Efficacy, safety and effectiveness of image-guided percutaneous microwave ablation in cystic renal lesions Bosniak III or IV after 24 months follow up

Carrafiello, Gianpaolo; Dionigi, Gianlorenzo; Petrillo, Mario; Fontana, Federico; Floridi, Chiara; Boni, Luigi; Rovera, Francesca; Rausei, Stefano; Mangano, Alberto; Spampatti, Sebastiano; Marconi, A; Carcano, Giulio; Dionigi, Renzo

doi:10.1016/s1743-9191(13)60010-2

Cited by 26 publications

(20 citation statements)

References 24 publications

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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%

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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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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“…Even though Bosniak III and IV complex renal cysts are uncommon renal tumors, they are an important subgroup due to their risk of malignancy, which ranges from 16–100% and 90–100%, respectively ( 16 ). The current standard of care for both Bosniak III and IV lesions is surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In our sample, we treated small lesions (diameter: 1.5–4.1cm; mean: 2.5cm) and our results were not affected by this limitation. Interestingly, microwave ablation (MWA) may minimize thermal dispersion and reduce the “heat sink effect”, resulting in a positive outcome in larger cystic lesions, but only a single study to date has investigated the efficacy of MWA in only seven cystic renal lesions, which was not enough to adequately assess the efficacy of MWA ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Safety and feasibility of radiofrequency ablation for treatment of Bosniak IV renal cysts

et al. 2016

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Purpose To describe our initial experience with radiofrequency ablation (RFA) of Bosniak IV renal cysts.Materials and Methods From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were complex renal cysts and were treated with radiofrequency ablation.Results All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33–83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10–40%). No patients required retreatment with RFA and no immediate or late complications were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed.Conclusions Mid-term follow-up of the cases in our database suggests that image-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.

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“…Bosniak III or IV cystic lesions may carry a particular risk for malignancy even if some of these lesions (particularly Bosniak III lesions) are proven to be benign after biopsy or surgery [35]. Park et al [36] proposed image-guided percutaneous RFA as a valuable alternative for cystic lesions unsuitable for surgery with excellent results.…”

Section: Percutaneous Mwa Of Renal Tumors: Clinical Seriesmentioning

confidence: 99%

“…Park et al [36] proposed image-guided percutaneous RFA as a valuable alternative for cystic lesions unsuitable for surgery with excellent results. Carrafiello et al [35] treated seven cystic renal lesions with a total applied energy of 45 W for an ablation time of 10 min and reported a technical success, defined as the correct positioning of the antenna into the lesion, of 100 %; a technical effectiveness, as the absence of thermo-ablative residues on CECT performed at 1 month after MWA treatment, of 100 %; and no major complications were recorded. This preliminary experience shows a potential role of US/CT-guided percutaneous MWA in treating Bosniak category III or IV cystic renal lesions, as a safe approach to treat selected patients unsuitable for surgery [35].…”

Section: Percutaneous Mwa Of Renal Tumors: Clinical Seriesmentioning

confidence: 99%

Microwave ablation of renal tumors: state of the art and development trends

et al. 2014

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In the last decades an increased incidence of new renal tumor cases has been for clinically localized, small tumors \2.0 cm. This trend for small, low-stage tumors is the reflection of earlier diagnosis primarily as a result of the widespread and increasing use of non-invasive abdominal imaging modalities such as ultrasound, computerized tomography, and magnetic resonance imaging. Renal tumors are often diagnosed in elderly patients, with medical comorbidities whom the risk of surgical complications may pose a greater risk of death than that due to the tumor itself. In these patients, unsuitable for surgical approach, thermal ablation represents a valid alternative to traditional surgery. Thermal ablation is a less invasive, less morbid treatment option thanks to reduced blood loss, lower incidence of complications during the procedure and a less long convalescence. At present, the most widely used thermal ablative techniques are cryoablation, radiofrequency ablation and microwave ablation (MWA). MWA offers many benefits of other ablation techniques and offers several other advantages: higher intratumoral temperatures, larger tumor ablation volumes, faster ablation times, the ability to use multiple applicators simultaneously, optimal heating of cystic masses and tumors close to the vessels and less procedural pain. This review aims to provide the reader with an overview about the state of the art of microwave ablation for renal tumors and to cast a glance on the new development trends of this technique.

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Efficacy, safety and effectiveness of image-guided percutaneous microwave ablation in cystic renal lesions Bosniak III or IV after 24 months follow up

Cited by 26 publications

References 24 publications

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

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

Safety and feasibility of radiofrequency ablation for treatment of Bosniak IV renal cysts

Microwave ablation of renal tumors: state of the art and development trends

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