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Jiang A, Li J, He Z, Liu Y, Qiao K, Fang Y, Qu L, Luo P, Lin A, Wang L. Renal cancer: signaling pathways and advances in targeted therapies. MedComm (Beijing) 2024; 5:e676. [PMID: 39092291 PMCID: PMC11292401 DOI: 10.1002/mco2.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
Renal cancer is a highlyheterogeneous malignancy characterized by rising global incidence and mortalityrates. The complex interplay and dysregulation of multiple signaling pathways,including von Hippel-Lindau (VHL)/hypoxia-inducible factor (HIF), phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR), Hippo-yes-associated protein (YAP), Wnt/ß-catenin, cyclic adenosine monophosphate (cAMP), and hepatocyte growth factor (HGF)/c-Met, contribute to theinitiation and progression of renal cancer. Although surgical resection is thestandard treatment for localized renal cancer, recurrence and metastasiscontinue to pose significant challenges. Advanced renal cancer is associatedwith a poor prognosis, and current therapies, such as targeted agents andimmunotherapies, have limitations. This review presents a comprehensiveoverview of the molecular mechanisms underlying aberrant signaling pathways inrenal cancer, emphasizing their intricate crosstalk and synergisticinteractions. We discuss recent advancements in targeted therapies, includingtyrosine kinase inhibitors, and immunotherapies, such as checkpoint inhibitors.Moreover, we underscore the importance of multiomics approaches and networkanalysis in elucidating the complex regulatory networks governing renal cancerpathogenesis. By integrating cutting-edge research and clinical insights, this review contributesto the development of innovative diagnostic and therapeutic strategies, whichhave the potential to improve risk stratification, precision medicine, andultimately, patient outcomes in renal cancer.
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Affiliation(s)
- Aimin Jiang
- Department of UrologyChanghai HospitalNaval Medical UniversityShanghaiChina
| | - Jinxin Li
- Department of UrologyChanghai HospitalNaval Medical UniversityShanghaiChina
| | - Ziwei He
- Department of UrologyChanghai HospitalNaval Medical UniversityShanghaiChina
| | - Ying Liu
- Department of UrologyChanghai HospitalNaval Medical UniversityShanghaiChina
| | - Kun Qiao
- Department of UrologyChanghai HospitalNaval Medical UniversityShanghaiChina
| | - Yu Fang
- Department of UrologyChanghai HospitalNaval Medical UniversityShanghaiChina
| | - Le Qu
- Department of UrologyJinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Peng Luo
- Department of OncologyZhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Anqi Lin
- Department of OncologyZhujiang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Linhui Wang
- Department of UrologyChanghai HospitalNaval Medical UniversityShanghaiChina
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Bertolo R, Amparore D, Muselaers S, Marchioni M, Wu Z, Campi R, Antonelli A. Thermal ablation for T1b renal cancer: an "I wish I could, but I cannot?". Minerva Urol Nephrol 2024; 76:254-259. [PMID: 38742559 DOI: 10.23736/s2724-6051.24.05842-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Affiliation(s)
- Riccardo Bertolo
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy -
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands -
| | - Daniele Amparore
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Stijn Muselaers
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michele Marchioni
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, SS Annunziata Hospital, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, G. D'Annunzio Chieti-Pescara University, Chieti, Italy
| | - Zhenjie Wu
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Department of Urology, Shanghai Hospital, Naval Medical University, Shanghai, China
| | - Riccardo Campi
- EAU Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, the Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Antonelli
- Unit of Urology, Confortini Surgical Center, Civile Maggiore Hospital, University Hospital of Verona, University of Verona, Verona, Italy
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Gay Depassier J, Crombé A, Jambon E, Bernhard JC, Le Bras Y, Grenier N, Marcelin C. What is the benefit of gadolinium-chelate injection for the diagnosis of local recurrence of clear cell renal cell carcinoma after percutaneous thermal ablation with MRI? Diagn Interv Imaging 2023; 104:584-593. [PMID: 37442753 DOI: 10.1016/j.diii.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The purpose of this study was to compare the diagnostic capabilities of contrast-enhanced (CE)-MRI to those of non-CE-MRI to diagnose local recurrence of clear cell renal cell carcinoma (ccRCC) after percutaneous thermal ablation (TA). MATERIALS AND METHODS This institutional, review board-approved, case-control, single-center retrospective study included all consecutive adult patients with at least two post-TA MRIs showing local recurrence of ccRCC after TA validated by multidisciplinary board. 'Control' patients without recurrence were randomly-selected with a case:control ratio of 2/3. Four senior radiologists reviewed in a double-blinded fashion non-CE sequences of last two consecutive MRI examinations (non-CE-MRIs), assessed the presence of recurrence of ccRCC, then reviewed the CE sequences (CE-MRI) and determined again the presence of a recurrence. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity and accuracy were compared for each reader for non-CE-MRI and CE-MRI. RESULTS Fifty-one patients (41 men; mean age, 77.5 years) who underwent percutaneous TA for ccRCC were included. There were a total of 21 recurrences and 35 scars. Whoever the reader, AUROC was not significantly different (mean, 0.86 with-CE-MRI vs. 0.81 with non-CE-MRI; P values ranging between 0.08 and 0.98), neither sensitivity (mean, 76.2% with CE-MRI vs. 71.4% with non-CE-MRI; P values ranging between 0.06 and >0.99), nor accuracy (85.8% with CE-MRI vs. 80.8% with non-CE-MRI; P values ranging between 0.07 and >0.99). Change in specificity depended on the reader with a significant increase for one reader (+20%; P = 0.02) and a significant decrease for another reader (-17.2%; P = 0.03). CONCLUSION Non-CE MRI has good diagnostic performance for the follow-up of patients with ccRCC treated using percutaneous TA, questioning the systematic use of GBCA injection.
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Affiliation(s)
- Julien Gay Depassier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Amandine Crombé
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Jean-Christophe Bernhard
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Deparment of Urology, Hôpital Pellegrin, 33400 Bordeaux, France
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France
| | - Nicolas Grenier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251 & Bordeaux University, 33400, Talence, France
| | - Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Department of Radiology, Hôpital Pellegrin, 33076 Bordeaux, France; Bordeaux Institute of Oncology, BRIC U1312, INSERM, Université de Bordeaux, 33000 Bordeaux, France.
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Barjolle I, Ah-Thiane L, Frampas E, Karam G, Rigaud J, David A. Efficacy and safety of cryoablation for localized renal tumor as an alternative approach to partial nephrectomy. Front Oncol 2023; 13:1235705. [PMID: 37860181 PMCID: PMC10584313 DOI: 10.3389/fonc.2023.1235705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Renal cryoablation displays a profile of high tolerance, including in a frail population. Cryoablation appears as a validated alternative treatment to surgery for renal tumors smaller than 4 cm. However, evidence is lacking for larger tumors, despite encouraging data for tumors up to 7 cm. Material and methods This retrospective descriptive study of a population with a stage T1b renal tumor treated by cryoablation was conducted at the Nantes University Hospital between January 2009 and July 2021. Primary endpoint was 3-year rate of local recurrence. Secondary endpoints included technical efficacy, overall and cancer-specific survivals, and safety assessment. Results A total of 63 patients were analyzed. Three-year rate of local recurrence was 11.1%. Primary and secondary technical efficacies were achieved in 88.9% and 96.8% of patients, respectively, and 3-year overall and cancer-specific survival were 87.3% and 95.2%, respectively. Most patients (73%) experienced no complications, 13% of patients had minor (CIRSE grades 1 or 2) adverse effects, and 13% had severe but non-lethal (CIRSE grade 3) adverse effects. One patient died following cryoablation due to colic perforation. The most common AE (all grades) was hemorrhage (9.5%). Discussion This study showed a good efficacy and safety of cryoablation for renal tumors up to 7 cm (T1b). Our results were consistent with a rather sparse literature and contributed to guide future recommendations about cryoablation as an alternative to surgery for T1b renal tumors.
