Focal Ablative Therapy for Renal Cell Carcinoma in Transplant Allograft Kidneys

Gul, Zeynep; Griffith, John J.; Welch, C. Stuart; Fischman, A.; Palese, Michael; Badani, Ketan K.; Mehrazin, Reza

doi:10.1016/j.urology.2018.12.003

Cited by 13 publications

(18 citation statements)

References 22 publications

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“…No additional reports were found through searches of references. Eventually, 28 studies were selected[17-44]. No randomized clinical trials, prospective controlled studies or prospective uncontrolled studies were identified.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of ablative therapy for the treatment of renal allograft neoplasms

Favi

Raison

Ambrogi

et al. 2019

WJCC

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BACKGROUNDTo date, there are no guidelines on the treatment of solid neoplasms in the transplanted kidney. Historically, allograft nephrectomy has been considered the only reasonable option. More recently, nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected cases.AIMTo review outcomes of AT for the treatment of renal allograft tumours.METHODSWe conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist. PubMed was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE) of solid tumours of the kidney allograft. Only original manuscripts describing actual cases and edited in English were considered. All relevant articles were accessed in full text. Additional searches included all pertinent references. Selected studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa scale. Data on recipient characteristics, transplant characteristics, disease characteristics, treatment protocols, and treatment outcomes were extracted and analysed. Given the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series), a descriptive summary was provided.RESULTSTwenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 patients. Recipient age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 mo. Most of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical reasons. Preferred diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan, and magnetic resonance imaging. Main tumour types were: papillary renal cell carcinoma (RCC) and clear cell RCC. Maximal tumour diameter ranged from 5 to 55 mm. The vast majority of neoplasms were T1a N0 M0 with only 2 lesions staged T1b N0 M0. Neoplasms were managed by RFA (n = 78), CA (n = 15), MWA (n = 3), HIFU (n = 3), and IRE (n = 1). Overall, 3 episodes of primary treatment failure were reported. A single case of recurrence was identified. Follow-up ranged from 1 to 81 mo. No cancer-related deaths were observed. Complication rate was extremely low (mostly < 10%). Graft function remained stable in the majority of recipients. Due to the limited sample size, no clear benefit of a single procedure over the other ones could be demonstrated.CONCLUSIONAT for renal allograft neoplasms represents a promising alternative to radical nephrectomy and NSS in carefully selected patients. Properly designed clinical trials are needed to validate this therapeutic approach.

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Section: Resultsmentioning

confidence: 99%

“…Twenty-eight studies describing 100 AT of KTx neoplasms in 92 patients were considered[17-44]. Patients and tumours characteristics as well as technical details of the procedures (access to the allograft and guidance modality) have been described above.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of ablative therapy for the treatment of renal allograft neoplasms

Favi

Raison

Ambrogi

et al. 2019

WJCC

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“…Possible limitations, at least as shown in native kidneys, are higher risk of intra-operative bleeding[ 55 ], higher rate of primary treatment failure in case of neoplasms greater than 3 cm in maximal diameter[ 56 - 58 ], and higher recurrence rate for tumours with an endophytic growth pattern[ 59 ]. To date, only 10 cases of biopsy-proven T1aN0M0 and 1 case of biopsy-proven T1bN0M0 RCC of the transplanted kidney treated by cryoablation have been documented[ 34 , 60 - 63 ]. The procedures were mostly performed percutaneously under US- or CT-guidance with no persisting disease, no local relapse (post-ablation follow-up ranging from 1 to 59 mo), and excellent allograft function.…”

Section: Treatment Options and Treatment-specific Outcomesmentioning

confidence: 99%

“…There are several studies supporting the application of MWA for malignant tumours in native kidneys[ 67 , 68 ] but experience in renal allografts is limited to a couple of small case series. Successful ablation of one Fuhrman grade 1-2, T1aN0M0 clear cell RCC and two Fuhrman grade 1-2, T1aN0M0 papillary RCC was first reported by Gul et al[ 63 ]. The procedures were performed under CT-guidance via a percutaneous or a trans-osseous approach with no serious complications, no allograft dysfunction, and no recurrence after a follow-up ranging from 8 to 61 mo.…”

Section: Treatment Options and Treatment-specific Outcomesmentioning

confidence: 99%

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Treatment options for localised renal cell carcinoma of the transplanted kidney

Motta¹,

Ferraresso²,

Lamperti³

et al. 2020

WJT

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Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.

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