Embolization-induced Renal Tumor Shrinkage Followed by Definitive Cryoablation

Abstract

Significant incidental findings reported on computed tomography (CT) scans are common. This article describes a 72-year-old man evaluated for possible bowel obstruction in whom was found a 3.1-cm x 2.6-cm centrally located enhancing mass in the left kidney highly suspicious for renal cell carcinoma. Due to substantial medical comorbidities, the patient was deemed a poor surgical candidate for either partial or complete nephrectomy. Interventional radiology was consulted for a minimally invasive ablation procedure. The large size and central location of the tumor involving the renal collecting system initially precluded definitive percutaneous cryoablation. Intra-arterial embolization was used as neoadjuvant therapy to decrease tumor burden. Fluoroscopy-guided bland embolization was performed targeting the arterial supply of the mass until stagnation of flow was achieved. A subsequent two-month post-embolization follow-up CT scan showed a 30% reduction in tumor size. Shrinkage of the mass from a central to a more peripheral location allowed for a cryoablation approach that would avoid damage to the vulnerable collecting system. Cryoablation was performed, and intraoperative CT demonstrated complete coverage of the tumor by the ice ball with no damage to the renal collecting system. A follow-up CT scan four years later showed no residual malignancy at the ablation site.

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

“…As the rate of percutaneous ablation for renal tumors increases due to increased diagnosis, high technical success rates, promising patient outcomes, and relatively noninvasiveness of the procedures, the issue of cost efficiency deserves recognition. Cryoablation coupled with pre-ablation embolization has already been shown to increase the safety profile of cryoablation for certain tumor morphologies, as demonstrated by Matteo et al [4]. As presented in the preceding case, it also shows promise in reducing procedural costs.…”

“…Accompanying the increase in the number of percutaneous cryoablation cases is the increase in diversity of case presentations, necessitating refinement in techniques for tumor ablation [3]. Matteo et al described the use of pre-ablation embolization to reduce the risk of injuring the renal collecting system and surrounding parenchyma when performing cryoablation on endophytic, centrally located tumors [4]. This novel, two-step approach was shown to cause tumor shrinkage, allowing safe and effective percutaneous cryoablation of the lesions [4].…”

Cryoablation for the management of Small Renal Masses

“…Pre-ablation transarterial embolization (TAE) of a renal tumor prior to CA has been reported in several small series as a successful method for treatment for large tumors and central tumors [100,101] . Donato et al [102] recently reported a series where TAE was employed prior to PCA for patients with cT1b or central cT1a tumors.…”