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Affiliation(s)
- Irène Barjolle
- Department of Radiology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Loic Ah-Thiane
- Department of Radiotherapy, Western Cancer institute (ICO) René Gauducheau 44805 St-Herblain, Nantes University, Nantes, France
| | - Eric Frampas
- Department of Radiology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Georges Karam
- Department of Urology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
| | - Arthur David
- Department of Radiology, University Hospital (CHU) Nantes, Nantes University, Nantes, France
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Klein C, Cazalas G, Margue G, Piana G, DE Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Michiels C, Jegonday MA, Rouviere O, Grenier N, Marcelin C, Bernhard JC. Percutaneous tumor ablation versus image guided robotic-assisted partial nephrectomy for cT1b renal cell carcinoma: a comparative matched-pair analysis (UroCCR 80). Minerva Urol Nephrol 2023; 75:559-568. [PMID: 37728492 DOI: 10.23736/s2724-6051.23.05274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm). METHODS Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization. RESULTS A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS 3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France -
| | - Grégoire Cazalas
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | | | - Afshin Gangi
- Department of Interventional Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Phillipe Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers University Hospital, Angers, France
| | - Remi Grange
- Department of Radiology, Saint-Etienne University Hospital, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Bergonié Institute, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | | | - Nicolas Grenier
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Clément Marcelin
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
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Cazalas G, Klein C, Piana G, De Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Jegonday MA, Bigot P, Bensalah CK, Gaillard V, Pignot G, Paparel P, Badet L, Michiels C, Bernhard JC, Rouviere O, Grenier N, Marcelin C. A multicenter comparative matched-pair analysis of percutaneous tumor ablation and robotic-assisted partial nephrectomy of T1b renal cell carcinoma (AblatT1b study-UroCCR 80). Eur Radiol 2023; 33:6513-6521. [PMID: 37004570 DOI: 10.1007/s00330-023-09564-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE Renal cell carcinomas represent the sixth- and tenth-most frequently diagnosed cancer in men and women. Recently, percutaneous-guided thermal ablations have proved to be as effective as partial nephrectomy and safer for treating small renal masses (i.e., < 3 cm). This study compared the perioperative and recurrence outcomes of percutaneous thermal ablation (TA) and robotic-assisted partial nephrectomy (RAPN) for the treatment of T1b renal cell carcinomas (4.1-7 cm). METHODS Retrospective data from 11 centers on the national database, between 2010 and 2020, included 81 patients treated with thermal ablation (TA) and 308 patients treated with RAPN for T1b renal cell carcinoma, collected retrospectively and matched for tumor size, histology results, and the RENAL score. TA included cryoablation and microwave ablation. Endpoints compared the rate between the two groups: local recurrence, metastases, complications, renal function decrease, and length of hospitalization. RESULTS After matching, 75 patients were included in each group; mean age was 76.6 (± 9) in the TA group and 61.1 (± 12) in the RAPN group, including 69.3% and 76% men respectively. The local recurrence (LR) rate was significantly higher in the TA group than in the PN group (14.6% vs 4%; p = 0.02). The LR rate was 20% (1/5) after microwave ablation, 11.1% (1/9) after radiofrequency ablation, and 14.7% (9/61) after cryoablation. The major complication rate (Clavien-Dindo ≥ 3) was higher following PN than after TA (5.3% vs 0%; p < 0.001). Metastases, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS The local recurrence rate was significantly higher after thermal ablation; however, thermal ablation resulted in significantly lower rates of complications. Thermal ablation and robotic-assisted partial nephrectomy are effective treatments for T1b renal cancer; however, the local recurrence rate was higher after thermal ablation. KEY POINTS • The local recurrence rate was significantly higher in the thermal ablation group than in the partial nephrectomy group. • The major complication rate (Clavien-Dindo ≥ 3) was higher following PN than after TA (5.3% vs. 0%; p < 0.001).
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Affiliation(s)
- Grégoire Cazalas
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Clément Klein
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - Eric De Kerviler
- Department of Radiology, Hôpital Saint-Louis 1, avenue Claude Vellefaux, 75010, Paris, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Puech
- Department of Radiology CHU Lille, Radiology Department, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, University Hospital, CHU Angers, 4 rue Larrey, 49933, Angers, France
| | - Remi Grange
- Department of Radiology, CHU Nord Saint-Etienne Avenue Albert Raimond, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | | | - Pierre Bigot
- Department of Urology, University Hospital of Angers, Angers, France
| | | | - Victor Gaillard
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - Philippe Paparel
- Service d'Urologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Lionel Badet
- Service d'Urologie, Hôpital Edouard Herriot, Lyon, France
| | - Clément Michiels
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Jean Christophe Bernhard
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Olivier Rouviere
- Department of Radiology - Pavillon B, Hôpital E. Herriot, 69003, Lyon, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France.
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Radiofrequency Ablation, Cryoablation, and Microwave Ablation for the Treatment of Small Renal Masses: Efficacy and Complications. Diagnostics (Basel) 2023; 13:diagnostics13030388. [PMID: 36766493 PMCID: PMC9914157 DOI: 10.3390/diagnostics13030388] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 01/22/2023] Open
Abstract
Over the last two decades the detection rate of small renal masses has increased, due to improving diagnostic accuracy, and nephron-sparing treatments have become the first-choice curative option for small renal masses. As a minimally invasive alternative, thermal ablation has increased in popularity, offering a good clinical outcome and low recurrence rate. Radiofrequency ablation, Cryoablation, and Microwave ablation are the main ablative techniques. All of them are mostly overlapping in term of cancer specific free survival and outcomes. These techniques require imaging study to assess lesions features and to plan the procedure: US, CT, and both of them together are the leading guidance alternatives. Imaging findings guide the interventional radiologist in assessing the risk of complication and possible residual disease after procedure. The purpose of this review is to compare different ablative modalities and different imaging guides, underlining the effectiveness, outcomes, and complications related to each of them, in order to assist the interventional radiologist in choosing the best option for the patient.
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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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Uka M, Iguchi T, Okawa N, Matsui Y, Tomita K, Umakoshi N, Munetomo K, Gobara H, Araki M, Hiraki T. Percutaneous cryoablation for clinical T3a renal cell carcinoma (< 7 cm) with segmental vein involvement or perinephric fat invasion based on preoperative evaluation of high-resolution multidetector computed tomography scan. Jpn J Radiol 2022; 40:1201-1209. [PMID: 35727459 PMCID: PMC9616741 DOI: 10.1007/s11604-022-01297-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022]
Abstract
Purpose To retrospectively assess the feasibility, safety, renal function, technique efficacy rate, and survival of patients with clinical T3a renal cell carcinoma (RCC). Materials and methods Sixteen cryoablation sessions were performed in 14 patients (10 men; mean age, 69.8 ± 10.5 years; range, 49–90 years) with 14 clear cell T3a RCCs (mean, 3.3 ± 0.9 cm; range, 1.9–5.2 cm). One patient was on dialysis. Transcatheter arterial embolization was performed before cryoablation in 15 sessions. The primary endpoint was the technique efficacy rate. The secondary endpoints included feasibility, safety, renal function, and survival. Results Cryoablation was technically successful in all RCC cases. In two RCCs, cryoablation was performed twice because of local tumor progression. No major adverse events were observed. All patients were alive without metastases, with a median follow-up of 45 months (6−93 months). Complete response was achieved by cryoablation in 11 RCCs (78.6%). The primary and secondary technique efficacy rates were 77.1% and 84.4% at 1 year, 57.9% and 73.9% at 3 years, and 57.9% and 73.9% at 5 years, respectively. One patient underwent dialysis given a total contralateral nephrectomy due to another RCC 1 month after initial cryoablation and a total ipsilateral nephrectomy 46 months after initial cryoablation due to local progression. Except for two dialysis patients, of the 12 patients with a median follow-up of 41 months (6–93 months), none were on dialysis.
Conclusion Cryoablation was safe and effective in T3a RCC, which mainly involved the renal venous branches and may represent an alternative treatment for inoperable patients.
