Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes

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/1.73m 2 , 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. ARTICLE HISTORY

Percutaneous Microwave Ablation of Stage T1b Renal Cell Carcinoma: Short-Term Assessment of Technical Feasibility, Short-Term Oncologic Outcomes, and Safety

“…In addition, the 1-, 2-, and 3-year OS was 95.2%, 85.7%, and 71.4%, respectively, in the study. Compared to CA for T1b RCC, the results of the present study show similar short-term local tumor control rates, [19][20][21] suggesting that MWA is as effective as the more commonly reported CA for T1b RCC.…”

Local recurrence and other oncologic outcomes after percutaneous image-guided tumor ablations on stageT1b renal cell carcinoma: a systematic review and network meta-analysis

“…The location of ice formation and, therefore, the mechanism of cell death vary with the freezing rate and final tissue temperature [28,29]. Five studies used CA: Atwell et al [11], Andrews et al [16], Hasegawa et al [8], Hebbadj et al [8], Gunn et al [17] and Grange et al [13]. Overall, 204 patients were treated with CA (Figure 2).…”

“…Mean follow-up varied across studies ranging from 14 months in Grange et al [13] to 6 years in Andrews et al [16]. Local recurrence rates ranged from 0% in Takaki et al's [10] study to 23.5% in Andrews et al's [16].…”

“…International guidelines recommended surgery (radical nephrectomy (RN) or partial nephrectomy (PN)) as the best treatment for T1b RCC (4 tumor 7 cm) [9]. However, thermal ablation of T1b RCC has been published with good results recently [8,[10][11][12][13][14][15][16][17][18].…”

Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center

“…Surgical intervention is still the first treatment of choice with partial nephrectomy being the gold standard treatment for T1 tumors [ 1 , 11 ]. Nephrectomy was historically performed with a radical intent and was then converted to a partial approach, since literature has widely demonstrated superimposable results between the two techniques with comparable five-year survival rates [ 7 , 8 , 12 , 13 ]. The use of partial nephrectomy is driven by the emerging need of a nephron sparing surgery, whose aims are the preservation of as much renal function as possible and the reduction of pain, morbidity, and length of hospitalization [ 14 , 15 ].…”