PMCID: PMC5894043 DOI: 10.12659/pjr.901219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022] Open
Abstract
Background Kidney tumors account for about 3% of tumors in adults. The primary therapy of renal cancer is the surgical removal. Traditionally, and also modern procedures are performed to remove the kidneys, especially when the tumor involves the entire kidney. In the cases of unresectable tumors embolization is used as a palliative procedure. Case Report The aim of this study is to present the case of endovascular treatment of renal cell carcinoma in patient with solitary kidney. 77-years old patient had an ultrasound examination because of the pain in left lumbar region. MRI confirmed the presence of tumor size 29×45 mm in the left kidney. The right kidney had been removed eight years earlier because of clear cell carcinoma. Histopathological diagnosis was renal clear cell carinoma. The patient did not consent to surgical treatment. Tumor embolization was proceeded as a minimally invasive procedure. Pathological tumor vessels were closed using particles filling the entire vascular tumor. Next, the blood vessels supplying the tumor were closed using a mixture of lipiodolu and glubranu. Control angiographiy of the left renal artery confirmed the effective closure of all vascular pathology. In a recent ultrasound examination which was done 15 months after surgery no evidence of vascular pathology was found. Conclusions Embolization of kidney cancer in particular cases may be an alternative way of treatment and give a good result in the form of stopping the growth of the tumor with simultaneous retaining the remaining parenchyma and renal function.
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Affiliation(s)
- Ewa Kuklik
- Department of Radiology and Interventional Neuroradiology, Independent Public Hospital No. 4 (SPSK 4), Lublin, Poland
| | - Łukasz Światłowski
- Department of Radiology and Interventional Neuroradiology, Independent Public Hospital No. 4 (SPSK 4), Lublin, Poland
| | - Michał Sojka
- Department of Radiology and Interventional Neuroradiology, Independent Public Hospital No. 4 (SPSK 4), Lublin, Poland
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Irreversible electroporation and thermal ablation of tumors in the liver, lung, kidney and bone: What are the differences? Diagn Interv Imaging 2017; 98:609-617. [DOI: 10.1016/j.diii.2017.07.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
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Laguna MP. Re: Irreversible Electroporation of Small Renal Masses: Suboptimal Oncologic Efficacy in an Early Series. J Urol 2017; 198:481-482. [PMID: 28817909 DOI: 10.1016/j.juro.2017.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McCarthy CJ, Gervais DA. Decision Making: Thermal Ablation Options for Small Renal Masses. Semin Intervent Radiol 2017; 34:167-175. [PMID: 28579684 DOI: 10.1055/s-0037-1602708] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Renal cell carcinoma is a relatively common tumor, with an estimated 63,000 new cases being diagnosed in the United States in 2016. Surgery, be it with partial or total nephrectomy, is considered the mainstay of treatment for many patients. However, those patients with small renal masses, typically less than 3 to 4 cm in size who are deemed unsuitable for surgery, may be suitable for percutaneous thermal ablation. We review the various treatment modalities, including radiofrequency ablation, microwave ablation, and cryoablation; discuss the advantages and disadvantages of each method; and review the latest data concerning the performance of the various ablative modalities compared with each other, and compared with surgery.