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Affiliation(s)
- Mayu Uka
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan.
| | - Toshihiro Iguchi
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan.,Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Nanako Okawa
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Division of Medical Informatics, Okayama University Hospital, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Motoo Araki
- Department of Urology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Dentistry and Pharmaceutical Science, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho kita-ku, Okayama, 700-8558, Japan
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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11
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Kotamarti S, Michael Z, Silver D, Teper E, Aminsharifi A, Polascik TJ, Schulman A. Device-related complications during renal cryoablation: insights from the Manufacturer and User Facility Device Experience (MAUDE) database. Urol Oncol 2022; 40:199.e9-199.e14. [DOI: 10.1016/j.urolonc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
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12
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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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13
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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [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: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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14
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Fukushima Y, Nakamura J, Seki Y, Ando M, Miyazaki M, Tsushima Y. Patients' radiation dose in computed tomography-fluoroscopy-guided percutaneous cryoablation for small renal tumors. Eur J Radiol 2021; 144:109972. [PMID: 34619620 DOI: 10.1016/j.ejrad.2021.109972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aimed to evaluate patients' radiation dose in computed tomography (CT)-fluoroscopy-guided cryoablation for small renal tumors and assess the possible factors affecting it. METHODS In our institution, cryoablation was performed in 152 patients between 2013 and 2020. Procedures that were not for renal tumors and did not have radiation dose records and detailed information were excluded from the analysis. The size-specific dose estimates (SSDE), volume CT dose index (CTDIvol), dose-length product (DLP), and entrance skin dose (ESD) were evaluated for both spiral scan and CT-fluoroscopy. The effects of the number of cryoneedle punctures; combined use of hydro- and/or pneumodissection procedures; patients' characteristics, such as body-mass index (BMI); and the tumor-related factors, such as tumor location, were determined by the univariate and multivariate analyses. RESULTS In the 72 included procedures, the median SSDE was 658 mGy and the median CTDIvol was 456 mGy. The median percentage dose of CT-fluoroscopy to the total procedure dose was estimated as 89.8% (591/658 mGy) with SSDE and 41.4% (611/1,475 mGy cm) with DLP. The combined use of hydro- and/or pneumodissection and number of cryoneedle punctures were significantly associated with the total ESD, and the maximum total ESD was 863 mGy in our cases. CONCLUSIONS Using SSDE as an index, 89.8% of patients' radiation dose was attributed to CT-fluoroscopy, and ESD for the total procedure did not exceed 1 Gy. The increased number of cryoneedle punctures and combined use of hydro- and/or pneumodissection increased the total ESD.
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Affiliation(s)
- Yasuhiro Fukushima
- Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Junpei Nakamura
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yuko Seki
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Masashi Ando
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Masaya Miyazaki
- Department of Radiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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15
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Cazalas G, Jambon E, Coussy A, Le Bras Y, Petitpierre F, Berhnard JC, Grenier N, Marcelin C. Local recurrence and other oncologic outcomes after percutaneous image-guided tumor ablations on stageT1b renal cell carcinoma: a systematic review and network meta-analysis. Int J Hyperthermia 2021; 38:1295-1303. [PMID: 34461802 DOI: 10.1080/02656736.2021.1970826] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE A systematic review of clinical trials on thermal ablation of T1b RCC was conducted to assess oncologic outcomes of those procedures. The primary endpoint was the rate of local recurrence. Secondary endpoints included technical efficacy, progression to metastatic disease, cancer-specific mortality, complications and renal function decrease. METHODS PubMed (MEDLINE) and Embase databases were searched in June 2020 for eligible trials following the PRISMA selection process. Prevalence of local recurrence and per procedural major adverse effects were calculated using double arcsine transformation and a random-effects model. RESULTS Nine clinical trials (all retrospective) involving 288 patients with T1b renal clear cell carcinoma treated with either percutaneous microwave ablation, cryoablation or radiofrequency ablation were analyzed. Using a random-effects model, the overall prevalence of local recurrence following percutaneous ablation was 0.08 (0.04-0.14; p = 0.05). Primary technical efficacy was 226/263 (86%) patients and secondary technical efficacy was 247/263 (94%). Overall, 10/176 (6%) patients presented metastatic locations following the ablation. Major adverse effects prevalence was 0.09 (0.06-0.14; p = 0.05). CONCLUSIONS Thermal ablations are feasible, safe, and effective to treat T1b renal clear cell carcinoma. More trials are necessary to determine the rate of the evidence of the benefit.HighlightsThermal ablations are feasible and safe to treat T1b renal clear cell carcinoma.Oncologic outcomes appear to be very good on both local control and distant progression.Due to small number and heterogeneity of studies more trials are necessary to determine the rate of the evidence of the benefit.
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Affiliation(s)
- Grégoire Cazalas
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Eva Jambon
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Alexis Coussy
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Yann Le Bras
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - François Petitpierre
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Jean Christophe Berhnard
- Service d'urologie, andrologie et transplantation rénale, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
| | - Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, Place Amélie-Raba-Léon, Bordeaux, France
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16
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Park BK, Shen SH, Fujimori M, Wang Y. Thermal Ablation for Renal Cell Carcinoma: Expert Consensus from the Asian Conference on Tumor Ablation. Korean J Radiol 2021; 22:1490-1496. [PMID: 34448380 PMCID: PMC8390817 DOI: 10.3348/kjr.2020.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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17
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Shimizu K, Enoki K, Kameoka Y, Motohashi K, Yanagisawa T, Miki J, Baba A, Sekiguchi H, Sadaoka S. Image-guided percutaneous cryoablation of T1b renal cell carcinomas in patients with comorbidities. Jpn J Radiol 2021; 39:1213-1222. [PMID: 34228240 DOI: 10.1007/s11604-021-01168-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/29/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the influence of comorbidities and tumor characteristics on outcomes following percutaneous cryoablation (PCA) of T1b renal cell carcinoma (RCC). MATERIALS AND METHODS Age-adjusted Charlson comorbidity index (ACCI); standardized system for quantitating renal tumor size, location, and depth (RENAL nephrometry score [RNS]); and local tumor control and survival were retrospectively investigated in 28 patients who underwent PCA for stage T1b RCC. Risk factors for elevated serum creatinine levels were also investigated. RESULTS Complete ablation was obtained in 27 of 28 patients. Two cases of metastasis were observed; one patient died 12 months after PCA. Overall survival at 5 years was 79.1%, with a mean follow-up of 42.0 ± 16.0 months. Local tumor control was not correlated with the ACCI and RNS. Worsening renal function 3 months after PCA was observed in ten patients, and it correlated with the presence of single kidneys (7/28 patients; p = 0.023). Significant worsening of renal function continued until 1 year after PCA (p = 0.013). Having a single kidney was a risk factor for worsened renal function after PCA (odds ratio, 8.00; 95% confidence interval 1.170-54.724). CONCLUSION PCA for T1b RCC confers positive local tumor control regardless of comorbidities and tumor characteristics.
