Microwave ablation of 105 T1 renal tumors: technique efficacy with a mean follow-up of two years

Background Thermal ablation (TA) with radiofrequency (RFA) or cryoablation (CA) are established treatments for small renal masses (≤4 cm). Microwave ablation (MWA) has several potential benefits (decreased ablation time, less susceptibility to heat-sink, higher lesion temperatures than RFA) but is still considered experimental considering the available small-sample studies with short follow-up. Purpose To evaluate technique efficacy and complications of our initial experience of renal tumors treated using percutaneous MWA with a curative intent. Material and Methods A total of 105 renal tumors (in 93 patients) were treated between April 2014 and August 2017. MWA was performed percutaneously with computed tomography (CT) guidance under conscious sedation (n=82) or full anesthesia. Patients were followed with contrast-enhanced CT scans at six months and yearly thereafter for a minimum of five years. The mean follow-up time was 2.1 years. The percentage of tumors completely ablated in a single session (primary efficacy rate) and those successfully treated after repeat ablation (secondary efficacy rate) were recorded. Patient and tumor characteristics as well as complications were collected retrospectively. Results The median patient age was 70 years and median tumor size was 25 mm. Primary efficacy rate was 96.2% (101/105 tumors). After including two residual tumors for a second ablation session, secondary efficacy was 97.1% (102/105). Periprocedural complications were found in 5.2% (5/95) sessions: four Clavien-Dindo I and one Clavien-Dindo IIIa. One postprocedural Clavien-Dindo II complication was found. Conclusion MWA has high efficacy rates and few complications compared to other TA methods at a mean follow-up of two years.

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Clinical application of contrast-enhanced ultrasound after percutaneous renal tumor ablation

British Journal of Radiology ◽

10.1259/bjr.20190183 ◽

2019 ◽

Vol 92 (1103) ◽

pp. 20190183 ◽

Cited By ~ 1

Author(s):

Fang Guo ◽

Bing Hu ◽

Lei Chen ◽

Jia Li

Keyword(s):

Local Recurrence ◽

Tumor Ablation ◽

Renal Tumors ◽

Ablation Zone ◽

Recurrent Tumors ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Complete Tumor

Objective: To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in detecting incomplete ablation and local recurrence of renal tumors after percutaneous radiofrequency ablation (RFA). Methods: 31 patients were included for RFA treatment and underwent CEUS examination after RFA, ablation zone and contrast distribution in the ablation area were observed, CEUS images were compared with enhanced CT/MRI images to determine the residual tumors and local recurrence of renal tumors. Results: The average maximum diameters of the tumor and the ablation zone after the first RFA were 32.3 ± 14.7 mm and 35.9 ± 12.2 mm, respectively. A higher rate of complete tumor ablation was achieved if the ablation zone was larger than the primary tumor (p = 0.026). Within 1 month after RFA, contrast-enhanced CT/MRI examinations demonstrated incomplete ablation in 9 of 31 patients (29.0%), while CEUS revealed incomplete ablation in 8 of 31 patients (25.8%). The sensitivity, specificity, positive predictive value and negative predictive value of CEUS in evaluating complete ablation of renal tumors were 88.9%, 100%, 100%, 95.7%, respectively. During the follow-up period, local recurrence was reported in 2 (7.4%) of the 27 patients with complete tumor ablation. Tumor recurrence signs in the two patients were identified by both CEUS and contrast-enhanced CT/MRI. Therefore, both the sensitivity and specificity of CEUS for the evaluation of tumor recurrence were 100%. Conclusion: After percutaneous RFA of renal tumors, the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors is basically the same as that of contrast-enhanced CT/MRI. Advances in knowledge: In this study, we evaluated the effectiveness of CEUS in the follow-up assessment of residual and recurrent tumors after RFA is basically the same as that of contrast-enhanced CT/MRI. Combining multiple follow-up methods may improve the detection rate of residual or recurrent tumors.