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Affiliation(s)
- Colin J McCarthy
- Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Debra A Gervais
- Division of Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts
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Wells SA, Wong VK, Wittmann TA, Lubner MG, Best SL, Ziemlewicz TJ, Hinshaw JL, Lee FT, Abel EJ. Renal mass biopsy and thermal ablation: should biopsy be performed before or during the ablation procedure? Abdom Radiol (NY) 2017; 42:1773-1780. [PMID: 28184961 DOI: 10.1007/s00261-016-1037-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine if renal mass biopsy should be performed before or during the ablation procedure with emphasis on complications and rate of ablation for renal cell carcinomas (RCC), benign tumors, and small renal masses without a histologic diagnosis. METHODS This HIPAA-compliant, single-center retrospective study was performed under a waiver of informed consent from the institutional review board. Two hundred eighty-four consecutive patients with a small renal mass (≤4.0 cm) treated with percutaneous thermal ablation between January 2001 and January 2015 were included. Two cohorts were identified based upon the timing of renal mass biopsy: separate session two weeks prior to ablation and same session obtained immediately preceding ablation. Clinical and pathologic data were collected including risk factors for non-diagnostic biopsy. Two-sided t test, χ 2 test or Fischer's exact tests were used to evaluate differences between cohorts. Univariate and multivariate logistic regression models were constructed. RESULTS A histologic diagnostic was achieved more frequently in the separate session cohort [210/213 (98.6%) vs. 60/71 (84.3%), p < 0.0001]. The rate of ablation of RCC was higher in the separate session group [201/213 (94.4%) vs. 46/61 (64.7%), p = 0.001]. The rate of ablation for benign tumors [14/71 (19.7%) vs. 6/213 (2.8%), p < 0.0001] and small renal masses without a histologic diagnosis [3/213 (1.4%) vs. 11/71 (15.5%), p < 0.0001] was higher in the same session cohort. There were no high-grade complications in either cohort. CONCLUSION Performing renal mass biopsy prior to the day of ablation is safe, increases the rate of histologic diagnosis, and reduces the rate of ablation for benign tumors and small renal masses without a histologic diagnosis.
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Affiliation(s)
- Shane A Wells
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Vincenzo K Wong
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Tyler A Wittmann
- Health Sciences Learning Center, University of Wisconsin School of Medicine and Public Health, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Meghan G Lubner
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Fred T Lee
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - E Jason Abel
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin Medical Foundation Centennial Building, Third Floor, 1685 Highland Avenue, Madison, WI, 53705, USA
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Liu N, Huang D, Cheng X, Chong Y, Wang W, Gan W, Guo H. Percutaneous radiofrequency ablation for renal cell carcinoma vs. partial nephrectomy: Comparison of long-term oncologic outcomes in both clear cell and non-clear cell of the most common subtype. Urol Oncol 2017; 35:530.e1-530.e6. [PMID: 28408296 DOI: 10.1016/j.urolonc.2017.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To compare the clinical outcomes of percutaneous radiofrequency ablation (PRFA) and partial nephrectomy (PN) in patients with clear cell renal cell carcinoma (ccRCC) and non-clear cell RCC (nccRCC) of the most common subtypes. MATERIALS AND METHODS A retrospective study was conducted to review the records of all the patients who underwent PRFA or PN between February 2005 and April 2014 at our institution. Patients with histologic confirmation of ccRCC, papillary RCC, and chromophobe RCC were included. The Mann-Whitney U test was applied to compare PRFA to PN in the ccRCC and nccRCC groups. The Kaplan-Meier method was used to generate the survival curves that were compared to the log-rank test. RESULTS A total of 264 patients meeting the selection criteria were included in this study. The tumor size ranged from 0.9 to 7.0cm. The median follow-up period was 78 months (range: 8-132 mo). Although PRFA provided comparable 10-year overall survival rates and 10-year disease-free survival (DFS) rates to PN both in ccRCC ≤4cm and nccRCC, the 10-year DFS for patients treated with PRFA was lower than that of PN in ccRCC >4cm. The DFS survival curve between the 2 operations and 2 subtypes was statistically significant in patients with tumor size >4cm. Limitations include retrospective review and selection bias. CONCLUSIONS Patients with T1b ccRCC treated with PRFA have less favorable outcomes than those with PN whereas PRFA provides comparable oncologic outcomes to PN in patients with T1b nccRCC. It is necessary to take RCC subtypes into consideration when choosing a surgical approach to treat T1b RCC between PFRA and PN.
