1
|
Abdelsalam ME, Mecci N, Awad A, Bassett RL, Odisio BC, Habibollahi P, Lu T, Irwin D, Karam JA, Matin SF, Ahrar K. Magnetic-Resonance-Imaging-Guided Cryoablation for Solitary-Biopsy-Proven Renal Cell Carcinoma: A Tertiary Cancer Center Experience. Cancers (Basel) 2024; 16:1815. [PMID: 38791894 PMCID: PMC11119189 DOI: 10.3390/cancers16101815] [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: 03/27/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Our purpose is to evaluate the long-term oncologic efficacy and survival rates of MRI-guided cryoablation for patients with biopsy-proven cT1a renal cell carcinoma (RCC). MATERIALS AND METHODS We retrospectively reviewed our renal ablation database between January 2007 and June 2021 and only included patients with solitary-biopsy-proven cT1a RCC (≤4 cm) who underwent MRI-guided cryoablation. We excluded patients with genetic syndromes, bilateral RCC, recurrent RCC or benign lesions, those without pathologically proven RCC lesions and patients who underwent radiofrequency ablation or CT-guided cryoablation. For each patient, we collected the following: age, sex, lesion size, right- or left-sided, pathology, ablation zone tumor recurrence, development of new tumor in the kidney other than ablation zone, development of metastatic disease, patient alive or not, date and cause of death. We used the Kaplan and Meier product limit estimator to estimate the survival outcomes. RESULTS Twenty-nine patients (median age 70 years) met our inclusion criteria. Twenty-nine MRI-guided cryoablation procedures were performed for twenty-nine tumor lesions with a median size of 2.2 cm. A Clavien-Dindo grade III complication developed in one patient (3.4%). Clear cell RCC was the most reported histology (n = 19). The median follow up was 4.5 years. No tumor recurrence or metastatic disease developed in any of the patients. Two patients developed new renal lesions separate from the ablation zone. The 5- and 10-year OS were 72% and 55.6%, respectively. The 5- and 10-year DFS were 90.5% and the 5-year and 10-year LRFS, MFS and CSS were all 100%. CONCLUSIONS MRI-guided cryoablation is a safe treatment with a low complication rate. Long-term follow-up data revealed long-standing oncologic control.
Collapse
Affiliation(s)
- Mohamed E. Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.A.); (B.C.O.); (P.H.); (T.L.); (D.I.); (K.A.)
| | - Nabeel Mecci
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.L.B.)
| | - Ahmed Awad
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.A.); (B.C.O.); (P.H.); (T.L.); (D.I.); (K.A.)
| | - Roland L. Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (R.L.B.)
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.A.); (B.C.O.); (P.H.); (T.L.); (D.I.); (K.A.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.A.); (B.C.O.); (P.H.); (T.L.); (D.I.); (K.A.)
| | - Thomas Lu
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.A.); (B.C.O.); (P.H.); (T.L.); (D.I.); (K.A.)
| | - David Irwin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.A.); (B.C.O.); (P.H.); (T.L.); (D.I.); (K.A.)
| | - Jose A. Karam
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.A.K.); (S.F.M.)
| | - Surena F. Matin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.A.K.); (S.F.M.)
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.A.); (B.C.O.); (P.H.); (T.L.); (D.I.); (K.A.)
| |
Collapse
|
2
|
Wang Y, Butaney M, Wilder S, Ghani K, Rogers CG, Lane BR. The evolving management of small renal masses. Nat Rev Urol 2024:10.1038/s41585-023-00848-6. [PMID: 38365895 DOI: 10.1038/s41585-023-00848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/18/2024]
Abstract
Small renal masses (SRMs) are a heterogeneous group of tumours with varying metastatic potential. The increasing use and improving quality of abdominal imaging have led to increasingly early diagnosis of incidental SRMs that are asymptomatic and organ confined. Despite improvements in imaging and the growing use of renal mass biopsy, diagnosis of malignancy before treatment remains challenging. Management of SRMs has shifted away from radical nephrectomy, with active surveillance and nephron-sparing surgery taking over as the primary modalities of treatment. The optimal treatment strategy for SRMs continues to evolve as factors affecting short-term and long-term outcomes in this patient cohort are elucidated through studies from prospective data registries. Evidence from rapidly evolving research in biomarkers, imaging modalities, and machine learning shows promise in improving understanding of the biology and management of this patient cohort.