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The Role of Surveillance in the Management of Small Renal Masses

The Scientific World JOURNAL ◽

10.1100/tsw.2007.157 ◽

2007 ◽

Vol 7 ◽

pp. 860-868 ◽

Cited By ~ 11

Author(s):

Alessandro Volpe

Keyword(s):

Natural History ◽

Active Treatment ◽

Initial Period ◽

Renal Tumors ◽

Small Renal Masses ◽

Renal Masses ◽

Cross Sectional ◽

Slow Growth Rate ◽

History Of

Incidentally detected, small renal masses (SRMs) have been increasing significantly in recent years due to the widespread use of improved cross-sectional imaging. A significant number of incidental SRMs are diagnosed in elderly patients who are more likely to undergo imaging for other medical issues. The natural history of SRMs has not been historically well understood because most masses are surgically removed soon after diagnosis.Several reports of surveillance of SRMs have been published in the last few years. When followed conservatively with serial imaging, SRMs have variable growth rates with an average of 0.28 cm/year, according to a recent meta-analysis. Larger series with longer follow-up are needed, but a significant number of small tumors seem to have an indolent behavior with a slow growth rate and a limited tendency to progress. The standard of care for enhancing SRMs is surgery. Up to one-third of surgically removed, <4-cm tumors are histologically benign. The outcomes of current surgical treatment of histologically confirmed, <4-cm, renal cell carcinomas are excellent, but this has not led to a decrease in mortality. Based on these considerations and on the available data on the natural history of SRMs, it seems reasonable to consider that we may be overtreating these lesions. This is especially true for elderly or unfit patients who have a decreased life expectancy. In these selected patients and in patients who refuse active treatment, it seems reasonable to propose an initial period of active surveillance for incidental SRMs, with delayed intervention for those tumors that will exhibit fast growth during follow-up. Percutaneous needle biopsies of renal tumors can be safely performed with the use of modern techniques and have the potential to characterize SRMs at histologically diagnosis, thereby allowing a better selection of the conservative or active treatment that is best suited for each individual patient.

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Management of Small Renal Masses

10.2310/tywc.11094 ◽

2018 ◽

Author(s):

Keith A Lawson ◽

Antonio Finelli

Keyword(s):

Natural History ◽

Renal Mass ◽

The Body ◽

Renal Tumors ◽

Small Renal Mass ◽

Small Renal Masses ◽

Tumor Biopsy ◽

Renal Masses ◽

History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm. This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

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Management of Small Renal Masses

10.2310/uro.11094 ◽

2018 ◽

Author(s):

Keith A Lawson ◽

Antonio Finelli

Keyword(s):

Natural History ◽

Renal Mass ◽

The Body ◽

Renal Tumors ◽

Small Renal Mass ◽

Small Renal Masses ◽

Tumor Biopsy ◽

Renal Masses ◽

History Of

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Growth kinetics and outcomes of cT1b renal masses under active surveillance.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.440 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 440-440

Author(s):

Reza Mehrazin ◽

Marc C. Smaldone ◽

Alexander Kutikov ◽

Jeffrey J. Tomaszewski ◽

Tianyu Li ◽

...

Keyword(s):

Growth Rate ◽

Tumor Growth ◽

Metastatic Disease ◽

Growth Kinetics ◽

Tumor Size ◽

Renal Tumors ◽

Tumor Growth Rate ◽

Renal Masses ◽

Delayed Intervention

440 Background: The natural history of untreated T1b renal masses is poorly understood. We assessed the growth kinetics and outcomes of ≥cT1b cortical renal tumors which continue to remain on radiographic AS compared to those who underwent definitive surgery after a period of AS. Methods: Prospectively maintained, renal tumor database was reviewed to identify enhancing solid and cystic masses managed expectantly from 2000-2012. cT1a masses, transitional cell carcinoma or those suspected for metastatic disease were excluded from analysis. Localized tumors > 4.0 cm (≥T1b) that were radiographically followed for > 6 months were included for analysis. Clinical and pathological records were reviewed to determine tumor growth rate and clinical outcomes in those remained on AS or those who underwent delayed intervention. Mean for tumor size on presentation, annual linear tumor growth rate (LGR), Charlson comorbidity index (CCI), and follow-up (FU) were calculated. Chi−square test & Logistic regression were used for uni- and multi-variable analyses. Results: Of 457 pts managed with AS, 67 cT1b tumors (in 63 patients) were identified. 43 pts (67%) were managed solely with AS, while 21 pts (33%) progressed to intervention. The median age at presentation pts managed with AS and intervention was 77 and 60 yrs respectively (p=0.0002), while no difference was observed in median CCI (3 vs. 2, p=0.6). No difference was observed in tumor size at presentation between pts managed with AS and those undergoing delayed intervention (5.9 vs. 5.4 cm, p=0.8). In contrast, the mean LGR significantly differed between pts managed expectantly and pts progressed to intervention (0.37 vs. 0.73 cm/yr; p=0.02). On MVA, age (OR=0.9,CI:0.8−0.98) and LGR (OR=11,CI:1.8−60) were significant predictors of surgical intervention. With a mean FU period of 38.9 ± 24.0 months (6−105), 9 pts died (14%) from other cause and no pt progressed to metastatic disease. Conclusions: Localized cT1b≥ renal masses show comparable growth rates to small tumors managed expectantly with low rates of progression to metastatic disease with short term follow up. An initial period of AS to determine tumor growth kinetics is a reasonable option in select pts with significant competing risks and limited life expectancy.