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Affiliation(s)
- Ning Liu
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Daoguang Huang
- Department of Urology, Lichuan People's Hospital, Lichuan, Hubei Province, People's Republic of China
| | - Xiangming Cheng
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yankun Chong
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Wei Wang
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
| | - Weidong Gan
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu Province, People's Republic of China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu Province, People's Republic of China
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Abreu LADS, Damasceno-Ferreira JA, Costa WS, Pereira-Sampaio MA, Sampaio FJB, de Souza DB. Glomerular Loss After Renal Radiofrequency Ablation Are Comparable to 30 Minutes of Warm Ischemia. J Endourol 2017; 31:517-521. [PMID: 28326799 DOI: 10.1089/end.2016.0899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare, with stereological methods, the glomerular loss in kidneys submitted to radiofrequency ablation (RFA) or warm ischemia. MATERIALS AND METHODS Twenty-six male pigs were divided into three groups. Eight animals were allocated in the sham group, which was submitted to laparoscopic dissection of the left renal hilum, without renal ischemia. Eight animals were allocated in the ischemia group, which had the left renal hilum clamped for 30 minutes under laparoscopic access. Ten animals were submitted to RFA of the left kidney lower pole, under laparoscopic visualization. Animals were euthanized 21 days after surgery, when kidneys were collected. Fragments of the upper pole of the left kidney were processed for morphometric analysis. Right kidney was used as self-controls for each animal. Glomerular volumetric density (Vv[glom]); volume-weighted glomerular volume (VWGV); and glomerular density were quantified by stereological methods and compared by Student's t-test and one-way-analysis of variance with Dunnett's post-test. RESULTS Three animals in the RFA group developed postoperative complications (Urinoma/Hydronephrosis) and were excluded from the analysis. No difference was found among the kidneys submitted to RFA and warm ischemia for all parameters. However, these kidneys showed lower Vv[glom] and glomerular density when compared to its self-controls (right kidneys), and when compared to sham-operated animals (p < 0.05). No difference was observed in regards to VWGV among the groups. CONCLUSION RFA in pigs determines a significant reduction of glomerular density in the remaining parenchyma. This alteration was comparable to that observed in kidneys submitted to 30 minutes of warm ischemia.
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Affiliation(s)
- Leonardo Albuquerque Dos Santos Abreu
- 1 Urogenital Research Unit, State University of Rio de Janeiro , Rio de Janeiro, Brazil .,2 Faculty of Medicine, Estacio de Sá University , Rio de Janeiro, Brazil
| | - José Aurelino Damasceno-Ferreira
- 1 Urogenital Research Unit, State University of Rio de Janeiro , Rio de Janeiro, Brazil .,3 Department of Veterinary Clinical Pathology, Fluminense Federal University , Niterói, Brazil
| | - Waldemar Silva Costa
- 1 Urogenital Research Unit, State University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Marco Aurélio Pereira-Sampaio
- 1 Urogenital Research Unit, State University of Rio de Janeiro , Rio de Janeiro, Brazil .,4 Department of Morphology, Fluminense Federal University , Niterói, Brazil
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Irreversible electroporation of small renal masses: suboptimal oncologic efficacy in an early series. World J Urol 2017; 35:1549-1555. [DOI: 10.1007/s00345-017-2025-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/13/2017] [Indexed: 01/03/2023] Open
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Neutrophil-to-lymphocyte ratio as an independent predictor for survival in patients with localized clear cell renal cell carcinoma after radiofrequency ablation: a propensity score matching analysis. Int Urol Nephrol 2017; 49:967-974. [PMID: 28247169 DOI: 10.1007/s11255-017-1554-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/22/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To investigate the role of neutrophil-to-lymphocyte ratio as a prognostic indicator in patients with localized clear cell renal cell carcinoma treated with radiofrequency ablation. PATIENTS AND METHODS We retrospectively analyzed data from patients with renal cell carcinoma who underwent radiofrequency ablation from 2006 to 2013. The Kaplan-Meier method was used to generate the survival curves according to different categories of neutrophil-to-lymphocyte ratio. Relationships between preoperative neutrophil-to-lymphocyte ratio or the change of neutrophil-to-lymphocyte ratio and survival were evaluated with multivariable Cox proportional hazards regression analysis. A propensity score matching analysis was carried out to avoid confounding bias. RESULTS A total of 185 patients were included in present study. When stratified by preoperative neutrophil-to-lymphocyte ratio cutoff value of 2.79, 5-year recurrence-free survival, 5-year disease-free survival, and 5-year overall survival rates of neutrophil-to-lymphocyte ratio <2.79 versus ≥2.79 were 100, 98.5, and 99.2% versus 80.5, 72.6, and 90.6%, respectively (P < 0.001, P < 0.001, P = 0.003). In terms of propensity score matching analysis, 5-year recurrence-free survival, 5-year disease-free survival, and 5-year overall survival rates of neutrophil-to-lymphocyte ratio <2.79 versus ≥2.79 were 100, 97.9, and 100% versus 82.3, 73.4, and 89.4%, respectively (P = 0.003, P = 0.001, P = 0.022). When combining preoperative neutrophil-to-lymphocyte ratio with the change of neutrophil-to-lymphocyte ratio, patients with both preoperative neutrophil-to-lymphocyte ratio ≥2.79 and the change of neutrophil-to-lymphocyte ratio ≥0.40 had the worst disease-free survival. Results of multivariable analysis showed that preoperative neutrophil-to-lymphocyte ratio and the change of neutrophil-to-lymphocyte ratio correlated with cancer relapse remarkably. CONCLUSIONS High preoperative neutrophil-to-lymphocyte ratio and elevated postoperative neutrophil-to-lymphocyte ratio are associated with significant increase in risk of local recurrence as well as distant metastasis. The combination of neutrophil-to-lymphocyte ratio with the other prognostic indicators can be applied in the evaluation of relapse risk in patients with clear cell renal cell carcinoma after radiofrequency ablation.