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Affiliation(s)
- Kanichiro Shimizu
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan.
| | - Keitaro Enoki
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
| | - Yoshihiko Kameoka
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
| | - Kenji Motohashi
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita 163-1, Kashiwa-shi, Chiba, Japan
| | - Jun Miki
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita 163-1, Kashiwa-shi, Chiba, Japan
| | - Akira Baba
- Department of Radiology, Jikei University School of Medicine, Nishisinnbashi 3-19-1, Minato-ku, Tokyo, Japan
| | - Huruki Sekiguchi
- Department of Cardiology, Tokyo Women's Medical University Hospital, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan
| | - Shunichi Sadaoka
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
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Wetley KA, Abel EJ, Dreyfuss LD, Huang W, Brace CL, Wells SA. CT and MR imaging surveillance of stage 1 renal cell carcinoma after microwave ablation. Abdom Radiol (NY) 2020; 45:2810-2824. [PMID: 32715335 DOI: 10.1007/s00261-020-02662-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe the CT and MR imaging findings after microwave ablation of clinical stage 1 renal cell carcinoma (RCC). METHODS This single-center retrospective study was performed under a waiver of informed consent. 49 patients (38 M/11F, mean age 66 ± 9.0) with 52 cT1a RCC and 19 patients (10M/9F, mean age 67 ± 9.7) with 19 cT1b RCC were treated with percutaneous microwave ablation between January 2012 and June 2014. The size and volume of the RCC and ablation zone were measured and the kidney, ablation zones and retroperitoneum were assessed at immediate post-procedure CT and surveillance CT and MRI. RESULTS Median imaging follow-up was 18 months (IQR 12-28). Ablation zones were heterogeneously hyperintense on T1W and hypointense on T2W MRI and hyperdense at CT. Thin peripheral, but no internal enhancement after contrast administration signified successful ablation zones. Ablation zones decreased in size, but did not resolve during surveillance. Immediate post-procedure subcapsular gas and hematoma (5/71, 7%) resolved prior to first follow-up. Focal, enhancing soft tissue within the ablation zone, invariably along the renal margin, signified local recurrence. Local recurrence rates were higher for T1b (2/19, 11%) compared to T1a (1/52, 2%). Urinomas (4/71, 6%) decreased in size and resolved during surveillance. Retroperitoneal fat necrosis (6/71, 9%), with opposed-phase loss of T1W MRI signal, was confirmed at histology after percutaneous biopsy. CONCLUSION CT and MR imaging features after microwave ablation of renal cell carcinoma are predictable and reliably demonstrate treatment success, early and delayed complications, and local recurrences that can guide patient management.
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Affiliation(s)
- Karla A Wetley
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
| | - E Jason Abel
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Leo D Dreyfuss
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Wei Huang
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/366, 600 Highland Avenue, Madison, WI, 53792, USA.
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Adachi T, Machida Y, Fukuma E, Tateishi U. Fluorodeoxyglucose positron emission tomography/computed tomography findings after percutaneous cryoablation of early breast cancer. Cancer Imaging 2020; 20:49. [PMID: 32678029 PMCID: PMC7364607 DOI: 10.1186/s40644-020-00325-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To document 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) findings after percutaneous cryoablation for early breast cancer. METHODS Data of 193 consecutive patients who had undergone cryoablation for invasive ductal carcinoma or ductal carcinoma in situ ≤ 15 mm without a history of ipsilateral breast cancer, synchronous ipsilateral lesion, and with estrogen receptor positive/human epidermal growth factor 2 negative were enrolled. The imaging characteristics of the treated areas were evaluated and classified on CT images as one of two types: fatty mass or non-fatty mass type. The maximum standardized uptake value (SUVmax) of the initial post-cryoablation PET/CT, the CT type of the treated area and selected clinical factors (age, menopausal status, lesion area, breast density, timing of PET/CT) were retrospectively evaluated. RESULTS The median interval between cryoablation and the initial post-cryoablation PET/CT was 12 months. The median SUVmax of the treated area was 1.36. The CT findings of the treated area were classified as fatty mass type (n = 137, 71.0%) or non-fatty mass type (n = 56, 29.0%). The treated areas of patients with lower breast density, of older age, post-menopausal status, and lower radiation dose were significantly more likely to be of fatty mass type (P < 0.001). Non-fatty mass type averaged a significantly higher SUVmax than did fatty mass type. CONCLUSIONS Post-cryoablation PET/CT findings are of fatty or non-fatty mass type. A non-fatty appearance, which can show higher SUVmax, does not necessarily denote recurrence.
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Affiliation(s)
- Takuya Adachi
- Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Youichi Machida
- Department of Radiology, Kameda Medical Center, Chiba, Japan
| | - Eisuke Fukuma
- Department of Breast Center, Kameda Medical Center, Chiba, Japan
| | - Ukihide Tateishi
- Department of Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Bhagavatula SK, Tuncali K, Shyn PB, Levesque VM, Chang SL, Silverman SG. Percutaneous CT- and MRI-guided Cryoablation of cT1 Renal Cell Carcinoma: Intermediate- to Long-term Outcomes in 307 Patients. Radiology 2020; 296:687-695. [PMID: 32633677 DOI: 10.1148/radiol.2020200149] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Percutaneous ablation for cT1 renal cell carcinoma (RCC) remains underused, partially because of heterogeneous and limited long-term outcomes data assessing recent cryoablation methods. Purpose To report intermediate- to long-term outcomes of image-guided percutaneous cryoablation of cT1 RCC and to compare outcomes for CT versus MRI guidance. Materials and Methods This HIPAA-compliant retrospective single-institution study assessed patients who underwent percutaneous cryoablation for solitary pathology-proven cT1 RCC between August 2000 and July 2017. Tumors (cT1a, n = 282; cT1b, n = 25; size range, 0.6-6.5 cm; median size, 2.5 cm) underwent cryoablation with CT (n = 155) or MRI (n = 152) guidance. Primary end points of overall survival (OS), disease-specific survival (DSS), imaging-confirmed disease-free survival (DFS), and local progression-free survival (LPFS) were calculated by using Kaplan-Meier analysis. Secondary end points of technique efficacy and adverse event rate were also calculated. Primary and secondary end points for CT and MRI guidance were compared by using univariable regression analysis. Results A total of 307 patients (mean age, 68 years ± 11 [standard deviation]; 192 men) were evaluated. Median clinical follow-up lasted 95 months (range, 8-219 months), and median imaging follow-up lasted 41 months (range, 0-189 months). Survival metrics at 3, 5, 10, and 15 years, respectively, included OS of 91% (95% confidence interval [CI]: 88%, 94%), 86% (95% CI: 82%, 90%), 78% (95% CI: 73%, 84%), and 76% (95% CI: 69%, 83%); DSS of 99.6% (95% CI: 99%, 100%), 99% (95% CI: 98%, 100%), 99% (95% CI: 98%, 100%), and 99% (95% CI: 98%, 100%); DFS of 94% (95% CI: 92%, 97%), 91% (95% CI: 88%, 96%), 88% (95% CI: 83%, 93%), and 88% (95% CI: 83%, 93%); and LPFS of 97% (95% CI: 94%, 99%), 95% (95% CI: 93%, 98%), 95% (95% CI: 93%, 98%), and 95% (95% CI: 93%, 98%). Survival did not significantly differ between CT and MRI guidance, with univariable Cox regression analysis hazard ratios of 0.97 (95% CI: 0.57, 1.67; P = .92) for OS, 0.63 (95% CI: 0.26, 1.52; P = .30) for DFS, and 0.83 (95% CI: 0.26, 2.74; P = .77) for LPFS. Primary and secondary technique efficacy were 96% and 99%, respectively. Overall adverse event rate was 14% (43 of 307), including 11 grade 3 events and three grade 4 events according to the Common Terminology Criteria for Adverse Events. Conclusion Percutaneous CT- and MRI-guided cryoablation of cT1 renal cell carcinoma had similar excellent intermediate- and long-term outcomes. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Georgiades in this issue.
