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Sun G, Eisenbrey JR, Smolock AR, Lallas CD, Anton KF, Adamo RD, Shaw CM. Percutaneous Microwave Ablation versus Cryoablation for Small Renal Masses (≤4 cm): 12-Year Experience at a Single Center. J Vasc Interv Radiol 2024; 35:865-873. [PMID: 38360294 DOI: 10.1016/j.jvir.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
PURPOSE To determine whether microwave ablation (MWA) has equivalent outcomes to those of cryoablation (CA) in terms of technical success, adverse events, local tumor recurrence, and survival in adult patients with solid enhancing renal masses ≤4 cm. MATERIALS AND METHODS A retrospective review was performed of 279 small renal masses (≤4 cm) in 257 patients (median age, 71 years; range, 40-92 years) treated with either CA (n = 191) or MWA (n = 88) between January 2008 and December 2020 at a single high-volume institution. Evaluations of adverse events, treatment effectiveness, and therapeutic outcomes were conducted for both MWA and CA. Disease-free, metastatic-free, and cancer-specific survival rates were tabulated. The estimated glomerular filtration rate was employed to examine treatment-related alterations in renal function. RESULTS No difference in patient age (P = .99) or sex (P = .06) was observed between the MWA and CA groups. Cryoablated lesions were larger (P < .01) and of greater complexity (P = .03). The technical success rate for MWA was 100%, whereas 1 of 191 cryoablated lesions required retreatment for residual tumor. There was no impact on renal function after CA (P = .76) or MWA (P = .49). Secondary analysis using propensity score matching demonstrated no significant differences in local recurrence rates (P = .39), adverse event rates (P = .20), cancer-free survival (P = .76), or overall survival (P = .19) when comparing matched cohorts of patients who underwent MWA and CA. CONCLUSIONS High technical success and local disease control were achieved for both MWA and CA. Cancer-specific survival was equivalent. Higher adverse event rates after CA may reflect the tendency to treat larger, more complex lesions with CA.
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Affiliation(s)
- George Sun
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda R Smolock
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kevin F Anton
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert D Adamo
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colette M Shaw
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Panhelleux M, Balssa L, David A, Thiery-Vuillemin A, Kleinclauss F, Frontczak A. Evaluation of local control after percutaneous microwave ablation versus partial nephrectomy: A propensity score matched study. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102534. [PMID: 37798161 DOI: 10.1016/j.purol.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION The incidence of small renal tumors (≤4cm) is on the rise. The gold standard treatment is partial nephrectomy (PN) but focal therapy can be a good alternative. We evaluated oncological control after treatment of T1a renal tumors by microwave ablation (MWA) compared to PN. METHODS This is a retrospective, single-center study of all patients treated for TNM stage T1a renal tumors by either PN or MWA between 2010 and 2020. A propensity score was calculated and patients were matched 2:1 to compare recurrence-free survival, metastasis-free survival and overall survival between groups. We also compared postoperative complications using the Clavien-Dindo classification. RESULTS After matching and propensity score, the two groups (41 MWA and 82 PN) were comparable. The median follow-up was 23 months (interquartiles, 9-48 months). Recurrence-free survival was higher in the PN group compared to MWA, with a recurrence rate of 17.1% in the MWA group vs 4.9% in the PN group (P=0.003). MWA treatment was a risk factor for tumor recurrence (P=0.002), but there was no significant difference in terms of metastasis-free survival (P=0.549) or overall survival (P=0.539). MWA was associated with fewer postoperative complications (P=0.0005). CONCLUSION This study shows that MWA was associated with higher risk of recurrence but similar metastasis-free survival and overall survival compared to PN. Recurrence was treated with new MWA or active surveillance. MWA may be an interesting alternative to PN for small renal tumors. LEVEL OF EVIDENCE Grade C.
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Affiliation(s)
- M Panhelleux
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France.