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Correas JM, Delavaud C, Gregory J, Le Guilchet T, Lamhaut L, Timsit MO, Méjean A, Hélénon O. Ablative Therapies for Renal Tumors: Patient Selection, Treatment Planning, and Follow-Up. Semin Ultrasound CT MR 2017; 38:78-95. [DOI: 10.1053/j.sult.2016.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Schulman AA, Tay KJ, Polascik TJ. Expanding thermal ablation to the 'intermediate-sized' renal mass: clinical utility in T1b tumors. Transl Androl Urol 2017; 6:127-130. [PMID: 28217461 PMCID: PMC5313302 DOI: 10.21037/tau.2017.01.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Ariel A Schulman
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kae Jack Tay
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Polascik
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Zondervan PJ, Wagstaff PGK, Desai MM, de Bruin DM, Fraga AF, Hadaschik BA, Köllermann J, Liehr UB, Pahernik SA, Schlemmer HP, Wendler JJ, Algaba F, de la Rosette JJMCH, Laguna Pes MP. Follow-up after focal therapy in renal masses: an international multidisciplinary Delphi consensus project. World J Urol 2016; 34:1657-1665. [PMID: 27106492 PMCID: PMC5114314 DOI: 10.1007/s00345-016-1828-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/04/2016] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To establish consensus on follow-up (FU) after focal therapy (FT) in renal masses. To formulate recommendations to aid in clinical practice and research. METHODS Key topics and questions for consensus were identified from a systematic literature research. A Web-based questionnaire was distributed among participants selected based on their contribution to the literature and/or known expertise. Three rounds according to the Delphi method were performed online. Final discussion was conducted during the "8th International Symposium on Focal Therapy and Imaging in Prostate and Kidney Cancer" among an international multidisciplinary expert panel. RESULTS Sixty-two participants completed all three rounds of the online questionnaire. The panel recommended a minimum follow-up of 5 years, preferably extended to 10 years. The first FU was recommended at 3 months, with at least two imaging studies in the first year. Imaging was recommended biannually during the second year and annually thereafter. The panel recommended FU by means of CT scan with slice thickness ≤3 mm (at least three phases with excretory phase if suspicion of collecting system involvement) or mpMRI. Annual checkup for pulmonary metastasis by CT thorax was advised. Outside study protocols, biopsy during follow-up should only be performed in case of suspicion of residual/persistent disease or radiological recurrence. CONCLUSIONS The consensus led to clear FU recommendations after FT of renal masses supported by a multidisciplinary expert panel. In spite of the low level of evidence, these recommendations can guide clinicians and create uniformity in the follow-up practice and for clinical research purposes.
