Percutaneous Cryoablation of Stage T1b Renal Cell Carcinoma: Safety, Technical Results, and Clinical Outcomes

Springer Science and Business Media LLC - Tập 42 - Trang 970-978 - 2019
Andrew J. Gunn1, Winston B. Joe2, Aliaksei Salei1, Husameddin El Khudari1, Khalid H. Mahmoud1, Eric Bready1, Eric M. Keasler1, Patrick P. Patten1, Jennifer B. Gordetsky3, Soroush Rais-Bahrami4, Ahmed K. Abdel Aal1
1Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, UK
2University of Alabama at Birmingham School of Medicine, Birmingham, UK
3Department of Pathology, University of Alabama at Birmingham, Birmingham, UK
4Department of Urology, University of Alabama at Birmingham, Birmingham, UK

Tóm tắt

The use of percutaneous cryoablation for T1b (4.1–7.0 cm) renal cell carcinoma, has not yet been widely adopted. The purpose of this study was to describe our experience in the cryoablation of stage T1b tumors with an emphasis on safety, technical results, and clinical outcomes. A retrospective review of hospital records identified 37 patients who underwent cryoablation for T1b lesions from 2008 to 2018. Patient demographics, comorbidities, tumor characteristics, technical parameters, and outcomes were recorded and analyzed. Recurrence-free, overall, and cancer-specific survival rates were estimated using the Kaplan–Meier method. Thirty-seven patients (22 males, 15 females; mean age 66.5 ± 11.3) with 37 T1b tumors (mean diameter 47.3 ± 6.3 mm) were included. A median of 3 probes were used (range: 1–7). Angio-embolization was used in 3/37 (8.1%) and 2/37 patients (5.4%) required hydrodissection. The mean number of total cryoablation procedures for each patient was 1.5 (median 1; range: 1–4). Technical success was achieved in 88.2% of patients. Recurrence-free survival was 96.5%, 86.1%, and 62.6% at 1, 2, and 3 years respectively. Cancer-specific survival was 100% at 1, 2, and 3 years respectively. Overall survival was 96.7%, 91.8%, and 77.6% at 1, 2, and 3 years respectively. Complications classified as CIRSE grade 2 or higher occurred in 6/37 (16.2%) patients. T1b cryoablation is associated with high rates of technical success, excellent cancer-specific survival, and an acceptable safety profile. Level 4, Case Series.

Tài liệu tham khảo

Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol. 2015;67(3):519–30. Sun M, Thuret R, Abdollah F, Lughezzani G, Schmitges J, Tian Z, et al. Age-adjusted incidence, mortality, and survival rates of stage-specific renal cell carcinoma in North America: a trend analysis. Eur Urol. 2011;59(1):135–41. Capitanio U, Montorsi F. Renal cancer. Lancet. 2016;387(10021):894–906. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006;98(18):1331–4. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA-Cancer J Clin. 2018;68(1):7–30. Kidney Cancer. In: NCCN Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network. 2018. https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf. Accessed 21 Dec 2018. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, et al. Renal mass and localized renal cancer: AUA guideline. J Urol. 2017;198(3):520–9. Thompson RH, Atwell T, Schmit G, Lohse CM, Kurup AN, Weisbrod A, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67(2):252–9. Takaki H, Yamakado K, Soga N, Arima K, Nakatsuka A, Kashima M, et al. Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma. Jpn J Radiol. 2010;28(6):460–8. Yang Y, Chen S, Chen F, Zhu K, Deng Q, Luo L, et al. Outcome of radiofrequency ablation over partial nephrectomy for small renal mass (< 4 cm): a systematic review and meta-analysis. Int J Clin Exp Med. 2015;8(11):20670. Dandrea D, Shariat SF, Klatte T. Update on ablative therapies of renal tumors. Curr Opin Urol. 2016;26(5):410–6. Moreland AJ, Ziemlewicz TJ, Best SL, Hinshaw JL, Lubner MG, Alexander ML, et al. High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol. 2014;28(9):1046–52. Tanagho YS, Roytman TM, Bhayani SB, Kim EH, Benway BM, Gardner MW, et al. Laparoscopic cryoablation of renal masses: single-center long-term experience. Urology. 2012;80(2):307–14. Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 2005;185(1):64–71. Best SL, Park SK, Yaacoub RF, Olweny EO, Tan YK, Trimmer C, et al. Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters. J Urol. 2012;187(4):1183–9. Schmit GD, Thompson RH, Kurup AN, Weisbrod AJ, Carter RE, Callstrom MR, et al. Percutaneous cryoablation of solitary sporadic renal cell carcinomas. BJU Int. 2012;110(11b):E526–31. Schmit GD, Atwell TD, Callstrom MR, Farrell MA, Leibovich BC, Patterson DE, et al. Percutaneous cryoablation of renal masses ≥ 3 cm: efficacy and safety in treatment of 108 patients. J Endourol. 2010;24(8):1255–62. Atwell TD, Vlaminck JJ, Boorjian SA, Kurup AN, Callstrom MR, Weisbrod AJ, et al. Percutaneous cryoablation of stage T1b renal cell carcinoma: technique considerations, safety, and local tumor control. J Vasc Interv Radiol. 2015;26(6):792–9. Hasegawa T, Yamanaka T, Gobara H, Miyazaki M, Takaki H, Sato Y, et al. Radiofrequency ablation versus cryoablation for T1b renal cell carcinoma: a multi-center study. Jpn J Radiol. 2018;36(9):551–8. Atwell TD, Carter RE, Schmit GD, Carr CM, Boorjian SA, Curry TB, et al. Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol. 2012;23(1):48–54. Hebbadj S, Cazzato RL, Garnon J, Shaygi B, Buy X, Tsoumakidou G, et al. Safety considerations and local tumor control following percutaneous image-guided cryoablation of T1b renal tumors. Cardiovac Intervent Radiol. 2018;41(3):449–58. Kutikov A, Uzzo RG. The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009;182(3):844–53. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A, De Caro R, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol. 2009;56(5):786–93. Venkatesan AM, Kundu S, Sacks D, Wallace MJ, Wojak JC, Rose SC, et al. Practice guideline for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol. 2010;21(11):1611–30. Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727–36. Chung MS, Maxwell AW, Wang LJ, Mayo-Smith WW, Dupuy DE. Should renal mass biopsy be performed prior to or concomitantly with thermal ablation? J Vasc Interv Radiol. 2018;29(9):1240–4. Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Interv Radiol. 2017;40(8):1141–6. Higgins LJ, Hong K. Renal ablation techniques: state of the art. AJR Am J Roentgenol. 2015;205(4):735–41. Patel N, King AJ, Breen DJ. Percutaneous image-guided cryoablation of small renal masses. Abdom Radiol (NY). 2016;41(4):754–66. Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology. 2011;258(2):351–69. Maxwell AW, Baird GL, Iannuccilli JD, Mayo-Smith WW, Dupuy DE. Renal cell carcinoma: comparison of RENAL nephrometry and PADUA scores with maximum tumor diameter for prediction of local recurrence after thermal ablation. Radiology. 2017;283(2):590–7. Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, et al. Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol. 2016;196(4):989–99. Taylor BL, Stavropoulos SW, Guzzo TJ. Ablative therapy for small renal masses. Urol Clin North Am. 2017;44(2):223–31. Schmit GD, Schenck LA, Thompson RH, Boorjian SA, Kurup AN, Weisbrod AJ, et al. Predicting renal cryoablation complications: new risk score based on tumor size and location and patient history. Radiology. 2014;272(3):903–10.