Renal cell carcinoma lung metastases treated by radiofrequency ablation integrated with systemic treatments: over 10 years of experience

Abstract

BackgroundTo determine safety and efficacy of radiofrequency ablation (RFA) for local treatment of lung metastases of renal cell carcinoma (RCC), sequenced or combined with systemic treatments.MethodsRetrospectively, we studied 53 patients treated by RFA for a maximum of six lung metastases of RCC. The endpoints were local efficacy, overall (OS), disease-free (DFS), pulmonary progression-free (PPFS) and systemic treatment-free (STFS) survivals, complications graded by the CTCAE classification and factors associated with survivals. Potential factors analysed were: clinical and pathological data, tumoral staging of TNM classification, primary tumor histology, Fuhrman’s grade, age, number and size of lung metastases and extra-pulmonary metastases pre-RFA.ResultsOne hundred metastases were treated by RFA. Median follow-up time was 61 months (interquartile range 90–34). Five-year OS was 62% (95% confidence interval (CI): 44–75). Median DFS was 9.9 months (95% CI: 6–16). PPFS at 1 and 3 years was 58.9% (95%CI: 44.1–70.9) and 35.2% (95%CI: 21.6–49.1), respectively. We observed 3% major complications (grade 3 and 4 of CTCAE classification). Local efficacy was 91%. Median STFS was 28.3 months. Thirteen patients (25%) with lung recurrence could be treated by another RFA. T3/T4 tumors had significantly worse OS, PPFS and STFS. Having two or more lung metastases increased the risk of pulmonary progression more than threefold.ConclusionIntegrated to systemic treatment strategy, RFA is safe and effective for the treatment strategy of lung metastasis from RCC with good OS and long systemic treatment-free survival. RFA offers the possibility of repeat procedures, with low morbidity.

Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

“…At present, despite higher local recurrence rates, local ablation of primary RCC is considered a reasonable alternative to surgery in appropriately selected patients, because is easy to use, with fewer complication rates, shorter hospital stay, faster convalescence and lower overall costs[ 6 , 39 ]. Moreover, RFTA is diffusely accepted as an effective minimally invasive modality in the treatment of metastases located to the liver and the lungs[ 40 , 41 ]. Also SBRT may be useful in the management of both primary and metastatic RCC[ 6 ], including LuMs[ 42 ].…”

Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation of Non–Small Cell Lung Cancer and Metastatic Disease to the Lungs

“…The majority of studies reporting the results of IGTA therapy for metastatic cancer to the lungs have included patients with a variety of cancer subtypes and lesion sizes. Of those studies that evaluated for OS, the 1-year OS was 58%-100% (17,(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82); the 5-year OS ranged from 31% to 67% (17,69,71,75,78,82). Local control rates have been well studied.…”

“…When the local control at 1 year falls below 70%, this warrants a review of the operator's performance. Full outcome data for metastatic disease is provided in Table 3 (17,(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82), along with recommended threshold values. For outcomes with limited data, no thresholds are recommended.…”

“…(17,68,69,71,74,75,79,(82)(83)(84)(85)(86)(87)(88)(89)(90)(91), all values are Outcomes of Image-Guided Thermal Ablation for Stage 1A Lung Tumors(17,(62)(63)(64)(65)(66)(67) Outcomes of Image-Guided Thermal Ablation for Metastatic Disease(17,(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82) …”

The role of cytoreductive nephrectomy in renal cell carcinoma patients with liver metastasis

“…The optimal treatment strategy for mRCC has not been established yet [ 4 ]. Comprehensive treatment including surgery, targeted therapy, and immunotherapy has provided more options for mRCC patients, which brings a significant survival benefit [ 5 - 11 ].…”