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Affiliation(s)
- P J Zondervan
- Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands.
| | - P G K Wagstaff
- Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands
| | - M M Desai
- Department of Urology, Keck School of Medicine USC, Los Angeles, CA, USA
| | - D M de Bruin
- Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, AMC University Hospital, Amsterdam, The Netherlands
| | - A F Fraga
- Department of Urology, Centro Hospitalar do Porto, Porto, Portugal
| | - B A Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Köllermann
- Department of Pathology, Sana Klinikum Offenbach, Offenbach, Germany
| | - U B Liehr
- Department of Urology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - S A Pahernik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - H P Schlemmer
- Department of Urology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - J J Wendler
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - F Algaba
- Department of Pathology, Fundació Puigvert, Barcelona, Spain
| | - J J M C H de la Rosette
- Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands
| | - M P Laguna Pes
- Department of Urology, AMC University Hospital, PO box 22660, 1100DD, Amsterdam, The Netherlands
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Su MZ, Memon F, Lau HM, Brooks AJ, Patel MI, Woo HH, Bariol SV, Vladica P. Safety, efficacy and predictors of local recurrence after percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma. Int Urol Nephrol 2016; 48:1609-16. [PMID: 27432413 DOI: 10.1007/s11255-016-1355-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/27/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) for localised renal cell carcinoma (RCC) and examine potential associations between age, gender, tumour size, location, chronic kidney disease, comorbidities, learning curve and local recurrence. METHODS We retrospectively analysed survival outcomes for patients with biopsy-proven RCC treated by RFA at Westmead Hospital. Complication data were gathered from all patients that underwent renal RFA. 3 and 5 year local recurrence-free (RFS), disease-free (DFS) and overall survival (OS) outcomes were reported. Univariate and multivariate analysis was used to examine each potential predictor. RESULTS A total of 168 patients were eligible for the study. Forty-eight patients with biopsy-proven RCC had minimum 3-year follow-up. Our complication rate was 1.2 % (2/168) and local recurrence rate 10.4 % (5/48). Five-year RFS, DFS and OS were 86.8, 82.3 and 92.6 % on a median 4.1-year follow-up (IQR 3.4-4.9). None of the patient or tumour-specific characteristics were associated with RFS. CONCLUSION Radiofrequency ablation performed at our centre was a safe and effective procedure with low complication rates and durable RFS. Tumour characteristics, comorbidities and learning curve were not associated with local recurrence.
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Affiliation(s)
- Michael Z Su
- Department of Surgery, University of Sydney, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, NSW, 2145, Australia.
| | - Fatima Memon
- Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
| | - Howard M Lau
- Department of Urology, Westmead Hospital, Sydney, NSW, Australia
| | - Andrew J Brooks
- Department of Urology, Westmead Hospital, Sydney, NSW, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, NSW, Australia
| | - Henry H Woo
- Sydney Medical School, University of Sydney, Wahroonga, NSW, Australia
| | - Simon V Bariol
- Department of Urology, Westmead Hospital, Sydney, NSW, Australia
| | - Philip Vladica
- Department of Radiology, Westmead Hospital, Sydney, NSW, Australia
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Acosta Ruiz V, Lönnemark M, Brekkan E, Dahlman P, Wernroth L, Magnusson A. Predictive factors for complete renal tumor ablation using RFA. Acta Radiol 2016; 57:886-93. [PMID: 26452975 DOI: 10.1177/0284185115605681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/02/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) can be used to treat renal masses in patients where surgery is preferably avoided. As tumor size and location can affect ablation results, procedural planning needs to identify these factors to limit treatment to a single session and increase ablation success. PURPOSE To identify factors that may affect the primary efficacy of complete renal tumor ablation with radiofrequency after a single session. MATERIAL AND METHODS Percutaneous RFA (using an impedance based system) was performed using computed tomography (CT) guidance. Fifty-two renal tumors (in 44 patients) were retrospectively studied (median follow-up, 7 months). Data collection included patient demographics, tumor data (modified Renal Nephrometry Score, histopathological diagnosis), RFA treatment data (electrode placement), and follow-up results (tumor relapse). Data were analyzed through generalized estimating equations. RESULTS Primary efficacy rate was 83%. Predictors for complete ablation were optimal electrode placement (P = 0.002, OR = 16.67) and increasing distance to the collecting system (P = 0.02, OR = 1.18). Tumor size was not a predictor for complete ablation (median size, 24 mm; P = 0.069, OR = 0.47), but all tumors ≤2 cm were completely ablated. All papillary tumors and oncocytomas were completely ablated in a single session; the most common incompletely ablated tumor type was clear cell carcinoma (6 of 9). CONCLUSION Optimal electrode placement and a long distance from the collecting system are associated with an increased primary efficacy of renal tumor RFA. These variables need to be considered to increase primary ablation success. Further studies are needed to evaluate the effect of RFA on histopathologically different renal tumors.