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Interest of percutaneous renal biopsy for small renal masses.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.4_suppl.539 ◽

2014 ◽

Vol 32 (4_suppl) ◽

pp. 539-539

Author(s):

Alexandre Ingels ◽

Eric Barret ◽

Francois Audenet ◽

Luca Lunelli ◽

Guilherme Prada Costa ◽

...

Keyword(s):

Ct Scan ◽

Renal Biopsy ◽

Renal Tumors ◽

Lumbar Pain ◽

Benign Tumors ◽

Small Renal Masses ◽

Renal Masses ◽

Renal Biopsies ◽

Outcomes Management

539 Background: Assess CT-scan guided renal biopsies relevance in the management of small renal masses. Methods: Retrospective analysis from 01/2007 to 12/2012 of percutaneous CT-scan guided renal biopsies performed at our institution for patients harboring renal tumors. Exclusion criteria were presence of metastasis and/or >4cm tumors. Data analyzed were pathological outcomes, management of the tumors and complications from the procedure during the 30 days post-biopsies. Results: 119 patients underwent a renal biopsy during this period. 79 presented the selection criteria. Renal biopsies lead to a diagnosis in 70 cases (88.6%) and were non contributive in 9 cases (11.4%). Among contributive biopsies, there were 46 (66%) cases of cancer and 24 cases (34%) of benign tumors. During follow-up, 2 (2.5%) patients presented Clavien-Dindo grade I-II complications: 1 acute urinary retention and 1 subfebrile lumbar pain. Conclusions: The yield of CT-scan guided renal biopsies to define pathological features of small renal masses was of 88.6%. Morbidity of the technique is low. We consider renal biopsy as a relevant strategy to diagnose a small renal mass, to define the best treatment and to prevent morbidity from useless invasive surgical procedures. [Table: see text]

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Impact of Perioperative Hypnosedation on Postmastectomy Chronic Pain: Preliminary Results

Integrative Cancer Therapies ◽

10.1177/1534735419869494 ◽

2019 ◽

Vol 18 ◽

pp. 153473541986949

Author(s):

Camille Lacroix ◽

Francois P. Duhoux ◽

Julie Bettendorff ◽

Christine Watremez ◽

Fabienne Roelants ◽

...

Keyword(s):

Chronic Pain ◽

Lower Incidence ◽

Reconstructive Surgical Procedures ◽

Small Sample ◽

Breast Cancer Patients ◽

Preliminary Results ◽

Shoulder Range Of Motion ◽

Potential Benefits ◽

Shoulder Range

Objectives: The main aim of this prospective nonrandomized study was to evaluate if mastectomy performed with perioperative hypnosedation led to a lower incidence of chronic pain compared with mastectomy under general anesthesia. Methods: Forty-two breast cancer patients who underwent mastectomy either under GA (GA group, n = 21) or HYP (HYP group, n = 21) associated with local and/or regional anesthesia were included. The type of adjuvant therapy as well as the number of reconstructive surgical procedures were well balanced between the 2 groups. The average age of the patients and the type of axillary surgery were also equivalent. Incidence of postmastectomy chronic pain, lymphedema, and shoulder range of motion (ROM) were evaluated after a mean 4-year follow-up. Results: The study shows a statistically significant lower incidence of postmastectomy chronic pain in HYP group (1/21, 1 patient out of 21 experiencing pain) compared with GA group (9/21) with 9 patients out of 21 experiencing pain ( P = .008). ROM for shoulder was also less frequently affected in the hypnosedation group, as only 1 patient had decreased ROM, instead of 7 in the other group ( P = .04). Conclusions: Our study is the first to hint at the potential benefits of hypnosedation on postmastectomy chronic pain. Despite the limitations of this study (nonrandomized, small sample), preliminary results merit further study of hypnosedation.

