scholarly journals Is percutaneous image-guided renal tumour ablation ready for prime time?

2020 ◽  
Vol 93 (1114) ◽  
pp. 20200284
Author(s):  
Roberto Luigi Cazzato ◽  
Julien Garnon ◽  
Pierre De Marini ◽  
Pierre Auloge ◽  
Guillaume Koch ◽  
...  
Keyword(s):  
Renal Cell ◽  
Recent Literature ◽  
Oncologic Outcomes ◽  
Prime Time ◽  
First Line ◽  
Image Guided ◽  
High Quality Evidence ◽  
Randomised Controlled ◽  
Quality Evidence

In the last few decades, thermal ablation (TA) techniques have been increasingly applied to treat small localised renal cell carcinomas. Despite this trend, there is still an underuse of TA compared to surgery and a substantial lack of high-quality evidence derived from large, prospective, randomised controlled trials comparing the long-term oncologic outcomes of TA and surgery. Therefore, in this narrative review, we assess published guidelines and recent literature concerning the diagnosis and management of kidney-confined renal cell carcinoma to understand whether percutaneous image-guided TA is ready to be proposed as a first-line treatment.

Long-term durable oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 384-384 ◽  
Author(s):  
Sarah P. Psutka ◽  
Francis J. McGovern ