Impact of tumor histology and grade on treatment success of percutaneous renal cryoablation

Beksaç, Alp Tuna; Rivera-Sanfeliz, Gerant; Dufour, Catherine A.; Nseyo, Unwanaobong; Hamilton, Zachary; Berquist, Sean; Hassan, Abd-Elrahman Said; Raheem, Omer; Wang, Song; Wake, Robert; Gold, R. E.; Derweesh, Ithaar

doi:10.1007/s00345-016-1911-6

Cited by 16 publications

(7 citation statements)

References 30 publications

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“…However, tumor size did not correlate with RFS rates, in agreement with other series [8,10]. Additionally, RFS rates were not significantly affected by tumor histotype, while Beksac et al [24] found an association between clear cell histology and progression. It is worth noting that treatment efficacy was not significantly affected by the type of anesthesia, including local anesthesia only.…”

Section: Discussionsupporting

confidence: 82%

Cryoablation of renal tumors: long-term follow-up from a multicenter experience

et al. 2021

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Purpose To retrospectively investigate long-term outcomes of renal cryoablation from a multicenter database. Methods 338 patients with 363 renal tumors underwent cryoablation in 4 centers in North-Eastern Italy. 340/363 tumors (93.7%) were percutaneously treated with CT guidance. 234 (68.8%) were treated after conscious sedation, 76 (22.3%) under local lidocaine anesthesia only and 30 (8.8%) under general anesthesia. Treatment efficacy and complication rate considered all procedures. Oncologic outcomes considered a subset of 159 patients with 159 biopsy proven renal cell carcinoma. Results Mean tumor size was 2.53 cm. Technical success was achieved in 355/363 (97.8%) treatments. Treatment efficacy after the first treatment was achieved in 348/363 (95.9%) tumors. Statistical analysis revealed a significant lower treatment efficacy for ASA score >3, Padua score >8, tumor size >2.5 cm, use of >2 cryoprobes, presence of one single kidney. In the subset of 159 patients, recurrence-free survival rates were 90.5% (95% CI 83.0%, 94.9%) at 3 years and 82.4% (95% CI 72.0%, 89.4%) at 5 years; overall survival rates were 96.0% (95% CI 90.6%, 98.3%) at 3 years and 91.0% (95% CI 81.7%, 95.7%) at 5 years; no patient in this subset developed metastatic disease. Clavien-Dindo >1 complications were recorded in 14/369 procedures (3.8%) and were related to age >70 years, tumor size >4 cm and use of >2 cryoprobes. Conclusion Cryoablation performed across four different centers in a large cohort of predominantly small renal tumors showed that this technique provides good recurrence-free survival rates and overall survival rates at three- and five-year with very low major complications rate.

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Section: Discussionsupporting

confidence: 82%

Cryoablation of renal tumors: long-term follow-up from a multicenter experience

et al. 2021

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“…This study showed a local recurrence rate of 2.9% at one year, of 2.9% at three years, and of 1.8% at five years, appearing consistent with some studies establishing a local recurrence rate between 0% and 5% in the first three years of follow-up [7,10,12,17,29] and significantly lower compared to others that report recurrence rates ranging from 7% to 16% [6,9,16,42,44,45] at three years. Similarly, long-term results are strongly encouraging, showing a local recurrence at five years of 1.8% against the 3% evident in some studies [8,46] and even 13% in other series [16,42,43].…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, this incidence rate disproportionally rose to 72% between 2006 and 2007 [4]. The incidence rate of RCC is still growing, with an increase of about 2.4% per year, on account of a rising number of abdominal imaging exams performed for non-renal symptoms, determining an incidental diagnosis in more than 50%-60% of cases of renal cancer [1,3,[5][6][7][8][9][10]. In particular, recent years showed a considerable increase in incidental detection of the small lesions intended as masses less than 4 cm in size, typically asymptomatic and generally affecting elderly [4].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence–free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43–89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02–99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%–98.8%) at 3 years, and 88.6% (95% CI: 71.8%–95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature.

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“…Emerging data suggest that for both cryoablation and RFA, patients with non-clear cell and lower grade histologies may have improved outcomes. 137 Patient counseling about thermal ablation should include a discussion of the risks of local recurrence, and potential need for re-intervention. Newer energy-ablative modalities have the potential to become additional nephron-sparing options, but further investigation is needed.…”

Section: Tumor Ablation Techniquesmentioning

confidence: 99%

Precision surgery and genitourinary cancers

Autorino

Porpiglia

Dasgupta

et al. 2017

European Journal of Surgical Oncology (EJSO)

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The landscape of the surgical management of urologic malignancies has dramatically changed over the past 20 years. On one side, better diagnostic and prognostic tools allowed better patient selection and more reliable surgical planning. On the other hand, the implementation of minimally invasive techniques and technologies, such as robot-assisted laparoscopy surgery and image-guided surgery, allowed minimizing surgical morbidity. Ultimately, these advances have translated into a more tailored approach to the management of urologic cancer patients. Following the paradigm of "precision medicine", contemporary urologic surgery has entered a technology-driven era of "precision surgery", which entails a range of surgical procedures tailored to combine maximal treatment efficacy with minimal impact on patient function and health related quality of life. Aim of this non-systematic review is to provide a critical analysis of the most recent advances in the field of surgical uro-oncology, and to define the current and future role of "precision surgery" in the management of genitourinary cancers.

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Impact of tumor histology and grade on treatment success of percutaneous renal cryoablation

Cited by 16 publications

References 30 publications

Cryoablation of renal tumors: long-term follow-up from a multicenter experience

Cryoablation of renal tumors: long-term follow-up from a multicenter experience

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

Precision surgery and genitourinary cancers

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