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Chang NW, Liu CA, Hong JA, Shen SH. Effect of iodized oil embolization on temperature change during cryoablation for renal cell carcinoma. MINIM INVASIV THER 2024; 33:237-244. [PMID: 38491916 DOI: 10.1080/13645706.2024.2326019] [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: 12/14/2022] [Accepted: 02/06/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION We aimed to evaluate the effect of transcatheter arterial embolization (TAE) with iodized oil (Lipiodol) on temperature change during cryoablation (CA) for renal cell carcinoma (RCC). MATERIAL AND METHODS We retrospectively reviewed patients receiving CA for RCC from February 2020 to July 2021, including those who received Lipiodol TAE prior to CA (TAE group) and those who underwent only CA with comparable clinical and tumor characteristics (non-TAE group). Clinical data and tumor characteristics of both groups were recorded. The temperature readings of each cryoprobe at every 15 s and 'time to -100 °C' were compared between the groups. RESULTS A total of 17 patients with 18 RCCs were recruited (seven in the TAE group and 11 in the non-TAE group). The 'time to -100 °C' was significantly longer in the TAE group than in the non-TAE group (64.5 ± 24.3 s vs. 48.8 ± 9.7 s, p = 0.018). Positive correlation between 'time to -100 °C' and tumor maximal diameter, RENAL nephrometry and PADUA score were observed in the non-TAE group, while no corresponding correlation was found in the TAE group. CONCLUSIONS Pre-embolization with iodized oil influences the temporal temperature changes during cryoablation by disrupting the positive correlation between the time to reach the target temperature and tumor characteristics.
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Affiliation(s)
- Nai-Wen Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jia-An Hong
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Uhlig A, Uhlig J, Shuch B, Kim HS. Stage IA papillary and chromophobe renal cell carcinoma: effectiveness of cryoablation and partial nephrectomy. Insights Imaging 2024; 15:171. [PMID: 38971873 PMCID: PMC11227485 DOI: 10.1186/s13244-024-01749-x] [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: 04/29/2024] [Accepted: 06/17/2024] [Indexed: 07/08/2024] Open
Abstract
OBJECTIVES To evaluate the effectiveness of cryoablation compared to partial nephrectomy in patients with stage IA papillary and chromophobe renal cell carcinoma (pRCC; chRCC). MATERIAL AND METHODS The 2004-2016 National Cancer Database was queried for adult patients with stage IA pRCC or chRCC treated with cryoablation or partial nephrectomy. Patients receiving systemic therapy or radiotherapy, as well as those with bilateral RCC or prior malignant disease were excluded. Overall survival (OS) was assessed using Kaplan-Meier plots and Cox proportional hazard regression models. Nearest neighbor propensity matching (1:1 cryoablation:partial nephrectomy, stratified for pRCC and chRCC) was used to account for potential confounders. RESULTS A total of 11122 stage IA renal cell carcinoma patients were included (pRCC 8030; chRCC 3092). Cryoablation was performed in 607 (5.5%) patients, and partial nephrectomy in 10515 (94.5%) patients. A higher likelihood of cryoablation treatment was observed in older patients with non-private healthcare insurance, as well as in those with smaller diameter low-grade pRCC treated at non-academic centers in specific US geographic regions. After propensity score matching to account for confounders, there was no statistically significant difference in OS comparing cryoablation vs partial nephrectomy in patients with pRCC (HR = 1.3, 95% CI: 0.96-1.75, p = 0.09) and those with chRCC (HR = 1.38, 95% CI: 0.67-2.82, p = 0.38). CONCLUSION After accounting for confounders, cryoablation, and partial nephrectomy demonstrated comparable OS in patients with stage IA papillary and chromophobe RCC. Cryoablation is a reasonable treatment alternative to partial nephrectomy for these histological RCC subtypes when radiologically suspected or diagnosed after biopsy. CRITICAL RELEVANCE STATEMENT Cryoablation might be considered as an upfront treatment alternative to partial nephrectomy in patients with papillary and chromophobe stage IA renal cell carcinoma, as both treatment approaches yield comparable oncological outcomes. KEY POINTS The utilization of cryoablation for stage IA papillary and chromophobe RCC increases. In the National Cancer Database, we found specific patterns of use of cryoablation. Cryoablation and partial nephrectomy demonstrate comparable outcomes after accounting for confounders.