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Affiliation(s)
- Sharath K Bhagavatula
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Kemal Tuncali
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Steven L Chang
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
| | - Stuart G Silverman
- From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.K.B., K.T., P.B.S., V.M.L., S.G.S.), and Division of Urology, Department of Surgery (S.L.C.), Brigham and Women's Hospital, Harvard Medical School; 75 Francis Street, Boston, MA 02115
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Is There a Role for Combination, Single-Session Selective Transarterial Embolization and Microwave Ablation for Large Renal Masses? Cardiovasc Intervent Radiol 2020; 43:1468-1473. [PMID: 32613266 DOI: 10.1007/s00270-020-02568-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/20/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Thermal ablation of small renal tumors is safe and efficacious. Thermoablation of tumors greater than 3 cm has decreased efficacy and a greater risk of complications. Combined embolization and radiofrequency ablation has shown encouraging results. We report on the use of combined single-session transarterial embolization and microwave ablation to treat large renal masses. MATERIALS AND METHODS After obtaining IRB approval, a review of the medical record between October 2016 and January 2020 was performed. Patients with renal tumors who underwent combined transarterial embolization and microwave ablation were assessed retrospectively. Patient demographic information, intraoperative, postoperative, and follow-up data were recorded. RESULTS Eleven patients were identified meeting inclusion criteria. The mean age was 73 years, with 64% male, an average BMI of 26.5, and average Charleston Comorbidity Index of 6.7. Nine tumors were identified as clear cell carcinoma, one as papillary carcinoma and one as an oncocytic neoplasm. Average tumor size was 4.5 cm (2.7-8.3), with an average RENAL score of 8.5. Successful ablation with a 5 mm margin was achieved in all patients, and in all cases, ablation and embolization were performed on the same day. The only related post-procedure complication was a single groin hematoma. Surveillance was performed with CT or MRI. Average follow-up was 419.5 days (range 27-747), with no patients showing evidence of recurrence to date. CONCLUSIONS Combined single-session transarterial embolization and microwave ablation is technically feasible, safe, and efficacious in treating large renal tumors in a series of 11 patients with no recurrence to date. LEVEL OF EVIDENCE Level 4, case series.
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Cazzato RL, Garnon J, De Marini P, Auloge P, Koch G, Dalili D, Buy X, Palussiere J, Rao PP, Tricard T, Lang H, Gangi A. Is percutaneous image-guided renal tumour ablation ready for prime time? Br J Radiol 2020; 93:20200284. [PMID: 32543890 DOI: 10.1259/bjr.20200284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In the last few decades, thermal ablation (TA) techniques have been increasingly applied to treat small localised renal cell carcinomas. Despite this trend, there is still an underuse of TA compared to surgery and a substantial lack of high-quality evidence derived from large, prospective, randomised controlled trials comparing the long-term oncologic outcomes of TA and surgery. Therefore, in this narrative review, we assess published guidelines and recent literature concerning the diagnosis and management of kidney-confined renal cell carcinoma to understand whether percutaneous image-guided TA is ready to be proposed as a first-line treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre De Marini
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Department of Diagnostic and Interventional Radiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, 0 St Thomas St, London SE1 9RS, United Kingdom
| | - Xavier Buy
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Jean Palussiere
- Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Pramod Prabhakar Rao
- Interventional Radiology, Civil Hospital of Colmar; 39 Avenue de la Liberté, 68024 Colmar, France
| | - Thibault Tricard
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Hervé Lang
- Urology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg; 1 place de l'hôpital, 67000, Strasbourg, France
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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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Mauri G, Cazzato RL. Introduction to image-guided thermal ablations special issue. Int J Hyperthermia 2020; 36:1-2. [PMID: 31537153 DOI: 10.1080/02656736.2019.1651906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, Istituto Europeo di Oncologia , IRCCS, Milano , Italy
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg , Strasbourg , France
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Grange R, Tradi F, Izaaryene J, Daidj N, Brunelle S, Walz J, Gravis G, Piana G. Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes. Int J Hyperthermia 2020; 36:1065-1071. [PMID: 31648584 DOI: 10.1080/02656736.2019.1675913] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose: To evaluate the safety, functional and oncological outcomes associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). Materials and methods: Institutional database was reviewed to identify patients treated by percutaneous CT-guidance cryoablation between 2013 and 2018 for biopsy-proven RCC tumors measuring 4.1-7.0 cm. The main outcome parameters analyzed were primary and secondary technique efficacy, progression-free survival (PFS), cancer-specific survival (CSS), loss of estimated glomerular filtration rate (eGFR) and complications. PFS and CSS were estimated by the Kaplan-Meier method. Complications were graded by the Clavien-Dindo system. Results: Twenty-three consecutive patients were included (mean tumor diameter: 45.6 ± 6.2 mm; mean RENAL score: 8.1 ± 1.8). The technical success rate was 95.7%. Primary and secondary technique efficacy rates were 86.3 and 100%, respectively. Three patients found to have incomplete ablations at 3 months were successfully treated by repeat cryoablation. Median duration follow-up was 11 months (range: 3-33). Imaging showed PFS to be 85.7% at 6 months, 66.7% at 12 months and 66.7% at 24 months. One patient with a local recurrence at 12 months was treated by radical nephrectomy. One patient died from progression of disease within 12 months. One patient reported a complication grade ≥ II (4.3%). Mean eGFR loss was 4.4 ± 8.5 ml/min/1.73m2, which was significantly higher among those treated for central tumors (p < .05). Conclusion: Cryoablation for stage T1b renal tumors is technically feasible, with favorable oncological and perioperative outcomes. Longer-term studies are needed to verify our findings.
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Affiliation(s)
- Rémi Grange
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Farouk Tradi
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Jean Izaaryene
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Nassima Daidj
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
| | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes , Marseille , France
| | - Gwenaëlle Gravis
- Department of Oncology, Institut Paoli-Calmettes , Marseille , France
| | - Gilles Piana
- Department of Radiology, Institut Paoli-Calmettes , Marseille , France
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Patel SR, Francois S, Bhamber T, Evans H, Gaston K, Riggs SB, Teigland C, Clark PE, Roy OP. Safety and effectiveness of percutaneous renal cryoablation with conscious sedation. Arab J Urol 2020; 18:163-168. [PMID: 33029426 PMCID: PMC7473112 DOI: 10.1080/2090598x.2020.1739382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate complications and treatment failure rates of percutaneous renal cryoablation (PRC) for small renal masses under local anaesthesia and conscious sedation (LACS), to assess the safety and effectiveness of this approach, as PRC is typically performed under general anaesthesia (GA). PATIENTS AND METHODS We retrospectively reviewed PRC under LACS from 2003 to 2017. We analysed perioperative parameters between patients who successfully underwent PRC under LACS and patients with post-procedural complications or treatment failure (renal mass enhancement after successful intraoperative tumour ablation). Two-sided non-parametric and Fisher's exact tests were performed to compare uncomplicated or disease-free PRC with the complication or treatment failure group, respectively. RESULTS A total of 100 PRCs under LACS were performed during the study period. Of these patients, six patients had at least one postoperative complication (6%), and treatment failure was diagnosed in nine patients (9%) after PRC [mean (SD) follow-up of 42.7 (26.6) months]. The procedural failure rate was 1%. No ablations were converted to GA. The mean tumour size was smaller in patients who had no complications during PRC compared to those who did, at a mean (SD) of 2.2 (0.6) cm vs 3.0 (1.0) cm (P = 0.039). The use of more intraoperative probes during the PRC was also associated with complications, at a mean (SD) 3.0 (1.4) vs 1.8 (0.8) (P = 0.021). CONCLUSIONS PRC under LACS is an effective and safe procedural approach for managing small renal masses with low complication, treatment failure, and procedural failure rates. Larger renal masses and intraoperative use of multiple probes is associated with an increased risk of PRC complications. ABBREVIATIONS BMI: body mass index; CCI: Charlson Comorbidity Index; GA: general anaesthesia; LACS: local anaesthesia and conscious sedation; PRC: percutaneous renal cryoablation; R.E.N.A.L.: Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location.
