Image-guided percutaneous cryoablation is a safe and efficacious treatment for selected small renal cell carcinoma (RRC) tumors, new findings published in the American Journal of Roentgenology confirm.
Joint first authors Emma Lim, MBChB, and Shankar Kumar, MBBS, senior author and attending interventional radiologist Miles Walkden, FRCR, and others at University College London Hospitals NHS Foundation Trust and University College London, studied 180 patients who underwent image-guided percutaneous cryoablation for a total of 185 clinical stage T1 biopsy-proven RCC lesions. “To our knowledge this series represents one of the largest cryoablation cohorts in the literature and is the first to shed some light on the effect of cryoablation on renal function,” the authors noted.
Patients had a mean age of 68.4 years (range 34.1 to 88.9 years). Of these patients, 52 (28.9%) were women. The investigators identified 168 cT1a lesions (90.8%) and 17 cT1b lesions (9.2%). The mean lesion size was 28.5 mm (range 11 to 58 mm).
The procedure was technically successful in 183 (98.9%) of 185 cases, the investigators reported. The investigators identified residual unablated tumor on the first follow-up scan in 4 (2.2%) of 183 tumors. The estimated local tumor progression-free survival at 3 and 5 years was 98.3% and 94.9%, respectively. No distant metastases or deaths attributable to RCC occurred.
The mean estimated glomerular filtration rate (eGFR) was 69.7 mL/min/1.73 m2 after the procedure and 70.7 and 69.8 mL/min/1.73 m2 at 1 and 2 years post-procedure. These eGFR values did not differ significantly from the mean eGFR value before the procedure (72.4 mL/min/1.73 m2).
Major complications (Clavien-Dindo classification grade III or higher) occurred in 4 (2.2%) of 185 cases.
The investigators concluded that “image-guided cryoablation offers a promising treatment option for cT1 RCC, offering long-term oncologic outcomes that rival more invasive methods with the benefit of an improved safety profile.”
Lim E, Kumar S, Seager M, et al. Outcomes of renal tumors treated by image-guided percutaneous cryoablation: Immediate and 3- and 5-year outcomes at a regional center [published online April 14, 2020]. AJR Am J Roentgenol. doi: 10.2214/AJR.19.22213