Safety Considerations and Local Tumor Control Following Percutaneous Image-Guided Cryoablation of T1b Renal Tumors

Hebbadj, Sonia; Cazzato, Roberto Luigi; Garnon, Julien; Shaygi, Benham; Buy, Xavier; Tsoumakidou, Georgia; Lang, Hervé; Gangi, Afshin

doi:10.1007/s00270-017-1820-0

Cited by 24 publications

(29 citation statements)

References 18 publications

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“…The PFS rates declined at 12 months (66.7%) but only nine patients were followed up at this point. These PFS rates are comparable with those of Hebbadj et al who evaluated 27 T1b renal RCC treated by percutaneous image-guided cryoablation, with PFS rates of 82.6%, 60.3% and 60.3% at 6-, 12-and 24-month follow-up respectively [9]. The CSS rates were 100% at 6-and 12-month follow-up visits.…”

Section: Discussionsupporting

confidence: 85%

“…our study (two asymptomatic hematomas) can partly be explained by clinicians' choice to avoid treatment options that were likely to increase the risk of bleeding (such as coaxial needle use and immediate pre-ablation biopsy). Preoperative angio-embolization [20] and pathway embolization [9], using hemostatic agents during needle removal, are often performed, without robust supporting evidence. Tumor size and aggressiveness, patient age, and number of cryoablation probes (but not preoperative embolization) have been identified as risk factors for bleeding [21].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed similar recurrence-free survival outcomes for PN and cryoablation for sporadic cT1b renal tumors (4-7 cm) [8]. However, few studies of cryoablation for cT1b tumors are available [9][10][11]. Atwell et al evaluated percutaneous cryoablation of 46 T1b renal tumors, with 15.2% of major complications, and 96.4% progression-free survival at 1-, 3and 5-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…Atwell et al evaluated percutaneous cryoablation of 46 T1b renal tumors, with 15.2% of major complications, and 96.4% progression-free survival at 1-, 3and 5-year follow-up. Hebbadj et al [9] evaluated percutaneous cryoablation of 27 T1b renal tumors, with 95.7% of cancer specific survival at 12-24-and 36-month follow-up. A recent study of Gunn et al [10] evaluated 37 renal cell carcinoma (RCC), with 100, 86.1 and 62.6% of recurrencefree survival at 1-2-and 3-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes

Grange

Tradi

Izaaryene

et al. 2019

International Journal of Hyperthermia

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Purpose: To evaluate the safety, functional and oncological outcomes associated with percutaneous cryoablation of stage T1b renal cell carcinoma (RCC). Materials and methods: Institutional database was reviewed to identify patients treated by percutaneous CT-guidance cryoablation between 2013 and 2018 for biopsy-proven RCC tumors measuring 4.1-7.0 cm. The main outcome parameters analyzed were primary and secondary technique efficacy, progression-free survival (PFS), cancer-specific survival (CSS), loss of estimated glomerular filtration rate (eGFR) and complications. PFS and CSS were estimated by the Kaplan-Meier method. Complications were graded by the Clavien-Dindo system. Results: Twenty-three consecutive patients were included (mean tumor diameter: 45.6 ± 6.2 mm; mean RENAL score: 8.1 ± 1.8). The technical success rate was 95.7%. Primary and secondary technique efficacy rates were 86.3 and 100%, respectively. Three patients found to have incomplete ablations at 3 months were successfully treated by repeat cryoablation. Median duration follow-up was 11 months (range: 3-33). Imaging showed PFS to be 85.7% at 6 months, 66.7% at 12 months and 66.7% at 24 months. One patient with a local recurrence at 12 months was treated by radical nephrectomy. One patient died from progression of disease within 12 months. One patient reported a complication grade ! II (4.3%). Mean eGFR loss was 4.4 ± 8.5 ml/min/1.73m 2 , which was significantly higher among those treated for central tumors (p < .05). Conclusion: Cryoablation for stage T1b renal tumors is technically feasible, with favorable oncological and perioperative outcomes. Longer-term studies are needed to verify our findings. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes

Grange

Tradi

Izaaryene

et al. 2019

International Journal of Hyperthermia

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“…Primary efficacy rates between 75 and 100% were reported in 12 and 7 T1b tumours, respectively [12,33]. In the literature, CA is more commonly used as ablation technique for T1b lesions with primary efficacy rates ranging from 76 to 97.2% [2,5,13,15]. Our results show that MWA can also be used and chosen as a treatment modality in T1b tumours with consideration of a second ablation.…”

Section: Discussionmentioning

confidence: 54%

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Aarts

Prevoo

Meier

et al. 2020

Cardiovasc Intervent Radiol

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Objectives To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC). Methods We analysed patients with a histologically proven RCC (B 7 cm) treated by MWA from April 2012-April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien-Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications. Results In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4-4.0). Primary efficacy was 89% (95%CI 0.81-0.94) for T1a lesions and 52% (95%CI 0.31-0.73) for T1b lesions (p \ 0.001). Fifteen lesions (7 T1a) were reablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10-60 months. Six (4%) AEs grade [ 3-5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012). Conclusion Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.

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Ablative Therapien kleiner Nierentumoren

Kriegmair

Wagener

Diehl

et al. 2018

Urologe

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Renal cell cancer is nowadays predominantly diagnosed in early stages due to the widespread use of sectional imaging for unrelated symptoms. Small renal masses (<4 cm) feature a largely indolent biology with a very low risk for metastasis or even a benign biology in up to 30% of the cases. Consequently, there is a need for less invasive therapeutic alternatives to nephron-sparing surgery. Meanwhile, there is a broad portfolio of local ablation techniques to treat small renal tumors. These include the extensively studied radiofrequency ablation and cryoablation techniques as well as newer modalities like microwave ablation and irreversible electroporation as more experimental techniques. Tumor ablation can be performed percutaneously under image guidance or laparoscopically. In particular, the percutaneous approach is a less invasive alternative to nephron-sparing surgery with lower risk for complications. Comparative studies and meta-analyses report a higher risk for local recurrence after renal tumor ablation compared to surgery. However, long-term oncological results after treatment of small renal masses are promising and do not seem to differ from partial nephrectomy. The possibility for salvage therapy in case of recurrence also accounts for this finding. Especially old patients with an increased risk of surgical and anesthesiological complications as well as patients with recurrent and multiple hereditary renal cell carcinomas may benefit from tumor ablation. Tumor biopsy prior to intervention is associated with very low morbidity rates and is oncologically safe. It can help to assess the biology of the renal mass and prevent therapy of benign lesions.

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Safety Considerations and Local Tumor Control Following Percutaneous Image-Guided Cryoablation of T1b Renal Tumors

Abstract: Percutaneous CA of T1b renal tumors is safe and satisfactory rates of LTC are expected at the early follow-ups. Further studies are needed to confirm the long-term efficacy of this procedure.

Cited by 24 publications

References 18 publications

Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes

Computed tomography-guided percutaneous cryoablation of T1b renal tumors: safety, functional and oncological outcomes

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Ablative Therapien kleiner Nierentumoren

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