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Affiliation(s)
- Sagar Rohitkumar Patel
- Department of Urology, Atrium Health, Charlotte, NC, USA
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Sean Francois
- Department of Urology, Atrium Health, Charlotte, NC, USA
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Holt Evans
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Kris Gaston
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | | | - Chris Teigland
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Peter E. Clark
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Ornob P. Roy
- Department of Urology, Atrium Health, Charlotte, NC, USA
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Ichijo Y, Miura H, Hirota T, Asai S, Hisano M, Hongo F, Ukimura O, Katsumori T, Yamada K. Ice Ball Cracks on CT During Cryoablation for Renal Tumors: A Retrospective Analysis. Cardiovasc Intervent Radiol 2020; 43:882-888. [DOI: 10.1007/s00270-020-02454-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/12/2020] [Indexed: 01/20/2023]
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Kajiwara K, Yoshimatsu R, Nishimori M, Yamanishi T, Minamiguchi H, Karashima T, Inoue K, Awai K, Yamagami T. Efficacy of arterial infusion of iodized oil on CT-guided cryoablation for renal cell carcinoma. MINIM INVASIV THER 2020; 30:327-333. [DOI: 10.1080/13645706.2020.1734622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Miki Nishimori
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Japan
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Lugnani F, Zhao JG. Translation of Cryobiological Techniques to Socially Economically Deprived Populations—Part 2: Cryosurgery. J Med Device 2020. [DOI: 10.1115/1.4045836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AbstractCold and cryogenic temperatures are used for treating cancer and other pathological conditions in various fields of medicine. Cryosurgery, which resides at the interface of medicine and engineering, has attracted the interest of engineers, scientists, and medical doctors. Recently, particularly since the end of the 1980s, technological developments in cryotherapy equipment and enormous advances in imaging techniques, such as computed tomography and ultrasonography, have allowed surgeons and interventional radiologists to precisely guide cryogenic probes into tumors while avoiding damage to surrounding tissues. Extensive studies have allowed us to conclude that the use of cryogenics facilitates the successful treatment of solid tumors in various organs such as lung, liver, bones, kidneys, prostate, etc. Its simplicity of use, effectiveness, low cost, and limited demand on hospital infrastructure and personnel have made cryosurgery particularly suitable for the treatment of patients of socio-economically deprived populations.
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Affiliation(s)
- Franco Lugnani
- Hippocrates Doo, Brezec pri Divaci 9a, Divaca 6215, Slovenia
| | - John Guojiang Zhao
- Asia-Pacific Institute for Biomedical Research, 28 Connaught Road West, Hong Kong, China
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Celia A, Pusceddu C, Silvestri T, Gidaro GB, Iannello F, Lanati EP, D'Ausilio A. Percutaneous cryoablation vs. open partial nephrectomy in small kidney cancers: the Italian experience. Minerva Urol Nephrol 2020; 73:178-186. [PMID: 32083414 DOI: 10.23736/s2724-6051.20.03625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the present work was to analyze the economic impact of PCA (percutaneous cryoablation) vs. OPN (open partial nephrectomy), as it represents the most common standard of care for SRMs (small renal masses), namely T1a renal cancers (<4 cm), in Italy. EVIDENCE ACQUISITION A cost analysis was performed to compare the difference of the total perioperative costs between PCA and OPN, both from the perspective of the National Healthcare System and the hospital. Clinical and resources consumption inputs were retrieved by a non-systematic literature search on scientific databases, complemented by a grey literature research, and validated by expert opinion. Costs calculation for the NHS perspective were based on reference tariffs published by the National Ministry of Health, while for the hospital perspective, unit costs published in the grey literature were used to compare the two alternatives. EVIDENCE SYNTHESIS Assuming the NHS perspective, the cost analysis shows there is an economic advantage in using PCA vs. OPN (€4080 vs. €7541) for the treatment of SRMs. Hospitalization time is the driver of the total costs, while the costs of complications are quite negligible in both groups. From the hospital perspective the costs of PCA is slightly higher (+€737) than OPN, with cryoprobes contributing as the greatest cost component. However, this increase is quite restrained and is offset by an inferior use of healthcare resources (surgery room, healthcare personnel, length of stay in the hospital). CONCLUSIONS According to our analysis, PCA results an advantageous technique compared to OPN respectively in terms of costs and resource consumption from both the NHS and the hospital perspective.
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Affiliation(s)
- Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Claudio Pusceddu
- Department of Oncological and Interventional Radiology, A. Businco Oncological Hospital, AO Brotzu, Cagliari, Italy
| | - Tommaso Silvestri
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
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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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Gunn AJ, Parikh NS, Bhatia S. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma. J Vasc Interv Radiol 2020; 31:195-201.e3. [PMID: 31917026 DOI: 10.1016/j.jvir.2019.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Nainesh S Parikh
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Fujimori M, Yamanaka T, Sugino Y, Matsushita N, Sakuma H. Percutaneous Image-guided Thermal Ablation for Renal Cell Carcinoma. INTERVENTIONAL RADIOLOGY 2020; 5:32-42. [PMID: 36284654 PMCID: PMC9550385 DOI: 10.22575/interventionalradiology.2020-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/17/2020] [Indexed: 11/05/2022]
Abstract
Nephrectomy is the gold standard for the treatment of renal cell carcinoma (RCC). However, some patients are not suitable candidates for nephrectomy because of high surgical risk, reduced renal function, or the presence of multiple renal tumors. Percutaneous image-guided thermal ablation, including cryoablation and radiofrequency ablation, is a minimally invasive and highly effective treatment and can be used to treat RCC in patients who are not good candidates for surgery. This article will review percutaneous image-guided thermal ablation for RCC, covering treatment indications, ablation modalities and techniques, oncologic outcomes, and possible complications. In addition, the characteristics of each ablation modality and its comparison with nephrectomy are also presented.
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Affiliation(s)
| | | | - Yuichi Sugino
- Department of Radiology, Mie University School of Medicine
| | | | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine
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Young S, Golzarian J, Anderson JK. Thermal Ablation of T1a Renal Cell Carcinoma: The Clinical Evidence. Semin Intervent Radiol 2019; 36:367-373. [PMID: 31798209 DOI: 10.1055/s-0039-1696650] [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: 12/27/2022]
Abstract
Renal cell carcinoma (RCC) is most commonly diagnosed at an early (T1a) stage and is typically amenable to several effective treatments. The current gold standard therapy is partial nephrectomy, given its decreased morbidity and similar oncologic outcomes when compared with radical nephrectomy. Thermal ablation is an evolving definitive therapy for T1a RCC which is even less invasive than partial nephrectomy. This article reviews the evidence for thermal ablation in the treatment of T1a RCC and compares outcomes of existing ablation modalities with surgical management.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Jafar Golzarian
- Department of Radiology and Surgery, University of Minnesota, Minneapolis, Minnesota
| | - J Kyle Anderson
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
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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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Machida Y, Shimauchi A, Igarashi T, Fukuma E. MRI Findings After Cryoablation of Primary Breast Cancer Without Surgical Resection. Acad Radiol 2019; 26:744-751. [PMID: 30149977 DOI: 10.1016/j.acra.2018.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 01/08/2023]
Abstract
RATIONALE AND OBJECTIVES To retrospectively evaluate findings on serial magnetic resonance imaging (MRI) after cryoablation for breast cancer lesions without subsequent surgical resection. MATERIALS AND METHODS This study was approved by the Institutional Review Board and the requirement to obtain informed consent waived. Ductal carcinoma in situ or invasive carcinoma ≤15 mm, nuclear grade 1 or 2, estrogen receptor positive/human epidermal growth factor 2 negative without lymph node metastasis were treated with cryoablation without subsequent excision. Two observers independently reviewed the first two postcryoablation MRIs for shape (none, focus-to-mass, or nonmass enhancement) and suspicion of residual disease (positive or negative). Fisher's exact or the Mann-Whitney U test was used to assess significance. Interobserver agreement on findings was evaluated by calculating κ values. RESULTS Fifty-four patients were enrolled. The first and second postcryoablation MRIs were performed 22-171 days and 82-487 days after cryoablation, respectively. Interobserver agreement ranged from fair to moderate (κ = 0.356-0.434). Observer 1 or 2 identified suspicious areas on the first postcryoablation MRI in seven cases (13.0%). These were significantly associated with focus-to-mass shape (vs non-focus-to-mass: nonmass enhancement or none) and residual disease or recurrence suspected by both observers (p < 0.001). There were no cases of both observers identifying suspicious findings on the second postcryoablation MRI. CONCLUSION Suspicious findings can be detected within the treated area at the first postcryoablation MRI. These can resolve during subsequent adjuvant therapies and follow-up.
