Percutaneous cryoablation for renal cell carcinoma using ultrasound-guided targeting and computed tomography-guided ice-ball monitoring: radiation dose and short-term outcomes

Abstract

Background Usefulness of ultrasound (US)-guided mass targeting and computed tomography (CT)-guided ice-ball monitoring in percutaneous cryoablation (PCA) for renal cell carcinoma (RCC) is still uncertain. Purpose To assess radiation dose and short-term outcomes of PCA for RCC using US-guided targeting and CT-guided ice-ball monitoring. Material and Methods Thirty-nine consecutive patients who underwent PCA for biopsy-proven RCC were included. Mass targeting was performed with US and ice-ball was monitored with CT guidance. Effective radiation dose of CT during PCA was recorded. Follow-up was conducted with contrast-enhanced CT or magnetic resonance imaging (MRI) (mean follow-up time = 10.1 ± 7.0 months). Local tumor progression was defined by the presence of focal enhancing areas at the ablation zone (CT, ≥ 20 HU; MRI, presence of focal enhancement on subtraction contrast-enhanced image). Technical success, major complication rate (e.g. Clavien-Dindo classification ≥ 3), and one-year local tumor progression-free survival (PFS) rate were analyzed. Results Mean effective radiation dose in association with PCA was 12.1 ± 4.5 mSv (range = 7.0-25.2 mSv). Technical success was achieved in 100%. Local tumor progression occurred in a single patient (2.6%, 1/39), and one-year local tumor PFS rate was 95.7%. No major complication was found. Conclusion PCA using US-guided targeting and CT-guided ice-ball monitoring may allow acceptable local tumor control for RCC, as a radiation-reducing strategy.

Security and Efficiency of Percutaneous Microwave Ablation using Combined Computed Tomography and Ultrasound-Guided Imaging in Patients with Hepatocellular Carcinoma: A Prospective Study

“…In our analysis, we prospectively compared the effectiveness and safety of US, CT, and combinationguided percutaneous MWA in treating patients with HCC. The local recurrence and grade C complication rates were not signi cantly different between patients with CT and US-guided MWA, which was consistent with the ndings of a previous related study [14,21]. US has the advantages of real-time monitoring, a short operation time, and a clear display of blood vessels and the bile duct, while CT has a high accuracy of puncture and a high image resolution [3,4].…”

“…One disadvantage of US guidance is the limited capability of visualizing tumor boundaries and monitoring thermal effects due to air bubbles produced by vaporization. CT guidance has a high accuracy and is not interrupted by air bubbles, particularly in patients with HCC who undergo TACE, which contributes to distinguishing adequate safety margins (measured as the distance from the initial tumor boundaries to the border of the posttreatment ablation zone) [21,22]. Therefore, these could partly explain why the local recurrence rates of the combination group were lower than those of the US group in our study.…”

sABLATE: a simplified ABLATE score for prediction of complications and outcome in percutaneous thermal ablation of renal lesions

“…Percutaneous thermal ablation was also efficacious, as we registered a residual disease rate of 2.2%, and a local tumor progression rate of 7.3% and 10.1% for all and malignant lesions, respectively, during a mean follow-up time of 21.9 months (range 1-73). These data are similar to what has been previously reported [29,[31][32][33]. In this study we focused on lesions, not patients, and on the efficacy of single procedures, not of cumulative treatments; thus, no outcomes such as secondary efficacy were calculated nor compared.…”

Safety and effectiveness of percutaneous microwave ablation using combined computed tomography and ultrasound-guided imaging in patients with hepatocellular carcinoma: A prospective study

“…Theoretically, CT guidance for mass targeting leads to a certain degree of radiation exposure in patients. Therefore, reductions in treatment time and puncture time can dramatically reduce the radiation dose that harms patients [20]. One disadvantage of US guidance is the limited capability of visualizing tumor boundaries and monitoring thermal effects due to air bubbles produced by vaporization.…”

“…The median follow-up period was 14 (12)(13)(14)(15)(16)(17)(18)(19)(20) months. During the follow-up period, 8 patients (combination group: 2 patients, CT group: 2 patients, US group: 4 patients) experienced local recurrence and received repeat MWA, and the local recurrence rates were 5.9%, 6.7%, and 16.7% in the combination group, CT group, and US group, respectively.…”