Combination therapy of three-dimensional (3D) visualisation operative treatment planning system and US-guided percutaneous microwave ablation in larger renal cell carcinomas (D ≥ 4 cm): preliminary results

Abstract

Materials and methods:The results from 20 patients with 20 larger RCCs treated with a 3D visualisation operative treatment planning system and US-guided PMWA were reviewed retrospectively. The patients were followed up by contrast-enhanced images at 1, 3, and 6 months and every 6 months thereafter. The outcomes of overall survival and local tumour progression rate were statistically analysed. Results: The median follow-up period was 26 months. The mean time of ablation for one tumour was 1.1 ± 0.3 sessions. The average number of ablation points of one tumour was 4.5 ± 0.9. The mean output power of ablation was 50.50 ± 2.2 W. The mean time of ablation for one tumour was 1374.4 ± 391.1 s. Artificial ascites was used in 12 (60%) tumours adjacent to the intestinal tract, and thermal monitoring system was used in all tumours (100%). Technical effectiveness and metastasis-free status were achieved in all tumours. The 1-and 2-year local tumour progression rates were both 5%. The cancer-specific survival rate and 2-year overall survival rates were both 100%. No severe major complications occurred. There was no significant difference in creatinine or urea nitrogen before or 3 days after ablation. Conclusions: Combination therapy of 3D visualisation operative treatment planning system and USguided PMWA appeared to be a safe and effective technique for the management of larger RCCs, which could improve clinical efficacy. ARTICLE HISTORY

Efficacy and Safety of Microwave Ablation for Malignant Renal Tumors: An Updated Systematic Review and Meta-Analysis of the Literature Since 2012

“…All studies had a retrospective study design. Eight studies were reported from Western countries ( 4 8 9 14 15 17 18 19 ) and five from Eastern countries ( 10 11 12 13 16 ). In nine studies, the mean tumor size was less than 3.0 cm ( 4 8 9 10 11 15 17 18 19 ).…”

“…For technical outcomes, six studies reported TSR ( 4 8 14 15 17 19 ) and 13 studies reported TER ( 4 8 9 10 11 12 13 14 15 16 17 18 19 ). For oncologic outcomes, 13 studies reported LRR ( 4 8 9 10 11 12 13 14 15 16 17 18 19 ), seven studies reported CSSR ( 8 10 12 13 14 17 18 ), and eight studies reported OSR ( 8 10 12 13 14 15 17 18 ). All 13 studies reported various major or minor complications post-MWA ( 4 8 9 10 11 12 13 14 15 16 17 18 19 ).…”

“…Ultrasonography was used for imaging guidance in five studies ( 10 11 12 13 16 ), CT in five studies ( 4 9 14 15 19 ), and both CT and US in three studies ( 8 17 18 ). The power of ablation was 50 W or more in eight studies ( 9 10 11 12 13 14 16 18 ) and 45 W in one study ( 8 ), and three studies failed to indicate specifically the details of ablation generator power ( 4 15 19 ).…”

“…Although each study classified complications into major or minor types according to a pre-specified definition, the minor complications included a broad spectrum of events. Notably, due to the lack of an objective method of pain assessment, one study reported a high incidence of mild pain ( 13 ). In addition, the values of 3-year CSSR, TER for US, and LRR for CT showed moderate heterogeneity.…”

“…Microwave ablation is a heat-based modality with a mechanism of cell death identical to that of other thermal ablation techniques, but which offers several physical advantages associated with the delivery of heat ( 5 6 ). As MWA has several advantages over RFA, including higher intratumoral temperatures, larger ablation volumes, and quicker ablation ( 7 ), multiple studies have recently investigated and reported the efficacy and safety of MWA ( 4 8 9 10 11 12 13 14 15 16 17 18 19 ). However, the results were varied, and most of the studies included a small number of patients, with limited precision of the estimated efficacy and safety of MWA.…”