Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: risk factors analysis of 171 tumors

Hao, Guoliang; Hao, Yong; Cheng, Zhigang; Zhang, Xu; Cao, Feng; Yu, Xiaoling; Han, Zhiyu; Liu, Fangyi; Mu, Mengjuan; Dou, Jianping; Li, Xin; Dupuy, Damian E.; Yu, Jie; Liang, Ping

doi:10.1080/02656736.2018.1475684

Cited by 25 publications

(19 citation statements)

References 36 publications

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“…After repeated MWA(s), a secondary efficacy of 99% was reached for T1a tumours. In the literature, primary efficacy rates of MWA from 84.6 to 100% are reported [8,11,14,22,29]. Therefore, the primary and secondary efficacy of T1a tumours underpins the existing evidence supporting MWA for the treatment of T1a RCC lesions.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Aarts

Prevoo

Meier

et al. 2020

Cardiovasc Intervent Radiol

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Objectives To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC). Methods We analysed patients with a histologically proven RCC (B 7 cm) treated by MWA from April 2012-April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien-Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications. Results In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4-4.0). Primary efficacy was 89% (95%CI 0.81-0.94) for T1a lesions and 52% (95%CI 0.31-0.73) for T1b lesions (p \ 0.001). Fifteen lesions (7 T1a) were reablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10-60 months. Six (4%) AEs grade [ 3-5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012). Conclusion Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.

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Section: Discussionmentioning

confidence: 99%

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Aarts

Prevoo

Meier

et al. 2020

Cardiovasc Intervent Radiol

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“…Use of both US and CT during the ablative procedure, might also increase the ability to immediately detect a vital unablated residual tissue, and thus to guide an immediate intraprocedural second ablation. The possible occurrence of an incomplete ablation is among the drawbacks of image-guided thermal ablations, and can particularly occur in case of large or centrally located tumors [30][31][32][33]. However, one of the principal aims of application of image-guided thermal ablation is to lower the invasiveness of treatment in frail patients unsuitable for surgery, or to minimize renal function damage particularly when surgery would require total nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, the need of multiple treatments is generally accepted and taken into account during multidisciplinary discussions when establishing the patient treatment strategy. In fact, with a second ablation complete tumor ablation can be achieved in the large majority of cases [30,31,34]. Furthermore, patients can have a local tumor progression during follow-up, develop new foci of renal tumors in the same or in the contralateral kidney, or distant metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients can have a local tumor progression during follow-up, develop new foci of renal tumors in the same or in the contralateral kidney, or distant metastases. In all these scenarios, image-guided thermal ablation can be applied to achieve disease control [30,[33][34][35][36]. Thus, it might easily occur that a patient requires multiple ablations over the course of his disease.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center

Mauri

Mistretta

Bonomo

et al. 2020

Cancers

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Image-guided thermal ablations are increasingly applied in the treatment of renal cancers, under the guidance of ultrasound (US) or computed tomography (CT). Sometimes, multiple ablations are needed. The aim of the present study was to evaluate the long-term results in patients with renal mass treated with radiofrequency ablation (RFA) with both US and CT, with a focus on the multiple ablations rate. 149 patients (median age 67 years) underwent RFA from January 2008 to June 2015. Median tumor diameter was 25 mm (IQR 17–32 mm). Median follow-up was 54 months (IQR 44–68). 27 (18.1%) patients received multiple successful ablations, due to incomplete ablation (10 patients), local tumor progression (8 patients), distant tumor progression (4 patients) or multiple tumor foci (5 patients), with a primary and secondary technical efficacy of 100%. Complications occurred in 13 (8.7%) patients (6 grade A, 5 grade C, 2 grade D). 24 patients died during follow-up, all for causes unrelated to renal cancer. In conclusion, thermal ablations with the guidance of US and CT are safe and effective in the treatment of renal tumors in the long-term period, with a low rate of patients requiring multiple treatments over the course of their disease.

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“…Although there is an extended literature regarding mid-and long-term outcomes of RFA and CA for RCCs, MWA has been less studied and there is still a lack of data concerning long term efficacy. The present study adds to the growing number of case series showing that CT-guided percutaneous microwave ablation (Figure 3) is an efficacious and safe technique in terms of achieving local tumor control and recurrence-free response on both a per lesion and per patient basis [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. The results of the current study showed efficient progression free (100%, 86.7%, 86.7% and 83.5% for 1, 6, 12 and 36 months, respectively), recurrence free (94.7%) and overall survival rates (mean 35.6 months), in a follow up time of 36 months.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography-Guided Percutaneous Microwave Ablation for Renal Cell Carcinoma: Impact of Tumor Size on the Progression Survival Rates

et al. 2021

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The aim of the present study was to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of renal cell carcinoma (RCC) along with identifying prognostic factors affecting the progression survival rate. Institutional database retrospective research identified 69 patients with a biopsy proven solitary T1a (82.6%) or TIb (17.4%) RCC who have underwent percutaneous CT-guided MWA. Kaplan–Meier survival estimates for events were graphed and Cox regression analysis was conducted. Mean patient age was 70.4 ± 11.5 years. Mean size of the lesions was 3 ± 1.3 cm. Mean follow up time was 35.6 months (SD = 21.1). The mean progression free survival time from last ablation was 84.2 months. For T1a tumors, the cumulative progression free survival rate for 1, 6, 12 and 36 months were 100% (SE = 0%), 91.2% (SE = 3.7%), 91.2% (SE = 3.7%) and 87.5% (SE = 4.4%); the recurrence free survival rate for T1a RCC was 94.9%. For T1b tumors, the cumulative progression free survival rate for 1, 6, 12 and 36 months were 100% (SE = 0%), 63.6% (SE = 14.5%), 63.6% (SE = 14.5%) and 63.6% (SE = 14.5%). Grade 1 complications were recorded in 5 (7.2%) patients. Significantly greater hazard for progression was found in cases with a tumor size > 4 cm (HR = 9.09, p = 0.048). No statistically important difference regarding tumor progression was recorded between T1a tumors with a diameter ≤ 3 cm and >3 cm. In summary, the results of the present study show that CT guided percutaneous MWA is an effective technique for treatment of T1a renal cell carcinomas, irrespective of tumor size. T1b tumors were associated with higher progression rates.

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Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: risk factors analysis of 171 tumors

Abstract: US-guided percutaneous MWA for T1a RCC achieved a relatively low LTP incidence rate. Tumors adjacent to the renal pelvis or bowel increased the potential of LTP occurrence.

Cited by 25 publications

References 36 publications

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center

Computed Tomography-Guided Percutaneous Microwave Ablation for Renal Cell Carcinoma: Impact of Tumor Size on the Progression Survival Rates

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