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Affiliation(s)
- Youichi Machida
- Department of Radiology, Kameda Kyobashi Clinic, 3-1-1 Kyobashi, Chuo Ward, Tokyo 104-0031, Japan.
| | - Akiko Shimauchi
- Department of Radiology, Kameda Kyobashi Clinic, 3-1-1 Kyobashi, Chuo Ward, Tokyo 104-0031, Japan
| | - Takao Igarashi
- Department of Diagnostic Imaging, Jikei University School of Medicine Hospital, Minato Ward, Tokyo, Japan.
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, Kamogawa City, Chiba, Japan.
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Yamagami T, Yoshimatsu R, Kajiwara K, Yamanishi T, Minamiguchi H, Karashima T, Inoue K. Protection from injury of organs adjacent to a renal tumor during percutaneous cryoablation. Int J Urol 2019; 26:785-790. [PMID: 31094038 DOI: 10.1111/iju.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/07/2019] [Indexed: 01/20/2023]
Abstract
Renal cryoablation has become accepted as treatment for small renal tumors as an alternative to surgery. However, parallel with the increase in the use of this therapy, there also has been increases in the number of reports of complications related to renal cryoablation. One potential complication is injury to important non-renal structures adjacent to the ablated renal tumor, such as the colon, duodenum, ureter, psoas muscle and so on. To prevent injury of adjacent organs, separating organs from the tumor is desirable. Over the past 15 years, several techniques have been developed to protect against injury of organs adjacent to renal tumors that are targets of cryoablation. The most commonly used technique for this purpose has been hydrodissection. Others include dissection with gas, balloon dissection and probe traction. To avoid injury of a ureter running near the renal tumor, pyeloperfusion is known to be useful. The rate of cases necessitating avoidance of organ injury by using these techniques is relatively high. In some cases, more than two techniques are combined. In the present review, we provided an overview of techniques currently available to protect against organ injuries, and discussed the advantages and disadvantages of each technique.
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Affiliation(s)
- Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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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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Maciolek KA, Abel EJ, Posielski NM, Hinshaw JL, Lubner MG, Lee FT, Ziemlewicz TJ, Wells SA. Tumor location does not impact oncologic outcomes for percutaneous microwave ablation of clinical T1a renal cell carcinoma. Eur Radiol 2019; 29:6319-6329. [PMID: 31016448 DOI: 10.1007/s00330-019-06121-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the impact of anterior tumor location on oncologic efficacy, complication rates, and procedure duration for 151 consecutive biopsy-proven clinical T1a renal cell carcinoma (RCC) treated with percutaneous microwave (MW) ablation. METHODS This single-center retrospective study was performed under a waiver of informed consent. One hundred forty-eight consecutive patients (103 M/45 F; median age 67 years, IQR 61-73) with 151 cT1a biopsy-proven RCC (median diameter 2.4 cm, IQR 1.9-3.0) were treated with percutaneous MW ablation between March 2011 and August 2017. Patient and procedural data collected included Charlson comorbidity index (CCI), RENAL nephrometry score (NS), use of hydrodisplacement, MW antennas/generator output/time, and procedure time (PT). Data were stratified by anterior, posterior, and midline tumor location and compared with the Kruskal-Wallis or chi-squared tests. The Kaplan-Meier method was used for survival analyses. RESULTS Tumor size, NS, and use/volume of hydrodisplacement were similar for posterior and anterior tumors (p > 0.05). Patients with anterior tumors had a higher CCI (3 vs 4, p = 0.001). Median PT for posterior and anterior tumors was similar (100 vs 108 min, p = 0.26). Single session technical success and primary efficacy were achieved for all 151 tumors including 61 posterior and 67 anterior tumors. The 4 (3%) Clavien III-IV complications and 6 (4%) local recurrences were not associated with tumor location (p > 0.05). Three-year RFS, CSS, and OS were 95% (95% CI 0.87, 0.98), 100% (95% CI 1.0, 1.0), and 96% (95% CI 0.89, 0.98), respectively. CONCLUSIONS The safety and efficacy of percutaneous microwave ablation for anterior and posterior RCC are similar. KEY POINTS • The safety profile for percutaneous microwave ablation of anterior and posterior T1a renal cell carcinoma is equivalent. • Percutaneous microwave ablation of T1a renal cell carcinoma provides durable oncologic control regardless of tumor location. • Placement of additional microwave antennas and use of hydrodisplacement are associated with longer procedure times.
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Affiliation(s)
- Kim A Maciolek
- University of Wisconsin School of Medicine and Public Health, Health Sciences Learning Center, 750 Highland Avenue, Madison, WI, 53705, USA
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - Natasza M Posielski
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
| | - J Louis Hinshaw
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Fred T Lee
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705, USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, E3/376 Clinical Science Center, Madison, WI, 53792, USA.
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AUTHOR REPLY. Urology 2018; 121:196. [DOI: 10.1016/j.urology.2018.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/10/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
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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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Introduction of Microwave Ablation Into a Renal Ablation Practice: Valuable Lessons Learned. AJR Am J Roentgenol 2018; 211:1381-1389. [PMID: 30247980 DOI: 10.2214/ajr.18.19775] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the early outcomes of percutaneous microwave ablation (MWA) for clinical stage T1 (cT1) renal masses when performed within a high-volume ablation practice with critical emphasis on procedural safety. MATERIALS AND METHODS A retrospective review of a percutaneous renal ablation registry identified 26 patients with a total of 27 cT1 renal masses treated with MWA between 2011 and 2017. Mean patient age was 63.8 years and 16 (61.5%) patients were male. Mean renal mass size ± SD was 2.3 ± 0.8 cm (range, 1.1-4.7 cm). The main outcome parameters investigated were technical success, local tumor progression, survival rates, and complications. Complications were categorized using the Clavien-Dindo classification system. Rates of local progression-free and cancer-specific survival (PFS and CSS, respectively) were estimated using the Kaplan-Meier method. RESULTS Technical success was 100% on contrast-enhanced CT or MRI performed immediately after renal MWA. Twenty-four patients (92%) with 25 tumors had follow-up imaging for 3 months or longer (mean, 20.6 ± 11.6 months), with no local tumor recurrences identified. Estimated 3-year local PFS and CSS were 96% and 94%, respectively. The overall complication rate was 19.2%; two patients (7.7%) experienced minor complications (grade I or II) and three patients (11.5%) experienced major bleeding or urinary-related complications (grade III or higher), including one death. CONCLUSION This study suggests that percutaneous MWA is a promising minimally invasive treatment option for cT1 renal masses. Nonetheless, major bleeding and urinary-related complications can occur, and further studies are needed to determine optimal patient and tumor selection for renal MWA.
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Percutaneous microwave ablation for local control of metastatic renal cell carcinoma. Abdom Radiol (NY) 2018; 43:2446-2454. [PMID: 29464274 DOI: 10.1007/s00261-018-1498-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of the article is to evaluate the safety and oncologic efficacy of microwave ablation for metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS From September 2011 to December 2016, 33 mRCC were ablated in 18 patients using percutaneous microwave ablation. Sites of mRCC include retroperitoneum (n = 12), contralateral kidney (n = 6), liver (n = 6), lung (n = 5), adrenal gland (n = 5). Technical success, local, and distant tumor progression, and complications were assessed at immediate and follow-up imaging. The Kaplan-Meier method was used for survival analysis. RESULTS Technical success was achieved for 33/33 (100%) mRCC tumors. Ablation provided durable local control for 28/30 (93%) mRCC tumors in 17 patients at a median duration of clinical and imaging follow-up of 1.6 years (IQR 0.7-3.6) and 0.8 years (IQR 0.5-2.7), respectively. In-hospital and perioperative mortality was 0%. There were 5 (15%) procedure-related complications including one high-grade event (Clavien-Dindo III). Four patients have died from mRCC at a median of 1.3 years (range 0.7-5.1) following ablation. Estimated OS (95% CI number still at risk) at 1, 2, and 5 years were 86% (53-96%, 11), 75% (39-92%, 8), and 75% (39-92%, 3), respectively. CONCLUSIONS Microwave ablation of oligometastatic renal cell carcinoma is safe and provides durable local control in appropriately selected patients.
