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Acosta Ruiz V, Dahlman P, Brekkan E, Lönnemark M, Magnusson A. Microwave ablation of 105 T1 renal tumors: technique efficacy with a mean follow-up of two years. Acta Radiol 2024; 65:294-301. [PMID: 32910687 DOI: 10.1177/0284185120956283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Thermal ablation (TA) with radiofrequency (RFA) or cryoablation (CA) are established treatments for small renal masses (≤4 cm). Microwave ablation (MWA) has several potential benefits (decreased ablation time, less susceptibility to heat-sink, higher lesion temperatures than RFA) but is still considered experimental considering the available small-sample studies with short follow-up. PURPOSE To evaluate technique efficacy and complications of our initial experience of renal tumors treated using percutaneous MWA with a curative intent. MATERIAL AND METHODS A total of 105 renal tumors (in 93 patients) were treated between April 2014 and August 2017. MWA was performed percutaneously with computed tomography (CT) guidance under conscious sedation (n=82) or full anesthesia. Patients were followed with contrast-enhanced CT scans at six months and yearly thereafter for a minimum of five years. The mean follow-up time was 2.1 years. The percentage of tumors completely ablated in a single session (primary efficacy rate) and those successfully treated after repeat ablation (secondary efficacy rate) were recorded. Patient and tumor characteristics as well as complications were collected retrospectively. RESULTS The median patient age was 70 years and median tumor size was 25 mm. Primary efficacy rate was 96.2% (101/105 tumors). After including two residual tumors for a second ablation session, secondary efficacy was 97.1% (102/105). Periprocedural complications were found in 5.2% (5/95) sessions: four Clavien-Dindo I and one Clavien-Dindo IIIa. One postprocedural Clavien-Dindo II complication was found. CONCLUSION MWA has high efficacy rates and few complications compared to other TA methods at a mean follow-up of two years.
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Affiliation(s)
- Vanessa Acosta Ruiz
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Pär Dahlman
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Einar Brekkan
- Department of Surgical Sciences - Urology, Uppsala University, Uppsala Sweden
| | - Maria Lönnemark
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Anders Magnusson
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
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Bertolotti L, Segato F, Pagnini F, Buti S, Casarin A, Celia A, Ziglioli F, Maestroni U, Pedrazzi G, Ascenti V, Martini C, Cicero C, De Filippo M. Percutaneous Ablation of T1 Renal Masses: Comparative Local Control and Complications after Radiofrequency and Cryoablation. Diagnostics (Basel) 2023; 13:3059. [PMID: 37835802 PMCID: PMC10572527 DOI: 10.3390/diagnostics13193059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
The efficacy and complication rates of percutaneous radiofrequency ablation (RFA) and cryoablation (CA) in the treatment of T1 renal masses in two Northern Italy hospitals were retrospectively investigated. Eighty-two patients with 80 T1a tumors and 10 T1b tumors treated with thermal ablation from 2015 through 2020 were included. A total of 43 tumors in 38 patients were treated with RFA (2.3 ± 0.9 cm), and 47 tumors in 44 patients were treated with CA (2.1 ± 0.8 cm). The mean follow-up observation period was 26 ± 19 months. The major complications and efficacy, as measured using the technical success and local tumor recurrence rates, were recorded. There were three (6.9%) technical failures with RFA and one (2.1%) with cryoablation (p = 0.30). Among the 40 tumors that were successfully treated with RFA, 1 tumor (2.5%) developed local tumor recurrence; 5/46 tumors that were treated with cryoablation (10.8%) developed local tumor recurrence (p = 0.17). T1b lesions (4.0 ± 0.7 cm) resulted in 1/6 technically unsuccessful cases with RFA and 0/4 with CA. No recurrent disease was detected in the T1b lesions. Major complications occurred after 2.3% (1/43) of RFAs and 0/47 of cryoablation procedures. RFA and cryoablation are both effective in the treatment of renal masses. Major complications with either procedure are uncommon.
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Affiliation(s)
- Lorenzo Bertolotti
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (L.B.); (F.P.); (M.D.F.)
| | - Federica Segato
- G.B. Rossi University Hospital, University of Verona, 37134 Verona, VR, Italy;
| | - Francesco Pagnini
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (L.B.); (F.P.); (M.D.F.)
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma–Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, PR, Italy;
| | - Andrea Casarin
- Department of Radiology, San Bassiano Hospital, 36061 Bassano del Grappa, VI, Italy; (A.C.); (C.C.)
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, VI, Italy;
| | - Francesco Ziglioli
- Department of Urology, Parma University Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (F.Z.); (U.M.)
| | - Umberto Maestroni
- Department of Urology, Parma University Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (F.Z.); (U.M.)
| | - Giuseppe Pedrazzi
- Centre of Statistic, Department of Medicine and Surgery, University of Parma, 43126 Parma, PR, Italy;
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Policlinico Universitario, University of Milan, 20133 Milano, MI, Italy;
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy
| | - Calogero Cicero
- Department of Radiology, San Bassiano Hospital, 36061 Bassano del Grappa, VI, Italy; (A.C.); (C.C.)
| | - Massimo De Filippo
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (L.B.); (F.P.); (M.D.F.)
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Safety and efficacy of RFA versus MWA for T1a renal cell carcinoma: a propensity score analysis. Eur Radiol 2023; 33:1040-1049. [PMID: 36066733 PMCID: PMC9889465 DOI: 10.1007/s00330-022-09110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/06/2022] [Accepted: 07/23/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Percutaneous radiofrequency ablation (RFA) is stated as a treatment option for renal cell carcinoma (RCC) smaller than 4 cm (T1a). Microwave ablation (MWA) is a newer technique and is still considered experimental in some guidelines. The objective of this study was to compare the safety and efficacy of RFA and MWA for the treatment of RCC. METHODS Patients with T1a RCC treated by RFA or MWA in two referral centers were retrospectively analyzed. Patient records were evaluated to generate mRENAL nephrometry scores. Local tumor progression (LTP) was considered when new (recurrence) or residual tumor enhancement within/adjacent to the ablation zone was objectified. Differences in LTP-free interval (residual + recurrence) between ablation techniques were assessed with Cox proportional hazards models and propensity score (PS) methods. RESULTS In 164 patients, 87 RFAs and 101 MWAs were performed for 188 RCCs. The primary efficacy rate was 92% (80/87) for RFA and 91% (92/101) for MWA. Sixteen patients had residual disease (RFA (n = 7), MWA (n = 9)) and 9 patients developed recurrence (RFA (n = 7), MWA (n = 2)). LTP-free interval was significantly worse for higher mRENAL nephrometry scores. No difference in LTP-free interval was found between RFA and MWA in a model with inverse probability weighting using PS (HR = 0.99, 95% CI 0.35-2.81, p = 0.98) and in a PS-matched dataset with 110 observations (HR = 0.82, 95% CI 0.16-4.31, p = 0.82). Twenty-eight (14.9%) complications (Clavien-Dindo grade I-IVa) occurred (RFA n = 14, MWA n = 14). CONCLUSION Primary efficacy for ablation of RCC is high for both RFA and MWA. No differences in efficacy and safety were observed between RFA and MWA. KEY POINTS • Both RFA and MWA are safe and effective ablation techniques in the treatment of T1a renal cell carcinomas. • High modified RENAL nephrometry scores are associated with shorter local tumor progression-free interval. • MWA can be used as heat-based ablation technique comparable to RFA for the treatment of T1a renal cell carcinomas.
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Spiliopoulos S, Marzoug A, Ra H, Arcot Ragupathy SK. Long-term outcomes of CT-guided percutaneous cryoablation of T1a and T1b renal cell carcinoma. Diagn Interv Radiol 2021; 27:524-528. [PMID: 34313238 PMCID: PMC8289428 DOI: 10.5152/dir.2021.20342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We aimed to evaluate the long-term outcomes of computed tomography-guided percutaneous cryoablation (PCA) for biopsy-confirmed renal cell carcinoma (RCC). METHODS This was a single-center, retrospective study investigating all patients treated with PCA between January 2010 and February 2019 for RCC tumors. Primary outcome measures included overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and cancer-specific survival (CSS). Secondary outcome measures included kidney function, complications, technical success, hospital stay, procedural time, and the identification of factors affecting the primary outcomes. RESULTS Fifty-three consecutive patients with 54 lesions (T1a: 49/54; T1b: 5/54) were included. Mean tumor diameter was 28.0±8.5 mm and mean R.E.N.A.L. score was 7.2±2.0. Technical success was 100% (54/54 lesions) after two reinterventions for incomplete ablation. Mean follow-up time was 46.7±28.6 months (range, 3-122 months). Local recurrence was noted in 5 patients (9.2%). According to Kaplan-Meyer analysis, OS was 98.2%, 94.2%, 71.2%, and 58.2% at 1, 3, 5, and 8 years. One patient (1.9%) died of cancer and CSS was 95.8% at 8 years. DFS was 100.0%, 95.5%, and 88.6%, and PFS was 100%, 94.3%, and 91.0%, at 1, 2, and 5 years. Clavien-Dindo grade II complication rate was 7.8% (5/64 procedures). There were no complications classified as grade III or greater. Mean creatinine increase was 7.1±6.3 μm/L (p = 0.31). No patient advanced to dialysis during follow up. Mean procedural time was 163±45 min. Median hospital stay was 2.0 days (IQR, 1-2.5 days). Diabetes was the only independent predictor of decreased OS (hazard ratio 4.3, 95% CI 0.043-0.914; p = 0.038). CONCLUSION PCA for stage T1a and T1b RCC provides favorable long-term oncological and renal function preservation outcomes, with acceptable complication rates.
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Affiliation(s)
- Stavros Spiliopoulos
- Department of Clinical Radiology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK;Division of Interventional Radiology, 2nd Department of Radiology, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Athens, Greece
| | - Abdelaziz Marzoug
- Department of Clinical Radiology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Hae Ra
- Department of Clinical Radiology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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Zhang R, Xu M, Xie XY. The Role of Real-Time Contrast-Enhanced Ultrasound in Guiding Radiofrequency Ablation of Reninoma: Case Report and Literature Review. Front Oncol 2021; 11:585257. [PMID: 33686368 PMCID: PMC7935754 DOI: 10.3389/fonc.2021.585257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/06/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reninoma is a rare renal endocrine tumor that can cause secondary hypertension, characterized by hypertension, hypokalemia, high renin and aldosterone with normal aldosterone renin ratio (ARR), and occurs more in young female. Mainstream treatment option is surgery, but is less suitable for small or deep lesions, which makes ablation a promising alternative. CASE PRESENTATION Two young female with typical manifestations of reninoma, including hypertension, hypokalemia, high renin, high aldosterone and normal ARR, were treated successfully with real-time contrast-enhanced ultrasound guided radiofrequency ablation, and contrast-enhanced ultrasound was also performed before and after treatment for diagnosis and postoperative assessment. Afterward, their blood pressure and laboratory tests became normal and remained steady during the follow-up of 32 and 6 months, respectively. CONCLUSION Contrast-enhanced ultrasound guided radiofrequency ablations is a promising alternative for reninoma treatment with comparable safety and efficacy with surgery, and has advantages especially in small or deep lesions.
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Affiliation(s)
| | - Ming Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-sen University, Guangzhou, China
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Garcia RG, Katz M, Falsarella PM, Malheiros DT, Fukumoto H, Lemos GC, Teich V, Salvalaggio PR. Percutaneous Cryoablation versus Robot-Assisted Partial Nephrectomy of Renal T1A Tumors: a Single-Center Retrospective Cost-Effectiveness Analysis. Cardiovasc Intervent Radiol 2021; 44:892-900. [PMID: 33388867 DOI: 10.1007/s00270-020-02732-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/26/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the cost-effectiveness of percutaneous cryoablation (PCA) versus robot-assisted partial nephrectomy (RPN) in patients with small renal tumors (T1a stage), considering perioperative complications. MATERIALS AND METHODS Retrospective study from November 2008 to April 2017 of 122 patients with a T1a renal mass who after being analyzed by a multidisciplinary board underwent to PCA (59 patients) or RPN (63 patients). Hospital costs in US dollars, and clinical and tumor data were compared. Non-complicated intervention was considered as an effective outcome. A hypothetical model of possible complications based on Clavien-Dindo classification (CDC) was built, grouping them into mild (CDC I and II) and severe (CDC III and IV). A decision tree model was structured from complications of published data. RESULTS Patients who underwent PCA were older (62.5 vs. 52.8 years old, p < 0.001), presented with more coronary disease and previous renal cancer (25.4% vs. 10.1%, p = 0.023 and 38% vs. 7.2%, p < 0.001, respectively). Patients treated with PCA had a higher preoperative risk (American Society of Anesthesiologists-ASA ≥ 3) than those in the RPN group (25.4% vs. 0%, p < 0.001). Average operative time was significantly lower with PCA than RPN (99.92 ± 29.05 min vs. 129.28 ± 54.85 min, p < 0.001). Average hospitalization time for PCA was 2.2 ± 2.95 days, significantly lower than RPN (mean 3.03 ± 1.49 days, p = 0.04). The average total cost of PCA was significantly lower than RPN (US$12,435 ± 6,176 vs. US$19,399 ± 6,047, p < 0.001). The incremental effectiveness was 5% higher comparing PCA with RPN, resulting a cost-saving result in favor of PCA. CONCLUSION PCA was the dominant strategy (less costly and more effective) compared to RPN, considering occurrence of perioperative complications.
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Affiliation(s)
- Rodrigo Gobbo Garcia
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil
| | - Marcelo Katz
- Department of Cardiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4o andar - Bloco A1, São Paulo, SP, 05652-900, Brazil
| | - Priscila Mina Falsarella
- Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil.
| | - Daniel Tavares Malheiros
- Value Management Office, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8º andar- bloco D, São Paulo, SP, 05652-900, Brazil
| | - Helena Fukumoto
- Financial Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 3º andar - Bloco E, São Paulo, SP, 05652-900, Brazil
| | - Gustavo Caserta Lemos
- Urology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4 andar - Bloco E, São Paulo, SP, 05652-900, Brazil
| | - Vanessa Teich
- Healthy Economics Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8 andar - Bloco D, São Paulo, SP, 05652-900, Brazil
| | - Paolo Rogério Salvalaggio
- Abdominal Surgery Division & Albert, Einstein Medical School, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 1oSS - Bloco A, São Paulo, SP, 05652-900, Brazil
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Abstract
Based on Surveillance, Epidemiology, and End Results studies, most renal cancers are low grade and slow growing. Long-term, single-center studies show excellent outcomes for T1a renal cell carcinoma (RCC), comparable to partial nephrectomy without affecting renal function and with much lower rates of complications. However, there are no multicenter randomized controlled trials of multiple ablative modalities or comparison with partial nephrectomy, and most studies are single-arm observational studies with short-term and intermediate follow-up. For treatment of stage T1a RCC, percutaneous TA is an effective alternative to surgery with preservation of renal function, low risk, and comparable overall and disease-specific survival.
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Motta G, Ferraresso M, Lamperti L, Di Paolo D, Raison N, Perego M, Favi E. Treatment options for localised renal cell carcinoma of the transplanted kidney. World J Transplant 2020; 10:147-161. [PMID: 32742948 PMCID: PMC7360528 DOI: 10.5500/wjt.v10.i6.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.
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Affiliation(s)
- Gloria Motta
- Urology, IRCCS Policlinico San Donato, San Donato Milanese 27288, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Luca Lamperti
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Dhanai Di Paolo
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Nicholas Raison
- MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
| | - Marta Perego
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
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Mershon JP, Tuong MN, Schenkman NS. Thermal ablation of the small renal mass: a critical analysis of current literature. MINERVA UROL NEFROL 2020; 72:123-134. [DOI: 10.23736/s0393-2249.19.03572-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Marshall HR, Shakeri S, Hosseiny M, Sisk A, Sayre J, Lu DS, Pantuck A, Raman S. Long-Term Survival after Percutaneous Radiofrequency Ablation of Pathologically Proven Renal Cell Carcinoma in 100 Patients. J Vasc Interv Radiol 2019; 31:15-24. [PMID: 31767409 DOI: 10.1016/j.jvir.2019.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 09/14/2019] [Accepted: 09/15/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To determine the long-term survival of patients treated with percutaneous radiofrequency (RF) ablation for pathologically proven renal cell carcinoma (RCC). MATERIALS AND METHODS In this single-center retrospective study, 100 patients with 125 RCCs (100 clear-cell, 19 papillary, and 6 chromophobe) 0.8-8 cm in size treated with RF ablation were evaluated at a single large tertiary-care center between 2004 and 2015. Technical success, primary and secondary technique efficacy, and pre- and postprocedural estimated glomerular filtration rate (eGFR) at 3-6 months and 2-3 years were recorded. Overall survival, cancer-specific survival, and local tumor progression-free survival were calculated by Kaplan-Meier survival curves. Complications were classified per the Clavien-Dindo system. Statistical testing was done via χ2 tests for proportions and paired t test for changes in eGFR. Statistical significance was set at α = 0.05. RESULTS Overall technical success rate was 100%, and primary and secondary technique efficacy rates were 90% and 100%, respectively. Median follow-up was 62.8 months, ranging from 1 to 120 months. The 10-year overall, cancer-specific, and local progression-free survival rates were 32%, 86%, and 92%, respectively. The number of ablation probes used was predictive of residual unablated tumor (P < .001). There were no significant changes in preprocedure vs 2-3-years postprocedure eGFR (65.2 vs 62.1 mL/min/1.73 m2; P = .443). There was a 9% overall incidence of complications, the majority of which were grade I. CONCLUSIONS Image-guided percutaneous RF ablation of RCCs is effective at achieving local control and preventing cancer-specific death within 10 years from initial treatment.
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Affiliation(s)
- Harry R Marshall
- Department of Abdominal Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Sepideh Shakeri
- Department of Abdominal Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095.
| | - Melina Hosseiny
- Department of Abdominal Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - Anthony Sisk
- Department of Pathology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - David S Lu
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - Allan Pantuck
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095; Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
| | - Steven Raman
- Department of Radiology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095; Department of Urology, David Geffen School of Medicine at the University of California, Los Angeles, BL-428 CHS, Room B2-187, 10833 Le Conte Ave., Los Angeles, CA 90095
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11
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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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12
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Favi E, Raiteri M, Paone G, Alfieri CM, Ferraresso M. Microwave Ablation of Renal Cell Carcinoma of the Transplanted Kidney: Two Cases. Cardiovasc Intervent Radiol 2019; 42:1653-1657. [PMID: 31388701 DOI: 10.1007/s00270-019-02302-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/28/2019] [Accepted: 07/30/2019] [Indexed: 12/22/2022]
Abstract
Thermal ablative techniques have been increasingly recognized as a valuable alternative to graftectomy and nephron-sparing surgery for the treatment of small neoplasms arising in the transplanted kidney. However, long-term efficacy and safety data are still lacking. In particular, current experience with microwave ablation is limited to a very recent single-centre series of three cases. We herein report two microwave ablations of renal cell carcinoma of the kidney allograft. The procedures were successfully performed under ultrasound guidance with complete tumour necrosis, no peri-operative complications, and preserved renal function. No recurrences were observed after 3 years of follow-up.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza n. 35, 20122, Milan, Italy.
| | - Mauro Raiteri
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza n. 35, 20122, Milan, Italy
| | - Giovanni Paone
- Liver Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Carlo Maria Alfieri
- Nephrology and Dialysis, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza n. 35, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
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Radiofrequency Ablation, Cryoablation, and Microwave Ablation for T1a Renal Cell Carcinoma: A Comparative Evaluation of Therapeutic and Renal Function Outcomes. J Vasc Interv Radiol 2019; 30:1035-1042. [DOI: 10.1016/j.jvir.2018.12.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 02/08/2023] Open
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Wu J, Chang J, Bai HX, Su C, Zhang PJ, Karakousis G, Reddy S, Hunt S, Soulen MC, Stavropoulos SW, Zhang Z. A Comparison of Cryoablation with Heat-Based Thermal Ablation for Treatment of Clinical T1a Renal Cell Carcinoma: A National Cancer Database Study. J Vasc Interv Radiol 2019; 30:1027-1033.e3. [PMID: 31176590 DOI: 10.1016/j.jvir.2019.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/21/2019] [Accepted: 01/29/2019] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To compare the overall survival (OS) of patients receiving cryoablation versus heat-based thermal ablation for clinical T1a renal cell carcinoma (RCC) in a large national cohort. MATERIALS AND METHODS Patients with RCC from 2004 to 2014 who were treated with ablation were identified from the National Cancer Database. OS was estimated with the use of the Kaplan-Meier method and evaluated by means of log-rank test, univariate and multivariate Cox proportional hazard regression, and propensity score-matched analysis. RESULTS A total of 3,936 patients who received cryoablation and 2,322 who received heat-based thermal ablation met the inclusion criteria. The mean age was 67 ± 12 year, and the mean size of tumors was 25 ± 8 mm. The 3-, 5-, and 10-year survival rates were, respectively, 91%, 82%, and 62% for cryoablation and 89%, 81%, and 55% for heat-based thermal ablation. After propensity score matching, cryoablation was associated with longer OS compared with heat-based thermal ablation (median 11.3 vs 10.4 years; hazard ratio 1.175, 95% CI 1.03-1.341; P = .016). For patients with tumors ≤2 cm, propensity score-matched analyses demonstrated no significant difference between the 2 treatment groups (P = .772). CONCLUSIONS Overall, cryoablation may be associated with longer OS compared with heat-based thermal ablation in cT1a RCC. No significant difference in survival rates was observed between the 2 treatments for patients with tumor sizes ≤2 cm. Owing to the inherent limitations of this study, further study with details on technology, local outcome, and complications is needed.
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Affiliation(s)
- Jing Wu
- Department of Radiology, Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China
| | - Joshua Chang
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harrison X Bai
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chang Su
- Yale School of Medicine, New Haven, Connecticut
| | - Paul J Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shilpa Reddy
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Hunt
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S William Stavropoulos
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zishu Zhang
- Department of Radiology, Second Xiangya Hospital, Central South University, No 139 Middle Renmin Road, Changsha, Hunan, 410011, People's Republic of China.
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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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Breen DJ, King AJ, Patel N, Lockyer R, Hayes M. Image-guided Cryoablation for Sporadic Renal Cell Carcinoma: Three- and 5-year Outcomes in 220 Patients with Biopsy-proven Renal Cell Carcinoma. Radiology 2018; 289:554-561. [DOI: 10.1148/radiol.2018180249] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- David J. Breen
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Alexander J. King
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Nirav Patel
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Richard Lockyer
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
| | - Matthew Hayes
- From the Departments of Radiology (D.J.B., A.J.K., N.P.) and Urology (R.L., M.H.), University Hospital Southampton NHS Trust, Tremona Road, Southampton SO16 6YD, England
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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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Talenfeld AD, Gennarelli RL, Elkin EB, Atoria CL, Durack JC, Huang WC, Kwan SW. Percutaneous Ablation Versus Partial and Radical Nephrectomy for T1a Renal Cancer: A Population-Based Analysis. Ann Intern Med 2018; 169:69-77. [PMID: 29946703 PMCID: PMC8243237 DOI: 10.7326/m17-0585] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Stage T1a renal cell carcinoma (RCC) (tumors <4 cm) is usually curable. Nephron-sparing partial nephrectomy (PN) has replaced radical nephrectomy (RN) as the standard of care for these tumors. Radical nephrectomy remains the first alternative treatment option, whereas percutaneous ablation (PA), a newer, nonsurgical treatment, is recommended less strongly because of the relative paucity of comparative PA data. Objective To compare PA, PN, and RN outcomes. Design Observational cohort analysis using inverse probability of treatment-weighted propensity scores. Setting Population-based SEER (Surveillance, Epidemiology, and End Results) cancer registry data linked to Medicare claims. Patients Persons aged 66 years or older who received treatment for T1a RCC between 2006 and 2011. Interventions PA versus PN and RN. Measurements RCC-specific and overall survival, 30- and 365-day postintervention complications. Results 4310 patients were followed for a median of 52 months for overall survival and 42 months for RCC-specific survival. After PA versus PN, the 5-year RCC-specific survival rate was 95% (95% CI, 93% to 98%) versus 98% (CI, 96% to 99%); after PA versus RN, 96% (CI, 94% to 98%) versus 95% (CI, 93% to 96%). After PA versus PN, the 5-year overall survival rate was 77% (CI, 74% to 81%) versus 86% (CI, 84% to 88%); after PA versus RN, 74% (CI, 71% to 78%) versus 75% (CI, 73% to 77%). Cumulative rates of renal insufficiency 31 to 365 days after PA, PN, and RN were 11% (CI, 8% to 14%), 9% (CI, 8% to 10%), and 18% (CI, 17% to 20%), respectively. Rates of nonurologic complications within 30 days after PA, PN, and RN were 6% (CI, 4% to 9%), 29% (CI, 27% to 30%), and 30% (CI, 28% to 32%), respectively. Ten percent of patients in the PN group had intraoperative conversion to RN. Seven percent of patients in the PA group received additional PA within 1 year of treatment. Limitations Analysis of observational data may have been affected by residual confounding by provider or from selection bias toward younger, healthier patients in the PN group. Findings from this older study population are probably less applicable to younger patients. Use of SEER-Medicare linked files prevented analysis of patients who received treatment after 2011, possibly reducing generalizability to the newest PA, PN, and RN techniques. Conclusion For well-selected older adults with T1a RCC, PA may result in oncologic outcomes similar to those of RN, but with less long-term renal insufficiency and markedly fewer periprocedural complications. Compared with PN, PA may be associated with slightly shorter RCC-specific survival but fewer periprocedural complications. Primary Funding Source Association of University Radiologists GE Radiology Research Academic Fellowship and Society of Interventional Radiology Foundation.
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Affiliation(s)
| | - Renee L Gennarelli
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - Elena B Elkin
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - Coral L Atoria
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - Jeremy C Durack
- Memorial Sloan Kettering Cancer Center, New York, New York (R.L.G., E.B.E., C.L.A., J.C.D.)
| | - William C Huang
- New York University Langone Medical Center, New York, New York (W.C.H.)
| | - Sharon W Kwan
- University of Washington, Seattle, Washington (S.W.K.)
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Filippiadis DK, Gkizas C, Chrysofos M, Siatelis A, Velonakis G, Alexopoulou E, Kelekis A, Brountzos E, Kelekis N. Percutaneous microwave ablation of renal cell carcinoma using a high power microwave system: focus upon safety and efficacy. Int J Hyperthermia 2017; 34:1077-1081. [DOI: 10.1080/02656736.2017.1408147] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- D. K. Filippiadis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - C. Gkizas
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - M. Chrysofos
- Urology Clinic, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Siatelis
- Urology Clinic, University General Hospital “ATTIKON”, Athens, Greece
| | - G. Velonakis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - E. Alexopoulou
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - E. Brountzos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - N. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
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Abboud SE, Patel T, Soriano S, Giesler J, Alvarado N, Kang P. Long-Term Clinical Outcomes Following Radiofrequency and Microwave Ablation of Renal Cell Carcinoma at a Single VA Medical Center. Curr Probl Diagn Radiol 2017. [PMID: 28648469 DOI: 10.1067/j.cpradiol.2017.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Microwave ablation (MWA) is a relatively newer treatment modality for treatment of renal cell carcinoma (RCC), and only a few small studies have examined the short- and long-term outcomes for MWA applied to renal tumors. The purpose of this retrospective review is to assess the initial experience including technical short- and long-term success rates of using radiofrequency ablation (RFA) and MWA for RCC at a single Veterans Affairs (VA) medical center. MATERIALS AND METHODS Tumor characteristics were recorded using the R.E.N.A.L. nephrometry score. Group comparisons were performed by using univariate logistic regression analysis to determine factors affecting primary treatment success, failure, and effectiveness. Kaplan-Meier local tumor progression-free survival following ablation was calculated. RESULTS MWA and RFA groups were not significantly different in primary treatment success (P = 0.82). MWA primary treatment success (90.2%) was not associated with R.E.N.A.L criteria, whereas primary success in the RFA group (88.2%) was predicted by smaller tumor size (P = 0.002). Primary treatment effectiveness rates were not significantly different in MWA (88.2%) and RFA (80.3%) groups (P = 0.29). Although overall primary technique effectiveness was associated with size (P = 0.02), univariate analysis showed a significant association between tumor size and primary effectiveness for RFA (P = 0.002) but not MWA. There was no significant association between R.E.N.A.L score or criteria and primary treatment effectiveness in the RFA or MWA groups. CONCLUSION RFA and MWA both represent effective treatment modalities for RCC; larger tumor size may be associated with decreased efficacy of thermal ablation techniques.
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Affiliation(s)
- Salim E Abboud
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
| | - Tanay Patel
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
| | - Stephanie Soriano
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
| | - Joseph Giesler
- Case Western Reserve University School of Medicine, Cleveland, OH.
| | - Nannette Alvarado
- Department of Radiology, Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH
| | - Preet Kang
- Department of Radiology, Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH
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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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Abstract
Small renal masses (SRMs) have been traditionally managed with surgical resection. Minimally invasive nephron-sparing treatment methods are preferred to avoid harmful consequences of renal insufficiency, with partial nephrectomy (PN) considered the gold standard. With increase in the incidence of the SRMs and evolution of ablative technologies, percutaneous ablation is now considered a viable treatment alternative to surgical resection with comparable oncologic outcomes and better nephron-sparing property. Traditional thermal ablative techniques suffer from unique set of challenges in treating tumors near vessels or critical structures. Irreversible electroporation (IRE), with its non-thermal nature and connective tissue-sparing properties, has shown utility where traditional ablative techniques face challenges. This review presents the role of IRE in renal tumors based on the most relevant published literature on the IRE technology, animal studies, and human experience.
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Percutaneous Thermal Ablation of Breast Cancer Metastases in Oligometastatic Patients. Cardiovasc Intervent Radiol 2016; 39:885-93. [DOI: 10.1007/s00270-016-1301-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/19/2016] [Indexed: 12/20/2022]
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Role of RENAL nephrometry scoring system in planning surgical intervention in patients with localized renal masses. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Chen JX, Guzzo TJ, Malkowicz SB, Soulen MC, Wein AJ, Clark TWI, Nadolski GJ, Stavropoulos SW. Complication and Readmission Rates following Same-Day Discharge after Percutaneous Renal Tumor Ablation. J Vasc Interv Radiol 2015; 27:80-6. [PMID: 26547122 DOI: 10.1016/j.jvir.2015.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate readmission rate and complications in patients undergoing same-day discharge following percutaneous thermal ablation of renal tumors. MATERIALS AND METHODS Patients undergoing same-day discharge following thermal ablation of renal tumors were reviewed. The primary outcome was the rate of readmission within 30 days of same-day discharge. The secondary outcomes included the rate and clinical outcomes of periprocedural complications. RESULTS Same-day discharge occurred in 166/174 patients (95%), of whom 2/166 (1%) required short-term readmission due to pulmonary embolism and acute-on-chronic kidney injury. Both patients recovered without permanent morbidity. Admission due to complications occurred in 8/174 (5%) cases, the majority of which were related to hemorrhage. No significant differences in rates of complications or admission were found between cryoablation and RF ablation. Major complications (Clavien-Dindo grade II or higher, SIR grade C or higher) occurred in 7/174 (4%) cases, the majority related to hemorrhage. All cases were detected in the standard 4 hour postprocedural observation period and managed conservatively. The mean hemorrhage volume was significantly larger in patients requiring admission versus those discharged the same day (289 mL vs 34 mL; P = .02). Higher-volume hemorrhage occurred in larger tumors (mean, 4.0 cm vs 3.0 cm; P = .04). There was no association between major complications and central tumor or age. CONCLUSIONS Routine same-day discharge following percutaneous renal tumor thermal ablation can be performed with a low rate of short-term readmission. The majority of periprocedural complications can be managed conservatively, and patients can be discharged the same day.
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Affiliation(s)
- James X Chen
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Thomas J Guzzo
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - S Bruce Malkowicz
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Michael C Soulen
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Alan J Wein
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Timothy W I Clark
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - S William Stavropoulos
- Division of Interventional Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
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Jun HY, Ryu JH, Byun SJ, Jeong CW, Kim TH, Lee YH, Yoon KH. Combined Radiofrequency Ablation and Double Anti-Angiogenic Protein Therapy to Increase Coagulation Efficacy: An Experimental Study in a Murine Renal Carcinoma Model. Korean J Radiol 2015; 16:776-82. [PMID: 26175576 PMCID: PMC4499541 DOI: 10.3348/kjr.2015.16.4.776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 03/18/2015] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate whether suppression of tumor microvasculature by double anti-angiogenic protein (DAAP) treatment could increase the extent of radiofrequency ablation (RFA)-induced coagulation in a murine renal cell carcinoma model. Materials and Methods Renal cell carcinoma cell lines were implanted subcutaneously into 10 nude mice. Four mice received adenoviral DAAP treatment and 6 mice received sterile 0.9% saline solution as DAAP-untreated group. The effect of DAAP was evaluated according to the vascularity by contrast-enhanced ultrasound (CEUS) using microbubbles. Four DAAP-treated mice and 4 DAAP-untreated mice were then treated with RFA, resulting in 3 groups: no-therapy (n = 2), RFA only (n = 4), and RFA combined with DAAP treatment (n = 4). Immediately after RFA, the size of coagulation necrosis and mitochondrial enzyme activity were compared between the groups using analysis of variance (ANOVA) and post hoc test. Results The contrast enhancement ratio for tumor vascularization on CEUS was significantly lower in the DAAP treated group than in DAAP-untreated group (30.2 ± 9.9% vs. 77.4 ± 17.3%; p = 0.021). After RFA, the mean coagulation diameter was 0 mm for no-therapy group, 6.7 ± 0.7 mm for the RFA only group and 8.5 ± 0.4 mm for the RFA with DAAP group (ANOVA, p < 0.001). The area of viable mitochondria within the tumor was 27.9 ± 3.9% in no-therapy group, 10.3 ± 4.5% in the RFA only group, and 2.1 ± 0.7% in the RFA with DAAP group (ANOVA, p < 0.001). Conclusion Our results suggest the potential value of combining RFA with anti-angiogenic therapy.
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Affiliation(s)
- Hong Young Jun
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Jong-Hyun Ryu
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Seung Jae Byun
- Department of Surgery, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Chang Won Jeong
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Tae-Hoon Kim
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Young Hwan Lee
- Department of Radiology, Wonkwang University School of Medicine, Iksan 570-711, Korea
| | - Kwon-Ha Yoon
- Imaging Science Research Center, Wonkwang University School of Medicine, Iksan 570-711, Korea. ; Department of Radiology, Wonkwang University School of Medicine, Iksan 570-711, Korea
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Zivin SP, Gaba RC. Technical and practical considerations for device selection in locoregional ablative therapy. Semin Intervent Radiol 2014; 31:212-24. [PMID: 25053866 DOI: 10.1055/s-0034-1373796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Percutaneous ablation therapy is an essential component of contemporary interventional oncologic therapy of primary and secondary malignancies. The growing armamentarium of available ablation technologies calls for thorough understanding of the different ablation modalities to optimize device selection in individual clinical settings. The goal of the current article is to provide direction on ablative device selection by reviewing device mechanisms of action, advantages and disadvantages, and practical considerations in real-life case scenarios.
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Affiliation(s)
- Sean P Zivin
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Ron C Gaba
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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29
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Kim KR, Thomas S. Complications of image-guided thermal ablation of liver and kidney neoplasms. Semin Intervent Radiol 2014; 31:138-48. [PMID: 25049443 DOI: 10.1055/s-0034-1373789] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Image-guided thermal ablation is a widely accepted tool in the treatment of a variety of solid organ neoplasms. Among the different techniques of ablation, radiofrequency ablation, cryoablation, and microwave ablation have been most commonly used and investigated in the treatment of liver and kidney neoplasms. This article will review complications following thermal ablation of tumors in the liver and kidney, and discuss the risks and clinical presentation of each complication as well as how to treat and potentially avoid complications.
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Affiliation(s)
- Kyung Rae Kim
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Thomas
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abstract
Thermal ablative technologies have evolved considerably in the recent past and are now an important component of current clinical guidelines for the treatment of small renal masses. Both radiofrequency ablation and cryoablation have intermediate-term oncologic control that rivals surgical options, with favorable complication profiles. Studies comparing cryoablation and radiofrequency ablation show no significant difference in oncologic control or complication profile between the two modalities. Early data from small series with microwave ablation have shown similar promising results. Newer technologies including irreversible electroporation and high-intensity-focused ultrasound have theoretical advantages, but will require further research before becoming a routine part of the ablation armamentarium. The purpose of this review article is to discuss the current ablative technologies available, briefly review their mechanisms of action, discuss technical aspects of each, and provide current data supporting their use.
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Affiliation(s)
- Vishal Khiatani
- Coastal Radiology Associates, Department of Radiology, Carolina East Medical Center, New Bern, North Carolina
| | - Robert G Dixon
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
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31
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Gunn AJ, Gervais DA. Percutaneous ablation of the small renal mass-techniques and outcomes. Semin Intervent Radiol 2014; 31:33-41. [PMID: 24596438 DOI: 10.1055/s-0033-1363841] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An increasing number of T1a renal cell carcinomas are being diagnosed in recent years, in part due to incidental detection from the increased use of cross-sectional imaging. Although partial nephrectomy is still considered the primary treatment for these small renal masses, percutaneous ablation is now being performed as a standard therapeutic, nephron-sparing approach in patients who are poor surgical candidates. Clinical studies to date have demonstrated that percutaneous ablation is an effective therapy with acceptable outcomes and low risk in the appropriate clinical settings. This article will review various clinical aspects regarding the percutaneous ablation of small renal masses, including patient selection, preprocedural preparations, and the procedural considerations of commonly employed ablative technologies. Specific techniques such as radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, and high-intensity focused ultrasound will be addressed in detail. In addition, the technical and oncologic outcomes of percutaneous ablation will be discussed and referenced to that of partial nephrectomy.
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Affiliation(s)
- Andrew J Gunn
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School
| | - Debra A Gervais
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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32
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Advances in Interventional Oncology: Percutaneous Therapies. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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33
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