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Imaging spectrum of renal masses on multi-slice computed tomography

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204247 ◽

2020 ◽

Vol 8 (10) ◽

pp. 3657

Author(s):

Dipak R. Thakor ◽

Yashpal R. Rana ◽

Megha M. Sheth

Keyword(s):

Computed Tomography ◽

Tumor Staging ◽

Preoperative Assessment ◽

Renal Tumors ◽

Management Approach ◽

Simple Cyst ◽

Renal Masses ◽

Imaging Center ◽

Male Preponderance

Background: Multi-slice computed tomography (MSCT) is the mainstay for preoperative assessment of many complex renal masses in current clinical practice. Benign renal processes may simulate malignant renal tumors and could be defined correctly by CT. MSCT has also an important role in tumor staging. The purpose of this article is to understand the imaging spectrum of renal masses on MSCT and assess the usefulness of CT in surgical planning and management.Methods: Studied 500 patients with suspected renal lesions who underwent MSCT during the period July 2017 to July 2020 at state-of-art imaging center. CT imaging was done in those patients in whom clinical examination and ultrasonography (USG) revealed possibility of diagnosis of renal masses for further detailed evaluation and deciding management.Results: Out of 500 total subjects, the common age group in this study is 51 to 60 years (25%). Male preponderance (59%) was noted. The most common presentation was pain (84%) followed by lump (29.4%) and haematuria (17.8%). Malignant masses (51%) were more common followed by benign (39%) and inflammatory masses (10%) respectively. Renal cell carcinoma has more incidence (30%) followed by simple cyst (20%). Calcification (19.6%), perinephric extension (78%) and vascular invasion (21.5%) are more common in malignant masses. Conclusion: MSCT is the modality of choice for the diagnosis of renal masses and deciding management approach in current practice. Detection of tumoral spread, invasion of surrounding organs and vascular structure are better with CT. MSCT also has a role in postoperative follow-up of renal masses.

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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

Cancers ◽

10.3390/cancers12051183 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1183 ◽

Cited By ~ 3

Author(s):

Giovanni Mauri ◽

Francesco Alessandro Mistretta ◽

Guido Bonomo ◽

Nicola Camisassi ◽

Andrea Conti ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Tumor Progression ◽

Renal Tumors ◽

Long Term Results ◽

Tumor Diameter ◽

Renal Masses ◽

Ct Guided ◽

Multiple Tumor

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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Radiofrequency Ablation of Small Renal Masses: Outcomes, Complications and Effects on Renal Function

Current Urology ◽

10.1159/000447218 ◽

2017 ◽

Vol 11 (4) ◽

pp. 196-200 ◽

Cited By ~ 4

Author(s):

David Curry ◽

Ajay Pahuja ◽

Willie Loan ◽

Ali Thwaini

Keyword(s):

Renal Function ◽

Radiofrequency Ablation ◽

Renal Impairment ◽

Disease Free Survival ◽

Renal Tumors ◽

Renal Masses ◽

Oncological Outcomes ◽

Benign Pathology ◽

Patients At Risk

Introduction: To describe oncological outcomes, effects on renal function and complications with radiofrequency ablation (RFA) of T1 renal tumors in an 8-year experience. Materials and Methods: A retrospective study of RFA in 89 consecutive patients between 2005 and 2013 was undertaken. Those with metastatic disease, incomplete follow-up, genetic pre-disposition to renal tumors and biopsy proven benign pathology were excluded, with 79 patients meeting inclusion criteria. Data was collected on demographics, oncological outcomes, complications and effects on renal function. Results: We demonstrate 94% disease-free survival at median follow-up of 29 months in a population consisting of 42 T1a and 37 T1b tumors. No disease related deaths were recorded in the follow-up period. Post-RFA decline in renal function was shown to correlate with tumor size and increased age (p = 0.0009/0.0021). Pre-existing renal impairment was a risk for post-RFA function decline (p < 0.005). Two complications were encountered in the series. Conclusion: RFA produces durable oncological outcomes in T1 tumors with a minimal effect on renal function and low risk of complications. Patients at risk of developing renal impairment can be identified from described risk factors.

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