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Affiliation(s)
| | - Maria Lönnemark
- Department of Radiology, University Hospital, Uppsala, Sweden
| | - Einar Brekkan
- Department of Urology, University Hospital, Uppsala, Sweden
| | - Pär Dahlman
- Department of Radiology, University Hospital, Uppsala, Sweden
| | - Lisa Wernroth
- Department of Medical Sciences, Molecular Epidemiology, University Hospital, Uppsala, Sweden
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Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes. Curr Urol Rep 2016; 17:59. [DOI: 10.1007/s11934-016-0611-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Zhang F, Chang X, Liu T, Wang W, Zhao X, Ji C, Yang R, Guo H. Prognostic Factors for Long-Term Survival in Patients with Renal-Cell Carcinoma After Radiofrequency Ablation. J Endourol 2016. [PMID: 26222920 DOI: 10.1089/end.2015.0454] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Fan Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaofeng Chang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Tieshi Liu
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wei Wang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaozhi Zhao
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Changwei Ji
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Rong Yang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Kiechle JE, Abouassaly R, Smaldone MC, Shah ND, Dong S, Cherullo EE, Nakamoto D, Zhu H, Cooney MM, Kim SP. National Trends of Local Ablative Therapy Among Young Patients With Small Renal Masses in the United States. Urology 2015; 86:962-7. [PMID: 26341571 DOI: 10.1016/j.urology.2015.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To assess national trends in the usage of local ablative therapy for small renal masses (SRMs) in a cohort of young patients. Ablation of SRMs has been shown to offer cancer control with limited follow-up. Although ablation is considered effective for patients with limited life expectancy, its use among younger patients may be considered controversial. METHODS We used the National Cancer Data Base to identify patients between the ages of 40 and 65 years who were diagnosed with SRMs from 2004 to 2011. The primary outcome was the use of local ablative therapy. Multivariable logistic regression analysis was used to identify patient and hospital factors associated with ablation therapies in this cohort. RESULTS During the study period, we identified 49,441 patients with SRMs, of which 2789 (5.6%) were treated with ablative therapies. The proportion of patients undergoing ablation gradually rose from 2.2% in 2004 to 6.2% in 2011 (P < .001). On multivariable analysis, patients were more likely to receive local ablation at academic hospitals (odds ratio [OR]: 1.5; P < .001) compared with community hospitals, or primarily insured by Medicaid (OR: 1.4; P < .001) or Medicare (OR: 1.3; P < .001) compared with private insurance. CONCLUSION The use of local ablative therapies is gradually rising but has so far been limited to a small fraction of young patients with SRMs. Patients treated at high-volume, academic hospitals or insured with Medicaid or Medicare were treated to a greater degree with ablation. These results have important implications for the adoption of ablation and the need for long-term surveillance.
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Affiliation(s)
- Jonathan E Kiechle
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Robert Abouassaly
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Center for Health Care Quality and Research, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Marc C Smaldone
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Nilay D Shah
- Division of Health Policy and Research, Mayo Clinic, Rochester, MN
| | - Shan Dong
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Edward E Cherullo
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Dean Nakamoto
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Department of Radiology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Hui Zhu
- Louis Stokes Veteran's Affairs Medical Center, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH
| | - Matthew M Cooney
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH; Department of Medical Oncology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Simon P Kim
- Urology Institute, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH; Center for Health Care Quality and Research, University Hospitals Case Medical Center, Cleveland, OH; Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH.
