Active Surveillance for Renal Cortical Neoplasms

Rosales, Juan Carlos; Haramis, G. M.; Moreno, Jorge; Badani, Ketan K.; Benson, Mitchell C.; McKiernan, James M.; Casazza, Cristin; Landman, Jaime

doi:10.1016/j.juro.2010.01.024

Cited by 97 publications

(54 citation statements)

References 35 publications

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“…While prompt surgical excision of renal malignancies had been the accepted standard of care, recent data have shown conclusively that an increase in size from 1.5 cm to 3 cm does not alter the rate of tumour-free survival. 3,4,[28][29][30] Moreover, recent reports have shown minimal metastatic progression during surveillance or follow-up after cryoablation, which allows delay of definitive surgery without affecting tumour-free survival. 3,4,30 To further improve identification of recurrent tumour by imaging studies, the use of CT-guided biopsy has been advocated.…”

Section: Discussionmentioning

confidence: 99%

“…3,4,[28][29][30] Moreover, recent reports have shown minimal metastatic progression during surveillance or follow-up after cryoablation, which allows delay of definitive surgery without affecting tumour-free survival. 3,4,30 To further improve identification of recurrent tumour by imaging studies, the use of CT-guided biopsy has been advocated. 31 Furthermore, recent statistical analysis has shown the cause of death in older patients with RCC and medical comorbidities to be more likely intercurrent disease than RCC.…”

Section: Discussionmentioning

confidence: 99%

“…2 These newly emerged concepts make surveillance or management by minimally invasive techniques, such as cryoablation, a viable alternative to surgery, for older patients with medical comorbidities. 3,4,30 While segmental or laparoscopic resection remains the gold standard for treating amenable RCCs, recent data show acceptable results [6][7][8][9][10][11][12]14,[25][26][27]32 (98% tumour-free survival for segmental resection and a 93% to 98.7% tumour-free survival for cryoablation. [5][6][7][8][9][10][11]14,17,20,[25][26][27][28][29][32][33][34] The efficacy of cryoablation treating RCCs in our patients is 97% (68 of 70) based on imaging follow-up criteria (lack of enhancement of ablated tissue), which is similar to that reported in the literature (93.3%-98.7%).…”

Section: Discussionmentioning

confidence: 99%

“…2 These pertinent facts suggest an increased role for surveillance or minimally invasive treatment modalities in this patient group. [3][4][5][6] Cryoablation is one option; it can achieve cancer-specific survival in 96% to 100% of patients. [7][8][9][10][11] We have undertaken a retrospective analysis of results of cryoablation in 70 older patients with medical comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients

Lang

Zhang

Nguyen

et al. 2015

CUAJ

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Introduction: The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. Methods: We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. Results: Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. Conclusion: Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients

Lang

Zhang

Nguyen

et al. 2015

CUAJ

View full text Add to dashboard Cite

show abstract

“…Canadian phase II trials reported, among 178 patients, only one patient who died from metastasis of renal cell carcinoma, and 10 patients who died from unrelated causes at 3-42 months [21]. In previous small retrospective studies, the possibility of metastasis during AS for SRMs has been reported as 0%-5% [1][2][3][4]9]. The Delayed Intervention and Surveillance for Small Renal Masses Registry, the largest prospective study, did not show distant metastasis in 223 patients after 5 years of follow-up [13].…”

Section: Discuissionmentioning

confidence: 99%