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Affiliation(s)
- Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brian Shuch
- Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hyun S Kim
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
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Moulin B, Kammoun T, Audoual R, Droupy S, Servois V, Meria P, Beregi JP, Frandon J. Single-Probe Percutaneous Cryoablation with Liquid Nitrogen for the Treatment of T1a Renal Tumors. Cancers (Basel) 2023; 15:5192. [PMID: 37958366 PMCID: PMC10648217 DOI: 10.3390/cancers15215192] [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: 09/17/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Kidney cancer accounts for 3% of adult malignancies and is increasingly detected through advanced imaging techniques, highlighting the need for effective treatment strategies. This retrospective study assessed the safety and efficacy of a new single-probe percutaneous cryoablation system using liquid nitrogen for treating T1a renal cancers. From May 2019 to May 2022, 25 consecutive patients from two academic hospitals, with a median age of 64.8 years [IQR 59; 75.5], underwent cryoablation for 26 T1a renal tumors. These tumors had a median size of 25.3 mm [20; 30.7] and a median RENAL nephrometry score, indicating tumor complexity, of 7 [5; 9]. No major complications arose, but three non-clinically relevant perirenal hematomas were detected on post-procedure CT scans. With a median follow-up of 795 days [573; 1020], the primary local control rate at one month stood was 80.8% (21 out of 26). The five recurrent lesions, which exhibited a higher renal score (p = 0.016), were treated again using cryoablation, achieving a secondary local control rate of 100%. No patient died, and the disease-free survival rate was 92% (23 out of 25). In conclusion, single-probe percutaneous cryoablation emerges as a promising modality for managing small renal masses. Notably, recurrence rates appear influenced by RENAL nephrometry scores, suggesting a need for further research to refine the technique.
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Affiliation(s)
- Benjamin Moulin
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (B.M.); (V.S.)
| | - Tarek Kammoun
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, Place du Pr. Robert Debré, 30029 Nîmes, France; (T.K.); (J.p.B.)
| | - Regis Audoual
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (B.M.); (V.S.)
| | | | - Vincent Servois
- Interventional Radiology Unit, Imaging Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (B.M.); (V.S.)
| | - Paul Meria
- Urology Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France;
| | - Jean paul Beregi
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, Place du Pr. Robert Debré, 30029 Nîmes, France; (T.K.); (J.p.B.)
| | - Julien Frandon
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, Place du Pr. Robert Debré, 30029 Nîmes, France; (T.K.); (J.p.B.)
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Kammoun T, Prévot E, Serrand C, Perolat R, de Forges H, Houédé N, Beregi JP, Frandon J. Feasibility and Safety of Single-Probe Cryoablation with Liquid Nitrogen: An Initial Experience in 24 Various Tumor Lesions. Cancers (Basel) 2022; 14:cancers14215432. [PMID: 36358850 PMCID: PMC9655210 DOI: 10.3390/cancers14215432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022] Open
Abstract
Simple Summary Percutaneous cryoablation was developed to minimally perform multi-organ tumor ablations. The most widely known cryotherapy systems use argon gas (high-pressure) and multiple needles to achieve sufficient ablations. The aim of our retrospective study was to assess the feasibility of a new cryotherapy system using single-probe liquid nitrogen for tumor lesions of various sizes and locations, and to evaluate the safety of cryoablation with this technique. Correlations between ice ball sizes and ablation zone sizes with two needle sizes (10G or 13G) and with the freezing duration were evaluated, as well as the sphericity of the ice ball and ablation zones. We showed that this technique is safe in all organs tested. We showed a correlation between the freezing duration and the ice ball size, but not with the ablation zone, which is useful for planning the procedure and treatment conducted by the oncology team. Abstract Background: Percutaneous cryoablation with liquid nitrogen is a new technique being used in the treatment of some malignant tumors. Our objective was to assess its feasibility in the ablation of tumor lesions of various sizes and locations. Methods: This retrospective, monocentric study included all consecutive patients who underwent percutaneous cryoablation with liquid nitrogen between December 2019 and March 2021. Cryoablation was performed using 10G or 13G cryoprobes. The ablation volume was measured on post-treatment CT or MRI. Results: 22 patients (24 lesions) were included, 16 of whom were men (73%), while median age was 66 years. The lesions were located in the bone (42%), kidney (29%), soft tissue (17%), lung (8%), or liver (4%). It was feasible in all tumor locations and produced median ablation zones 25 mm in width and 35 mm in length, with a 23 min median freezing time. Freezing duration was correlated with the ice volume (p Spearman = 0.02), but not with the ablation volume (p = 0.11). The average difference between the ablation zone and ice ball sizes were −6.4 mm in width and −7.7 mm in length. Both ice and ablation volumes were larger when using the 10G probe as compared to when the 13G was used. No complications were reported. Discussion: We showed that this technique was safe and feasible in all organs tested. The freezing duration was correlated with the ice ball size, but not with the ablation zone.