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Camacho JC, Kokabi N, Xing M, Master VA, Pattaras JG, Mittal PK, Kim HS. R.E.N.A.L. (Radius, Exophytic/Endophytic, Nearness to Collecting System or Sinus, Anterior/Posterior, and Location Relative to Polar Lines) Nephrometry Score Predicts Early Tumor Recurrence and Complications after Percutaneous Ablative Therapies for Renal Cell Carcinoma: A 5-Year Experience. J Vasc Interv Radiol 2015; 26:686-93. [DOI: 10.1016/j.jvir.2015.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 01/20/2023] Open
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Wagstaff P, Ingels A, Zondervan P, de la Rosette JJMCH, Laguna MP. Thermal ablation in renal cell carcinoma management: a comprehensive review. Curr Opin Urol 2015; 24:474-82. [PMID: 25051022 DOI: 10.1097/mou.0000000000000084] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article provides an overview of recent developments in the field of thermal ablation for renal cell carcinoma and focuses on current standard techniques, new technologies, imaging for ablation guidance and evaluation, and future perspectives. RECENT FINDINGS Emerging long-term data on cryoablation and radiofrequency ablation (RFA) show marginally lower oncologic outcomes compared to surgical treatment, balanced by better functional and perioperative outcomes. Reports on residual disease vary widely, influenced by different definitions and strategies in determining ablation failure. Stratifying disease-free survival after RFA according to tumor size suggests 3 cm to be a reasonable cut off for RFA tumor selection. Microwave ablation and high-intensity focal ultrasound are modalities with the potential of creating localized high temperatures. However, difficulties in renal implementation are impairing sufficient ablation results. Irreversible electroporation, although not strictly thermal, is a new technology showing promising results in animal and early human research. SUMMARY Although high-level randomized controlled trials comparing thermal ablation techniques are lacking, evidence shows that thermal ablation for small renal masses is a safe procedure for both long-term oncologic and functional outcomes. Thermal ablation continues to be associated with a low risk of residual disease, for which candidates should be properly informed. RFA and cryoablation remain the standard techniques whereas alternative techniques require further studies.
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Affiliation(s)
- Peter Wagstaff
- Department of Urology, Academic Medical Center, Amsterdam, Netherlands *Peter Wagstaff and Alexandre Ingels contributed equally to the writing of this article
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Chang X, Liu T, Zhang F, Qian C, Ji C, Zhao X, Liu G, Guo H. The Comparison of R.E.N.A.L., PADUA and Centrality Index Score in Predicting Perioperative Outcomes and Complications after Laparoscopic Radio Frequency Ablation of Renal Tumors. J Urol 2015; 194:897-902. [PMID: 25813450 DOI: 10.1016/j.juro.2015.03.095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 01/20/2023]
Abstract
PURPOSE We assessed the association between the R.E.N.A.L., PADUA and centrality index scores and perioperative outcomes, and determined the efficacy of each scoring system over the simple parameter of tumor size. MATERIALS AND METHODS We conducted a retrospective review of the records of patients who underwent laparoscopic radio frequency ablation of renal tumors from February 2006 to April 2014 at our institution. Tumors were categorized using the R.E.N.A.L., PADUA and centrality index score, which were determined by analyzing preoperative imaging. The relationships between each variable and change in glomerular filtration rate, estimated blood loss, operative time and postoperative complications were examined. RESULTS Laparoscopic radio frequency ablation was performed in 215 selected patients with preoperative imaging available. The interclass correlations coefficient of the 3 observers was 0.87, 0.84 and 0.82 for the C-Index, the R.E.N.A.L. and the PADUA scoring system, respectively. R.E.N.A.L. score, PADUA score and PADUA complexity were significantly associated with postoperative complications (p=0.040, 0.015 and 0.006, respectively). However, major complications were only associated with high PADUA complexity (chi-square 23.851, p <0.05). Each scoring system had a significant association with operative time and estimated blood loss (p <0.05), except that the C-index score had no relationship with estimated blood loss (p=0.083). The accuracy of each scoring system in predicting perioperative outcomes and postoperative complications was superior to that of tumor size. CONCLUSIONS Each scoring system has an advantage over tumor size in describing tumor complexity and may help with surgical decision making. Further studies are required to validate their efficacy in evaluating the intraoperative and postoperative results after renal laparoscopic radio frequency ablation.