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Radiofrequency ablation versus cryoablation for T1b renal cell carcinoma: a multi-center study. Jpn J Radiol 2018; 36:551-558. [DOI: 10.1007/s11604-018-0756-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
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A Comparison of Bleeding Complications in Patients Undergoing Percutaneous Renal Cryoablation Using Cryoprobes with and without Heat-Based Track Ablation. J Vasc Interv Radiol 2018; 29:874-879. [DOI: 10.1016/j.jvir.2017.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/27/2017] [Accepted: 11/13/2017] [Indexed: 11/19/2022] Open
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West B, Keheila M, Smith JC, Erskine A, Abourbih SR, Khater N, Baldwin DD. Efficacy of antegrade and retrograde warm saline pyeloperfusion during renal cryoablation for ureteral preservation. Turk J Urol 2018; 44:142-147. [PMID: 29511584 DOI: 10.5152/tud.2017.44380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/23/2017] [Indexed: 01/20/2023]
Abstract
Objective Cryoablation of renal tumors adjacent to the ureter or pelvicalyceal system carries risks for thermal injury of the collecting system. Although cold antegrade perfusion has been described for radiofrequency ablation, warm saline perfusion for renal cryoablation has not been well-characterized. The purpose of this study was to determine the safety and feasibility of antegrade and retrograde warm saline perfusions during percutaneous renal cryoablation. Material and methods A retrospective review was performed on 136 patients treated with percutaneous renal cryoablation at a single academic institution between 2009 and 2015. Six patients undergoing antegrade (n=3) or retrograde (n=3) warm saline perfusion for protection of the collecting system were identified. Warm saline was perfused through a 4 French nephrostomy tube in the antegrade technique and through a 6 French end-hole catheter in the retrograde technique. Outcome measures were tumor recurrence rates, success of urothelial preservation, hospital stay, blood loss and procedural time. Results Four tumors were in the lower pole and two tumors in the middle pole. The mean distance from tumor to ureter was 6.8 mm (0.8-11.5 mm) and no patient developed ureteral stricture. There was no tumor recurrence at a median follow-up of 37.3 months (7-65). The median procedural time was 3 hours and 13 minutes. One patient in each group developed minor complications (Clavien I and II) and there were no major complications. Conclusion This study demonstrates the feasibility of antegrade and retrograde warm saline perfusion for ureteral preservation during cryoablation, without compromising oncologic outcomes.
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Affiliation(s)
- Benjamin West
- Department of Urology, Loma Linda University School of Medicine, California, USA
| | - Mohamed Keheila
- Department of Urology, Loma Linda University School of Medicine, California, USA
| | - Jason C Smith
- Department of Radiology, Loma Linda University School of Medicine, California, USA
| | - Alexander Erskine
- Department of Urology, Loma Linda University School of Medicine, California, USA
| | - Samuel R Abourbih
- Department of Urology, Loma Linda University School of Medicine, California, USA
| | - Nazih Khater
- Department of Urology, Loma Linda University School of Medicine, California, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University School of Medicine, California, USA
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Hebbadj S, Cazzato RL, Garnon J, Shaygi B, Buy X, Tsoumakidou G, Lang H, Gangi A. Safety Considerations and Local Tumor Control Following Percutaneous Image-Guided Cryoablation of T1b Renal Tumors. Cardiovasc Intervent Radiol 2017; 41:449-458. [DOI: 10.1007/s00270-017-1820-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/12/2017] [Indexed: 12/19/2022]
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [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] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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Sommer CM, Vollherbst DF, Richter GM, Kauczor HU, Pereira PL. [What can/should be treated in kidney tumors and when]. Radiologe 2017; 57:80-89. [PMID: 28130580 DOI: 10.1007/s00117-016-0202-y] [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: 10/20/2022]
Abstract
CLINICAL/METHODICAL ISSUE In the treatment of localized renal cell carcinoma, the lack of randomization in controlled trials on thermal ablation is a major limitation. The latter leads to significant study bias and it ultimately remains unclear whether the improved overall survival in favor of partial nephrectomy can actually be attributed to the treatment method. STANDARD RADIOLOGICAL METHODS For T1a (≤4 cm) renal cell carcinoma without lymph node and distant metastases, excellent technical and clinical results have been described after imaging-guided radiofrequency ablation and cryoablation. METHODICAL INNOVATIONS Low major complication rates, preservation of renal function and three-dimensional confirmation of negative ablation margins (A0 ablation) are the advantages of computed tomography (CT)-guided thermal ablation. PERFORMANCE According to the results of controlled (non-randomized) trials on T1a renal cell cancer, the cancer-specific survival rates are comparable between ablative and surgical techniques. ACHIEVEMENTS It is high time for prospective randomized controlled trials to define the actual value of percutaneous thermal ablation and partial nephrectomy in the treatment of T1a renal cell carcinoma. PRACTICAL RECOMMENDATIONS Apart from localized renal cell carcinoma, angiomyolipoma and oncocytoma can be treated by thermal ablation. Transarterial embolization extends the radiological spectrum for the treatment of renal tumors, either as complementary embolization (e. g. before thermal ablation of T1a and T1b renal cell carcinoma), prophylactic embolization (e. g. angiomyolipoma >6 cm), preoperative embolization (e. g. before laparoscopic partial nephrectomy) or palliative embolization (e. g. in patients with symptomatic macrohematuria due to renal cell carcinoma).
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Affiliation(s)
- C M Sommer
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland. .,Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland.
| | - D F Vollherbst
- Abteilung Neuroradiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - G M Richter
- Klinik für Diagnostische und Interventionelle Radiologie, Klinikum Stuttgart, Katharinenhospital, Stuttgart, Deutschland
| | - H U Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - P L Pereira
- Klinik für Radiologie, minimal-invasive Therapien und Nuklearmedizin, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
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Prins FM, Kerkmeijer LGW, Pronk AA, Vonken EJPA, Meijer RP, Bex A, Barendrecht MM. Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review. J Endourol 2017; 31:963-975. [PMID: 28741377 DOI: 10.1089/end.2017.0382] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The standard treatment of T1 renal cell carcinoma (RCC) is (partial) nephrectomy. For patients where surgery is not the treatment of choice, for example in the elderly, in case of severe comorbidity, inoperability, or refusal of surgery, alternative treatment options are available. These treatment options include active surveillance (AS), radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), or stereotactic body radiotherapy (SBRT). In the present overview, the efficacy, safety, and outcome of these different options are summarized, particularly focusing on recent developments. MATERIALS AND METHODS Databases of MEDLINE (through PubMed), EMBASE, and the Cochrane Library were systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The search was performed in December 2016, and included a search period from 2010 to 2016. The terms and synonyms used were renal cell carcinoma, active surveillance, radiofrequency ablation, microwave ablation, cryoablation and stereotactic body radiotherapy. RESULTS The database search identified 2806 records, in total 73 articles were included to assess the rationale and clinical evidence of alternative treatment modalities for small renal masses. The methodological quality of the included articles varied between level 2b and level 4. CONCLUSION Alternative treatment modalities, such as AS, RFA, CA, MWA, and SBRT, are treatment options especially for those patients who are unfit to undergo an invasive treatment. There are no randomized controlled trials available comparing surgery and less invasive modalities, leading to a low quality on the reported articles. A case-controlled registry might be an alternative to compare outcomes of noninvasive treatment modalities in the future.
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Affiliation(s)
- Fieke M Prins
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Linda G W Kerkmeijer
- 1 Department of Radiation Oncology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Anne A Pronk
- 2 Department of Urology, Tergooi Hospital , Hilversum, The Netherlands
| | - Evert-Jan P A Vonken
- 3 Department of Radiology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Richard P Meijer
- 4 Department of Urology, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Axel Bex
- 5 Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital , Amsterdam, The Netherlands
| | - Maurits M Barendrecht
- 6 Department of Urology, Tergooi Hospital, Hilversum and University Medical Center Utrecht , Utrecht, The Netherlands
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