CT–Guided Microwave Ablation of 45 Renal Tumors: Analysis of Procedure Complexity Utilizing a Percutaneous Renal Ablation Complexity Scoring System

Mansilla, Alberto V.; Bivins, Eugene; Contreras, Francisco; Hernandez, Manuel A.; Kohler, Nathan; Pepe, Julie

doi:10.1016/j.jvir.2016.10.013

Cited by 24 publications

(19 citation statements)

References 21 publications

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“…The LTR in this study was 4% over a 108 histologically proven RCCs. In the literature, LTR ranges from 0 to 17% [7,12,29], but most papers included every renal lesions without excluding non-diagnostic or benign lesions whereby efficacy and recurrence rates might be overestimated [23,31,33]. Surprisingly, the time to LTR was long in this current cohort which could be explained by the difficulties in detecting of recurrences in hypo-vascular tumours and slow growth rates of low-grade tumours.…”

Section: Discussionmentioning

confidence: 81%

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Aarts

Prevoo

Meier

et al. 2020

Cardiovasc Intervent Radiol

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Objectives To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC). Methods We analysed patients with a histologically proven RCC (B 7 cm) treated by MWA from April 2012-April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien-Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications. Results In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4-4.0). Primary efficacy was 89% (95%CI 0.81-0.94) for T1a lesions and 52% (95%CI 0.31-0.73) for T1b lesions (p \ 0.001). Fifteen lesions (7 T1a) were reablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10-60 months. Six (4%) AEs grade [ 3-5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012). Conclusion Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.

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Section: Discussionmentioning

confidence: 81%

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Aarts

Prevoo

Meier

et al. 2020

Cardiovasc Intervent Radiol

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“…Microwave ablation is a heat-based modality with a mechanism of cell death identical to that of other thermal ablation techniques, but which offers several physical advantages associated with the delivery of heat ( 5 6 ). As MWA has several advantages over RFA, including higher intratumoral temperatures, larger ablation volumes, and quicker ablation ( 7 ), multiple studies have recently investigated and reported the efficacy and safety of MWA ( 4 8 9 10 11 12 13 14 15 16 17 18 19 ). However, the results were varied, and most of the studies included a small number of patients, with limited precision of the estimated efficacy and safety of MWA.…”

Section: Introductionmentioning

confidence: 99%

“…This meta-analysis included studies which were published between 2010 and 2012. However, 13 percutaneous MWA studies were published after this meta-analysis (since 2012) ( 4 8 9 10 11 12 15 16 17 18 19 ). Hence, we believe that it is timely and important to establish a systematic summary regarding the efficacy and safety of MWA for the management of malignant renal tumor.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012

Choi

Kim

et al. 2018

Korean J Radiol

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ObjectiveTo systematically determine the treatment outcomes of percutaneous microwave ablation (MWA) in patients with malignant renal tumor.Materials and MethodsOriginal studies that reported the clinical outcomes of MWA in patients with malignant renal tumors were identified in MEDLINE and EMBASE from 2012 to June 30, 2017. Inverse variance and random-effects models were used to evaluate and acquire meta-analytic summary estimates of various clinical outcomes, including technical outcomes (technical success rate [TSR] and technical efficacy rate [TER]), oncologic outcomes (local tumor recurrence rate [LRR], cancer-specific survival rate [CSSR], and overall survival rate [OSR]), and complications.ResultsAmong the 145 articles screened, 13 articles including 567 patients carrying 616 malignant renal tumors were included in the meta-analysis. The meta-analytic pooled TSR and TER were 97.3% (95% confidence interval, 94.3–99.4%; I2 = 0.0%) and 97.6% (95.0–99.4%, I2 = 48.5%), respectively. The meta-analytic pooled LRR was 2.1% (0.3–4.7%, I2 = 54.1%). At 1-, 2-, 3-, and 5-year follow-up time points, the meta-analytic pooled CSSRs were 99.1% (97.2–100.0%; I2 = 0.0%), 98.4% (95.1–100.0%; I2 = 31.2%), 97.6% (93.4–99.9%; I2 = 52.3%), and 96.9% (93.3–99.2%; I2 = 0.0%) respectively, while the OSRs were 98.3% (96.1–99.8%; I2 = 0.0%), 94.9% (91.7–97.5%; I2 = 0.0%), 86.8% (81.9–91.1%; I2 = 22.1%), and 81.9% (75.4–87.6%; I2 = 0.0%). In terms of major complications, a 1.8% (0.6–3.3%; I2 = 0.0%) rate of meta-analytic pooled incidence was found.ConclusionMicrowave ablation showed favorable technical and oncologic outcomes with a low incidence of major complications. Hence, image-guided percutaneous MWA can be considered as a safe and effective treatment for malignant renal tumors.

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“…Based on published experience, overall complications following MWA of larger renal masses appear to be similar to the treatment of T1a tumors. Complications occur in 3-17% of patients, and have been reported to include perirenal hematoma, urinoma formation, and skin dysesthesia [18][19][20][21]. Importantly, the high heat generated by MWA can lead to significant urothelial injury.…”

Section: Microwave Ablationmentioning

confidence: 99%

“…Importantly, the high heat generated by MWA can lead to significant urothelial injury. Secondary ureteropelvic strictures, including those remote from the ablation site, have been reported in multiple series [14,21,22]. Thus, caution is needed in the thorough treatment of larger tumors.…”

Section: Microwave Ablationmentioning

confidence: 99%

The current status of thermal ablation in the management of T1b renal masses

Welch

Shah

Thompson

et al. 2019

International Journal of Hyperthermia

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The role of thermal ablation in the management of T1b renal masses is not well defined. The purpose of this review is to examine current evidence for cryoablation, radiofrequency ablation, and microwave ablation of T1b renal masses as well as review current AUA and EAU guidelines for thermal ablation of T1b masses. Given the size of these tumors, adjunctive maneuvers are often necessary to ensure patient safety and protect vital adjacent structures.

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CT–Guided Microwave Ablation of 45 Renal Tumors: Analysis of Procedure Complexity Utilizing a Percutaneous Renal Ablation Complexity Scoring System

Cited by 24 publications

References 21 publications

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012

The current status of thermal ablation in the management of T1b renal masses

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