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Affiliation(s)
- Xiaofeng Chang
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Tieshi Liu
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fan Zhang
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Cheng Qian
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Changwei Ji
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaozhi Zhao
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guangxiang Liu
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongqian Guo
- Department of Urology, the Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
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Thermal Ablative Techniques in Renal Cell Carcinoma. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abdullah BJJ, Yeong CH, Goh KL, Yoong BK, Ho GF, Yim CCW, Kulkarni A. Robotic-assisted thermal ablation of liver tumours. Eur Radiol 2014; 25:246-57. [PMID: 25189152 DOI: 10.1007/s00330-014-3391-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/20/2014] [Accepted: 08/07/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to assess the technical success, radiation dose, safety and performance level of liver thermal ablation using a computed tomography (CT)-guided robotic positioning system. METHODS Radiofrequency and microwave ablation of liver tumours were performed on 20 patients (40 lesions) with the assistance of a CT-guided robotic positioning system. The accuracy of probe placement, number of readjustments and total radiation dose to each patient were recorded. The performance level was evaluated on a five-point scale (5-1: excellent-poor). The radiation doses were compared against 30 patients with 48 lesions (control) treated without robotic assistance. RESULTS Thermal ablation was successfully completed in 20 patients with 40 lesions and confirmed on multiphasic contrast-enhanced CT. No procedure related complications were noted in this study. The average number of needle readjustment was 0.8 ± 0.8. The total CT dose (DLP) for the entire robotic assisted thermal ablation was 1382 ± 536 mGy.cm, while the CT fluoroscopic dose (DLP) per lesion was 352 ± 228 mGy.cm. There was no statistically significant (p > 0.05) dose reduction found between the robotic-assisted versus the conventional method. CONCLUSION This study revealed that robotic-assisted planning and needle placement appears to be safe, with high accuracy and a comparable radiation dose to patients. KEY POINTS • Clinical experience on liver thermal ablation using CT-guided robotic system is reported. • The technical success, radiation dose, safety and performance level were assessed. • Thermal ablations were successfully performed, with an average performance score of 4.4/5.0. • Robotic-assisted ablation can potentially increase capabilities of less skilled interventional radiologists. • Cost-effectiveness needs to be proven in further studies.
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Affiliation(s)
- Basri Johan Jeet Abdullah
- Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia,
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Chang X, Zhang F, Liu T, Ji C, Zhao X, Yang R, Yan X, Wang W, Guo H. Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes. J Urol 2014; 193:430-5. [PMID: 25106899 DOI: 10.1016/j.juro.2014.07.112] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2014] [Indexed: 01/20/2023]
Abstract
PURPOSE We compared outcomes in patients treated with radio frequency ablation or partial nephrectomy for clinical cT1b renal cell carcinoma. MATERIALS AND METHODS We retrospectively reviewed the records of all patients who underwent radio frequency ablation or nephrectomy between February 2006 and December 2010. Radiographic followup with contrast imaging was performed 7 days, 3 and 6 months, and every 6 months thereafter after radio frequency ablation sequentially. The followup protocol for partial nephrectomy was every 6 months in the initial 3 years and annually thereafter. The Kaplan-Meier method was used to generate survival curves, which were compared with the log rank test. Multivariable regression analysis was done to determine predictors of survival. RESULTS A total of 56 patients who met selection criteria were included in study. Patients in the radio frequency ablation group had relatively higher mean age and a higher mean ASA® score than those in the partial nephrectomy group. Mean tumor diameter was significantly larger in the partial nephrectomy cohort. For radio frequency ablation vs partial nephrectomy 5-year overall, cancer specific and disease-free survival was 85.5% (95% CI 72.2-98.8) vs 96.6% (95% CI 95.9-97.3), 92.6% (95% CI 82.4-98.1) vs 96.6% (95% CI 95.9-97.3) and 81.0% (95% CI 66.2-95.8) vs 89.7% (95% CI 78.5-97.9), respectively. The percent decrease in the glomerular filtration rate was significantly lower in the radio frequency ablation group at early and last followup. CONCLUSIONS In appropriately selected patients with stage cT1b renal cell carcinoma radio frequency ablation is an effective treatment option that provides 5-year overall, cancer specific and disease-free survival comparable to that of partial nephrectomy as well as better renal function preservation than partial nephrectomy.
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Affiliation(s)
- Xiaofeng Chang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Fan Zhang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Tieshi Liu
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Changwei Ji
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Xiaozhi Zhao
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Rong Yang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Xiang Yan
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Wei Wang
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Hongqian Guo
- Department of Urology, The Affiliated Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
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