Pre-cryoablation Embolization of Renal Tumors: Decreasing Probes and Saving Loads

Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3 cm or larger: a prospective study

BACKGROUND

We prospectively evaluated the safety and efficacy of percutaneous cryoablation combined with transcatheter renal arterial embolization for the treatment of tumors ≥ 3 cm in diameter.

METHODS

We included patients aged ≥ 20 years with histologically proven renal cell carcinoma with a tumor diameter ≥ 3 cm who were inoperable or refused surgery. Prior to ablation, transcatheter arterial embolization was performed using a mixture of absolute ethanol and iodized oil. All cryoablation procedures were performed percutaneously under computed tomography fluoroscopy guidance. The primary endpoint was safety, which was evaluated for adverse events using CTCAE version 4.0. The secondary endpoint was survival; overall survival, progression-free survival, and cancer-specific survival were calculated.

RESULTS

From October 2013 to March 2016, 19 patients (mean age, 75 ± 13 years; 5 women, 14 men) were prospectively enrolled. The mean tumor diameter was 3.9 ± 0.7 (range 3.1-5.3) cm. Four grade 3 hematologic adverse events occurred, while no symptomatic grade ≥ 3 events occurred. The median follow-up period was 68 (range 52-84) months. During the follow-up period, two patients developed local tumor progression at 3 and 42 months after the initial ablative procedure; no patient showed distant metastasis. Two patients died from causes other than RCC. Overall survival, progression-free survival, and cause-specific survival were 100%, 95%, and 100% at 3 years, and 95%, 84%, and 100% at 5 years, respectively.

CONCLUSION

Percutaneous cryoablation combined with prior TAE for the treatment of tumors ≥ 3 cm in diameter was safe and achieved favorable survival.

Rare Treatment for a Rare Tumor: Cryoablation of a Granular Cell Tumor

Background

Granular cell tumors (GCTs) or Abrikossoff's tumors are rare neoplasms known to originate from Schwann cells in the peripheral nervous system. These lesions are usually benign; malignancy only occurs in 1-2% of cases. Surgical resection is the traditional treatment method for GCTs, but it poses several risks and disadvantages related to the surgical incompatibility of the patient, the extended recovery time, and the chance of relapse. Cryoablation is becoming an increasingly favored method of treatment for tumors, both benign and malignant, due to its minimal invasiveness, natural analgesic properties, and ability to stimulate antitumor immunity. Cryoablation may contribute to the prevention of secondary and metastatic tumor growth in cases of malignancy by preserving tumor-associated antigen molecules for recognition by cell-mediated immunity.

Methods

This article describes a novel method for GCT treatment using cryoablation. This technique exposes tumor tissue to extreme cold temperatures, effectively destroying tumor cells by irreversibly compromising their plasma membranes. To our knowledge, this is the first report in the literature of cryoablative techniques being used for GCT.

Results

Cryoablation of this mass was successful with no complications. CT images during the procedure demonstrated circumferential coverage of the entire lesion with no injury to the surrounding tissues.

Conclusion

Cryoablation can be used as an alternative to surgical intervention to treat malignant GCTs. This procedure is minimally invasive, less painful, and potentially effective in promoting antitumor immunity.