Treatment of Renal Cancer Patients by Transcatheter Embolization and its Effects on Lymphocyte Proliferative Responses

Nakano, Hiroshi; Nihira, Hiromi; Toge, Tetsuya

doi:10.1016/s0022-5347(17)50935-0

Cited by 36 publications

(20 citation statements)

References 13 publications

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“…Several investigators have cited immunological benefits for patients undergoing RAE before surgery, including augmentation of natural killer cell activity and lymphoproliferative responses [10,11]. In addition, a retrospective study of RAE followed by nephrectomy vs a case‐matched control group of nephrectomy alone showed a significant survival benefit in the former group [12].…”

Section: Discussionmentioning

confidence: 73%

“…For those patients with significant tumour thrombus there might be a beneficial effect of decreasing the size or extent of tumour thrombus before surgery [9]. Interestingly, there might also be an advantage in the form of immunomodulation, whereby RAE‐induced tumour necrosis stimulates a tumour‐specific response [10–12]. It is likely that RAE is underutilized, perhaps because of a lack of prospective randomized studies demonstrating these potential benefits.…”

Section: Introductionmentioning

confidence: 99%

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Renal artery embolization: clinical indications and experience from over 100 cases

et al. 2006

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Renal artery embolization is used for various reasons, and authors from the USA review their experience of using this technique before nephrectomy in patients with large renal masses. They found it to be safe and effective, with minimal morbidity. They note the lack of published prospective randomized trials, and suspect that this contributes to it being underused. OBJECTIVE To review current indications and techniques for renal artery embolization (RAE) and more specifically to review cases of RAE before nephrectomy for treating patients with a large renal mass. PATIENTS AND METHODS All RAEs done at our institution between May 1993 and December 2005 were reviewed. Patients were identified using a database assembled by the Division of Cardiovascular Interventional Radiology. Indications, techniques and RAE‐related complications were then obtained from a retrospective review of medical records. Additional data for patients undergoing preoperative infarction were acquired, including estimated blood loss (EBL), transfusion requirement, pathological size, subtype, grade, stage, and level of tumour thrombus if present. RESULTS In all, there were 121 RAEs, 69 in males and 52 in females (mean age 57.6 years, range 11–89). Metallic microcoils were the most often used embolization agent, followed by acrylic microspheres (embospheres), polyvinyl alcohol particles, absolute ethanol, and Gelfoam (Pharmacia & Upjohn, USA). The most common indication for RAE was infarction before nephrectomy (54.5%). Other indications included symptomatic angiomyolipomas, palliation of unresectable renal cancer, haemorrhage, perinephric bleeding in end‐stage renal disease, vascular lesions, malignant hypertension, and sequelae of end‐stage renal disease. RAE‐associated complications including coil migration, incomplete embolization, and groin haematoma (in 5.0%). Symptoms of post‐infarction syndrome were common, with 74.4% of patients having flank pain, nausea, or vomiting; the vast majority of these symptoms were mild and self‐limited. In patients having nephrectomy after RAE the median (range) interval from RAE was 2 (0–78) days. The mean tumour size was 11.2 (3.5–25) cm and 46% of patients had tumour thrombus present in either the renal vein or inferior vena cava (IVC). The mean (median) overall EBL in patients having nephrectomy after RAE was 1048 (725) mL. The mean transfusion requirement over the course of hospitalization was 3.9 units of packed red blood cells. CONCLUSIONS RAE is a safe and effective therapeutic tool for many urological, renal and vascular conditions. Its use has increased at our institution due to improved techniques, embolization materials, and our increasing use of RAE as an adjuvant procedure for patients requiring nephrectomy with or without IVC thrombectomy. There are many potential operative advantages for patients having RAE before surgery, with minimal morbidity. It is likely that the lack of prospective randomized trials is the primary reason why it is underutilized in the preoperative setting.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Renal artery embolization: clinical indications and experience from over 100 cases

et al. 2006

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“…Some authors report on the immunological benefits in patients undergoing embolization prior to nephrectomy [18,19]. An increase in activity of NK lymphocytes was demonstrated in the first 24 h post--embolization.…”

Section: Discussionmentioning

confidence: 99%

The Role Of Transarterial Embolization In The Treatment Of Renal Tumors

et al. 2015

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Background. Renal arterial embolization (RAE) is one of the adjunctive methods in the treatment of renal tumors. Embolization is performed in patients prior to nephrectomy, in patients with inoperable renal tumors as palliative treatment.Objectives. The purpose of the study was to present and to analyze our own experiences in the embolization of renal tumors. Material and Methods. A retrospective analysis of 33 patients treated using RAE between 2011 and 2013 was carried out. In 30 cases (91%), embolization was performed due to renal carcinoma and in 3 cases (9%) due to angiomyolipoma. In 11 patients intervention was performed as a palliative procedure because of advanced disease. Histoacrylic glue, polyvinyl alcohol, sponge pledgets and embolization coils were used for embolization. Results. In 20 patients (61%), selective RAE was performed, whereas superselective RAE was carried out in 13 patients (39%). The technical success rate of RAE was 100%. In one case the procedure was complicated by reflux of the histoacrylic glue into the common femoral artery with its embolization that required surgical embolectomy. We used histoacrylic glue in 26 embolizations (79%), in 19 procedures (58%) as the only embolization agent. Polyvinyl alcohol was used in 10 procedures (30%), gelatin sponge pledgets and absolute ethanol in 6 patients (18%). In 4 cases (12%), coils were implemented. In 22 patients (67%), one or more components of postembolization syndrome (PES) developed. In all 22 patients with PES (100%), severe lumbar pain was observed and administration of analgesics proved necessary. In 10 patients treated by palliative embolization, both a regression of macrohaematuria and an increase in hemoglobin level were observed. In 10 further patients, the creatinine level decreased following RAE. Conclusions. RAE is an effective and minimally-invasive intervention burdened with low risk of major complications. PES occurs in about two-third of patients. In the majority of patients after palliative embolization, haematuria decreases and the quality of life improves (Adv Clin Exp Med 2015, 24, 5, 837-843).

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“…This survival benefit applied to patients with pT2, pT3 and pT3N+ disease. Modulation of immune responses seen after embolization, such as augmentation of lymph proliferative responses 16 and natural killer cell activities, 17 has been suggested as an explanation. More modern series, however, have not reproduced the same results with respect to improvement in survival.…”

Section: Discussionmentioning

confidence: 99%

Renal artery embolization prior to nephrectomy for locally advanced renal cell carcinoma

Zargar

Addison

McCall

et al. 2014

ANZ Journal of Surgery

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Treatment of Renal Cancer Patients by Transcatheter Embolization and its Effects on Lymphocyte Proliferative Responses

Cited by 36 publications

References 13 publications

Renal artery embolization: clinical indications and experience from over 100 cases

Renal artery embolization: clinical indications and experience from over 100 cases

The Role Of Transarterial Embolization In The Treatment Of Renal Tumors

Renal artery embolization prior to nephrectomy for locally advanced renal cell carcinoma

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