Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis

Abstract

Objective To evaluate the ef®cacy of transcatheter arterial embolization (TAE) in patients with unresectable renal cell carcinoma (RCC) and distant metastasis at the time of diagnosis. Patients and methods The study included 54 patients with histologically de®ned RCC (by biopsy in 28 and autopsy in 26) who were unable to undergo nephrectomy mainly because their performance status was poor (score o 2). The patients were classi®ed into two groups; 24 patients who underwent TAE with ethanol and 30 patients who did not. The two groups were compared for several clinical factors, mainly focusing on the prognosis. Results There were no signi®cant differences in the clinical factors, including performance status, tumour diameter, vascular invasion, lymph node involvement, adjuvant therapy, metastatic organs or the number of metastases between the groups. However, the proportion of patients with para-neoplastic signs in those undergoing TAE was greater than that in those not, and the difference was signi®cant (chi squared 0.35, P<0.05). The median survival of the two groups was 229 days (TAE) and 116 days (no TAE). The 1-, 2-and 3-year survival rates in the TAE group were 29%, 15% and 10%, respectively, and in those not undergoing TAE were 13%, 7% and 3%, respectively. Those undergoing TAE had a signi®-cantly better prognosis than those who did not (P=0.019). The adverse effects in patients undergoing TAE with ethanol included fever, back pain on the affected side, nausea and vomiting, but all the patients recovered from these adverse effects. Conclusion TAE with ethanol is a safe and effective treatment for patients with unresectable disseminated RCC and a poor performance status; TAE with ethanol not only induces ablation of the primary tumour, but also prolongs survival.

The Role Of Transarterial Embolization In The Treatment Of Renal Tumors

“…Polyvinyl alcohol, absolute ethanol and gelatin sponge were also used. Onishi et al applied only ethanol in a group of patients with RCC [14]. Munro et al most often used ethanol combined with other agents (alcohol with coils in 85%, alcohol and gelatin sponge in 8%, in 7% only alcohol) [10].…”

“…The symptoms were controlled using analgesics and antiemetic drugs. Other authors observed the symptoms of PES in over 80% of patients [8,14]. May et al analyzed 227 embolization procedures and observed PES in 89% of cases with a predominance of pain (100%) and fever (49%) [7].…”

“…Also according to other authors, embolization was most commonly performed due to RCC: in 100% [13,14], 90% [12], 88% [16] and 74% [9]. Embolization of the AML was carried out in the case of clinically symptomatic tumors -in patients with its rupture or impending rupture, and at times RAE was performed because of the large size of the tumor [17].…”

“…The procedure is also applied as a preoperative intervention, prior to elective nephrectomy, which is aimed at a reduction of loss of blood during the resections of large highly-vascularized tumors [7,9,12,13]. Onishi et al demonstrated an improvement in the quality of life and non-significant prolonged survival in patients with inoperable metastatic renal cancer who had undergone embolization [14].…”

Effect of renal embolization in patients with synchronous metastatic renal cell carcinoma: A retrospective comparison of cytoreductive nephrectomy and systemic medical therapy

“…www.impactjournals.com/oncotarget When combined with IT, there is no survival benefit of RE, with or without subsequent CN [17], and survival could even be lower, as reported by Demirci et al : median survival for RE of 1 (range, 1-74) months compared to 11 (range, 1-80) months for CN [18]. Although RE improved survival from 229 days to 7 months, compared to NT, survival was still lower than the 17.8 months for palliative nephrectomy [19,20]. In our dataset (Supplementary Table 1), the longest survival among patients with an intermediate risk classification was achieved with CN, followed by NT and RE, regardless of IT or TT treatment.…”