Collapse
Affiliation(s)
- Yuzhi Wang
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Samantha Wilder
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Khurshid Ghani
- Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Brian R Lane
- Division of Urology, Corewell Health West, Grand Rapids, MI, USA.
- Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| |
Collapse
|
3
|
Cazzato RL, De Marini P, Mayer T, Leclerc L, Leonard-Lorant I, Dalili D, Weiss J, Koch G, Autrusseau PA, Garnon J, Lang H, Gangi A. MRI- Versus CT-Guided Renal Tumor Cryoablation: Is There a Difference? Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03453-7. [PMID: 37225969 DOI: 10.1007/s00270-023-03453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/22/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE To compare procedure-related variables, safety, renal function, and oncologic outcomes in patients undergoing percutaneous cryoablation (CA) of renal tumors with MRI- or CT-guidance. MATERIALS AND METHODS Patient, tumour, procedure, and follow-up data were collected and analysed. MRI and CT groups were matched using a coarsened exact approach according to patient's gender and age, tumour grade, size and location. P < 0.05 was considered statistically significant. RESULTS Two-hundred fifty-three patients (266 tumors) were retrospectively selected. Following the coarsened exact matching 46 patients (46 tumors) in the MRI group and 42 patients (42 tumors) in the CT group were matched. There were no significant baseline differences between the two populations except for the duration of follow-up (P = 0.002) and renal function (P = 0.002). On average MRI-guided CA lasted 21 min longer than CT-guided ones (P = 0.005). Following CA, complication rates (6.5% for MRI vs 14.3% for CT; P = 0.30) and GFR decline (mean - 13.1 ± 15.8%; range - 64.5-15.0 for MRI; mean - 8.1 ± 14.8%; range - 52.5-20.4; for CT; P = 0.13) were similar in both groups. The 5-year local progression-free, cancer-specific and overall survivals in the MRI and CT groups were 94.0% (95% CI 86.3%-100.0%) and 90.8% (95% CI 81.3%-100.0%; P = 0.55), 100.0% (95% CI 100.0%-100.0%) and 100.0% (95% CI 100.0%-100.0%; P = 1), and 83.7% (95% CI 64.0%-100.0%) and 76.2% (95% CI 62.0%-93.6%; P = 0.41), respectively. CONCLUSIONS Apart from increased procedural times associated with MRI-guided CA of renal tumors compared to CT-guidance, both modalities demonstrate similar safety, GFR decline and oncologic outcomes.
Collapse
Affiliation(s)
- Roberto Luigi Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France.
| | - Pierre De Marini
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Theo Mayer
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Loïc Leclerc
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Ian Leonard-Lorant
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK
- Department of Diagnostic and Interventional Radiology, Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, KT18 7EG, UK
| | - Julia Weiss
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Pierre-Alexis Autrusseau
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Hervé Lang
- Service d'Urologie, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de L'hôpital, 67000, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, Strand London, London, WC2R 2LS, UK
| |
Collapse
|
4
|
Duus LA, Junker T, Rasmussen BS, Bojsen JA, Pedersen AL, Anthonsen A, Lund L, Pedersen M, Graumann O. Safety, efficacy, and mid-term oncological outcomes of computed tomography-guided cryoablation of T1 renal cancer. Acta Radiol 2023; 64:814-820. [PMID: 35297745 DOI: 10.1177/02841851221081825] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cryoablation is a promising minimally invasive, nephron-sparing treatment of small renal carcinoma (RCC) in co-morbid patients. PURPOSE To assess the safety, efficacy, and cancer-specific outcomes of computed tomography (CT)-guided cryoablation of stage T1 (RCC). MATERIAL AND METHODS A retrospective evaluation of 122 consecutive patients with 128 tumors treated with cryoablation during 2016-2017. All patients had biopsy-verified T1 RCC. RESULTS Median age was 69 years (IQR=59-76); 69% were male. Median tumor size was 26 mm (± 20-33); 9% were stage T1b. Mean follow-up time was 36.3±12.0 months. In total, 14 (11%) procedures led to complications, of which 4 (3%) were intraoperative, 5 (4%) appeared ≤30 days and 5 (4%) >30 days after treatment. Major complications arose after 4 (3%) procedures. Statistically significant associations were found between major complications and stage T1b (P = 0.039), RENAL score (P = 0.010), and number of needles used in cryoablation (P = 0.004). Residual tumor was detected after 4 (3%) procedures and 5 (4%) tumors had local tumor progression. Of 122 patients, 3 (2%) advanced to metastatic disease. Significant statistical associations were found between local tumor progression and T1b stage tumors and number of needles used in cryoablation (P = 0.05 and P = 0.004, respectively). For patients with T1a tumors, the one- and three-year disease-free survival was 98% and 95%, respectively, and for T1b 100% after one year and 75% after three years. CONCLUSIONS This study showed that cryoablation is a safe and effective treatment of stage T1 RCC and suggests that in selecting candidates for cryoablation of RCC, the tumor characteristics are more critical than patients' baseline health status.