| | - L Balssa
- Urology Department, University Hospital Center, Besançon, France
| | - A David
- Radiology Department, University Hospital Center, Besançon, France
| | - A Thiery-Vuillemin
- University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France; Oncology Department, University Hospital Center, Besançon, France
| | - F Kleinclauss
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
| | - A Frontczak
- Urology Department, University Hospital Center, Besançon, France; University of Franche-Comte, Besançon, France; Imagery and Therapeutics, EA 4662, Nanomedecine Lab, Besançon, France
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McClure T, Lansing A, Ferko N, Wright G, Ghosh SK, Raza S, Kalsekar I, Clarke K, Talenfeld A. A Comparison of Microwave Ablation and Cryoablation for the Treatment of Renal Cell Carcinoma: A Systematic Literature Review and Meta-analysis. Urology 2023; 180:1-8. [PMID: 37331485 DOI: 10.1016/j.urology.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis comparing microwave ablation (MWA) and cryoablation for renal cell carcinoma (RCC). METHODS The systematic search was performed in MEDLINE, Embase, and Cochrane databases. Studies published in English from January 2006 to February 2022 that assessed adults with primary RCC who received MWA or cryoablation were included. Study arms from RCTs, comparative observational, and single-arm studies were eligible. The outcomes included local tumor recurrence (LTR), overall survival, disease-free survival, overall/major complications, procedure/ablation time, 1- to 3-month primary technique efficacy, and technical success. Single-arm meta-analyses were performed using the random effects model. Sensitivity analyses excluding low-quality studies assessed using the MINORs scale were performed. Univariable and multivariable examined the effects of prognostic factors. RESULTS Baseline characteristics were similar between groups and mean tumor size for MWA and cryoablation were 2.74 and 2.69 cm. Single-arm meta-analyses were similar for LTR and secondary outcomes between cryoablation and MWA. Ablation time was significantly shorter with MWA than with cryoablation (meta-regression weighted mean difference 24.55 minutes, 95% confidence interval -31.71, -17.38, P < .0001). One-year LTR was significantly lower with MWA than cryoablation (odds ratio 0.33, 95% confidence interval 0.10-0.93, P = .04). There were no significant differences for other outcomes. CONCLUSION MWA provides significantly improved 1-year LTR and ablation time compared with cryoablation for patients with RCC. Other outcomes appeared similar or favorable for MWA; however, results were not statistically significant. MWA of primary RCC is as safe and effective as cryoablation, which should be confirmed with future comparative studies.
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Affiliation(s)
- Timothy McClure
- Departments of Radiology and Urology, Weill Cornell Medical College, New York, NY.
| | | | | | | | | | - Sajjad Raza
- Johnson & Johnson Services Inc, New Brunswick, NJ
| | | | | | - Adam Talenfeld
- Departments of Radiology and Urology, Weill Cornell Medical College, New York, NY
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Efthymiou E, Siatelis A, Liakouras C, Makris G, Chrisofos M, Kelekis A, Brountzos E, Kelekis N, Filippiadis D. Computed Tomography-Guided Percutaneous Microwave Ablation for Renal Cell Carcinoma: Impact of Tumor Size on the Progression Survival Rates. Diagnostics (Basel) 2021; 11:diagnostics11091618. [PMID: 34573960 PMCID: PMC8472140 DOI: 10.3390/diagnostics11091618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the present study was to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of renal cell carcinoma (RCC) along with identifying prognostic factors affecting the progression survival rate. Institutional database retrospective research identified 69 patients with a biopsy proven solitary T1a (82.6%) or TIb (17.4%) RCC who have underwent percutaneous CT-guided MWA. Kaplan–Meier survival estimates for events were graphed and Cox regression analysis was conducted. Mean patient age was 70.4 ± 11.5 years. Mean size of the lesions was 3 ± 1.3 cm. Mean follow up time was 35.6 months (SD = 21.1). The mean progression free survival time from last ablation was 84.2 months. For T1a tumors, the cumulative progression free survival rate for 1, 6, 12 and 36 months were 100% (SE = 0%), 91.2% (SE = 3.7%), 91.2% (SE = 3.7%) and 87.5% (SE = 4.4%); the recurrence free survival rate for T1a RCC was 94.9%. For T1b tumors, the cumulative progression free survival rate for 1, 6, 12 and 36 months were 100% (SE = 0%), 63.6% (SE = 14.5%), 63.6% (SE = 14.5%) and 63.6% (SE = 14.5%). Grade 1 complications were recorded in 5 (7.2%) patients. Significantly greater hazard for progression was found in cases with a tumor size > 4 cm (HR = 9.09, p = 0.048). No statistically important difference regarding tumor progression was recorded between T1a tumors with a diameter ≤3 cm and >3 cm. In summary, the results of the present study show that CT guided percutaneous MWA is an effective technique for treatment of T1a renal cell carcinomas, irrespective of tumor size. T1b tumors were associated with higher progression rates.
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Affiliation(s)
- Evgenia Efthymiou
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Argyris Siatelis
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Christos Liakouras
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Georgios Makris
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Michael Chrisofos
- C Urology Clinic, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.S.); (C.L.); (G.M.); (M.C.)
| | - Alexis Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Elias Brountzos
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital “ATTIKON”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.E.); (A.K.); (E.B.); (N.K.)
- Correspondence:
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