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

• Published in: Cardiovascular and interventional radiology 2019-07, Vol.42 (7), p.970-978
• Main Authors: Gunn, Andrew J., Joe, Winston B., Salei, Aliaksei, El Khudari, Husameddin, Mahmoud, Khalid H., Bready, Eric, Keasler, Eric M., Patten, Patrick P., Gordetsky, Jennifer B., Rais-Bahrami, Soroush, Abdel Aal, Ahmed K.
• Format: Article
• Language: English
• Subjects: ABLATION; Aged; Cancer; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - surgery; CARCINOMAS; Cardiology; Clinical Investigation; Clinical outcomes; Complications; Cryosurgery - methods; Demographics; Demography; Embolization; Female; Females; HOSPITALS; Humans; Identification methods; Imaging; Interventional Oncology; Kidney - diagnostic imaging; Kidney - surgery; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - surgery; KIDNEYS; Lesions; Male; Males; Medicine; Medicine & Public Health; Nuclear Medicine; PATIENTS; Quality; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Renal cell carcinoma; Retrospective Studies; REVIEWS; Safety; Survival; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; Tumors; Ultrasound; VASCULAR DISEASES
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-019-02226-5

Purpose 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. Materials and Methods 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. Results 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. Conclusion T1b cryoablation is associated with high rates of technical success, excellent cancer-specific survival, and an acceptable safety profile. Level of Evidence Level 4, Case Series.