Collapse
Affiliation(s)
- Louise A Duus
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, SDU, Odense C, Denmark
| | - Theresa Junker
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, SDU, Odense C, Denmark
| | - Benjamin S Rasmussen
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Jonas A Bojsen
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Allan L Pedersen
- Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Andrea Anthonsen
- Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Lars Lund
- Department of Urology, OUH, Odense C, Denmark.,Institute of Clinical Research, SDU, Odense C, Denmark
| | - Michael Pedersen
- Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Ole Graumann
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, SDU, Odense C, Denmark
| |
Collapse
|
5
|
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]
|
6
|
Cazzato RL, De Marini P, Leonard-Lorant I, Leclerc L, Auloge P, Tricard T, Dalili D, Garnon J, Lang H, Gangi A. Safety and Oncologic Outcomes of Magnetic Resonance Imaging-Guided Cryoablation of Renal Cell Carcinoma: A 10-Year Single-Center Experience. Invest Radiol 2021; 56:153-162. [PMID: 32897930 DOI: 10.1097/rli.0000000000000719] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Magnetic resonance imaging guidance has been sporadically reported for renal tumor cryoablation (CA); therefore, clinical experience with this modality is still limited.The aim of this study is to retrospectively analyze our 10-year experience with renal tumor CA performed on a 1.5 T magnetic resonance imaging unit with the intent of reporting procedural safety and oncologic outcomes. MATERIALS AND METHODS We included 143 patients (102 men; 41 women; median age, 73 years; range, 34-91 years) with 149 tumors (median size, 2.6 cm; range, 0.6-6.0 cm), treated between 2009 and 2019. Patient, tumor, procedure, and follow-up data were collected and analyzed. The Kaplan-Meier method was used to estimate local recurrence-free (LRFS), metastasis-free (MFS), disease-free (DFS), cancer-specific, and overall (OS) survival. Univariate and multivariate models were used to identify factors associated with complications, LRFS, MFS, DFS, and OS. RESULTS The overall complication rate was 10.7% (16/149 tumors), with 1 major (1/149 [0.7%]; 95% confidence interval, 0.0%-3.7%) hemorrhagic complication. Other minor complications (15/149 [10.1%]; 95% confidence interval, 0.6%-16.1%) did not include any cases of injury to nearby organs. There were no factors associated with complications.Five-year estimates of LRFS (primary/secondary), MFS, DFS, cancer-specific survival, and OS were 82.8%/91.5%, 91.1%, 75.1%, 98.2%, and 89.6%, respectively. Increasing tumor size (hazard radio [HR], 1.8; P = 0.02) and intraparenchymal tumor location (HR, 5.6; P < 0.01) were associated with lower LRFS; increasing patient's age (HR, 0.5; P = 0.01), high tumor grade (HR, 23.3; P < 0.01) and non-clear-cell/nonpapillary histology (HR, 20.1; P < 0.01) with metastatic disease; and high tumor grade (HR, 3.2; P = 0.04) with lower DFS. CONCLUSION Magnetic resonance imaging-guided CA of renal tumors is associated with acceptable morbidity and high survival estimates at 5-year follow-up. Given the absence of complications resulting from injuries to nearby organs, further studies are required to evaluate whether the potential reduced incidence of these adverse events justifies large-scale implementation of this interventional modality.
Collapse
Affiliation(s)
| | | | | | - Loïc Leclerc
- From the Departments of Interventional Radiology
| | | | | | | | | | - Hervé Lang
- Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- From the Departments of Interventional Radiology
| |
Collapse
|
7
|
Renal cryoablation: Multidisciplinary, collaborative and perspective approach. Cryobiology 2018; 83:90-94. [DOI: 10.1016/j.cryobiol.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
|
8
|
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]
|