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Affiliation(s)
- Tarek Kammoun
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Elodie Prévot
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology (BESPIM), CHU Nimes, 30029 Nimes, France
| | - Romain Perolat
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Hélène de Forges
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Nadine Houédé
- Gard Cancer Institute, Nimes University Hospital, University of Montpellier, 30029 Nimes, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
| | - Julien Frandon
- Department of Medical Imaging, Nimes University Hospital, University of Montpellier, Medical Imaging Group Nimes, 30029 Nimes, France
- Correspondence:
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Percutaneous image-guided cryoablation with temporary balloon occlusion of the renal artery for the treatment of central renal tumors. Diagn Interv Imaging 2022; 103:510-515. [PMID: 35934617 DOI: 10.1016/j.diii.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study was to report the technical feasibility and outcomes of percutaneous image-guided cryoablation with temporary balloon occlusion of the renal artery for the treatment of central renal tumors. MATERIALS AND METHODS All consecutive patients with central renal tumors treated with cryoablation and temporary renal artery occlusion from January 2017 to October 2021 were retrospectively included. Patient demographics, tumor's characteristics, procedural data, technical success, primary and secondary clinical efficacy, complications (according to Cardiovascular and Interventional Radiology Society of Europe [CIRSE] classification) and follow-up were investigated. RESULTS A total of 14 patients (8 men, 6 women; mean age 72.4 years ± 21.4 [SD] years; age range: 42-93 years) with 14 central renal tumors (median size, 32 mm; IQR: 23.5, 39.5 mm; range: 13-50 mm) were treated with percutaneous image-guided cryoablation and temporary balloon occlusion of the renal artery. Technical success was 13/14 (93%), with 1/14 (7%) failure of vascular access. A median of 4 cryoprobes (IQR: 3, 4.75) were inserted and protective hydrodissection was performed in 11/14 (79%) patients. Median time to perform cryoprobes insertion, hydrodissection and vascular access was 26.5 min (IQR: 18, 35 min), 10 min (IQR: 10, 17 min) and 30 min (IQR: 20, 45 min) respectively. Median duration of the whole intervention was 150 min (IQR: 129, 180 min; range: 100-270 min). Median hospital stay was 2.5 days (IQR: 2, 4 days; range: 2-14 days). Major complications occurred in 3/14 (21%) patients. Primary efficacy rate was 93% (13/14 patients). Median oncological follow-up was 25 months (IQR: 11, 33 months; range: 6-39 months). One patient experienced renal tumor recurrence at 14-months of follow-up, which was successfully treated with repeat cryoablation. CONCLUSION Percutaneous image-guided cryoablation of renal tumors with temporary balloon occlusion of the renal artery is technically feasible, with a high technical success rate and paths the way for percutaneous treatment of central renal tumors.
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Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review. Curr Oncol 2022; 29:4155-4177. [PMID: 35735441 PMCID: PMC9221897 DOI: 10.3390/curroncol29060332] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients’ quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.
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Ablation zone considerations in cryoablation of RCC: accuracy of manufacturer provided model and change from first to second freeze cycle. Clin Imaging 2022; 89:10-15. [DOI: 10.1016/j.clinimag.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
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Quirk MT, Lee S, Murali N, Genshaft S, Abtin F, Suh R. Alternatives to Surgery for Early-Stage Non-Small Cell Lung Cancer: Thermal Ablation. Clin Chest Med 2020; 41:197-210. [PMID: 32402356 DOI: 10.1016/j.ccm.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Thermal ablation involves the application of heat or cold energy to the lung under image guidance to eradicate tumors. It is indicated for treatment of early-stage non-small cell lung cancer in nonsurgical patients. Ablation technologies have advanced, such that nearly all small tumors can now be treated safely and effectively. Ablation does not cause a lasting decline in pulmonary function tests and may therefore be used to treat multiple synchronous and metachronous lung tumors, a chief advantage over other treatments. Large series with intermediate- and long-term data have been reported showing favorable overall survival, similar to radiation therapy.
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Affiliation(s)
- Matthew T Quirk
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA.
| | - Shimwoo Lee
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
| | - Nikitha Murali
- Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Scott Genshaft
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
| | - Fereidoun Abtin
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
| | - Robert Suh
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
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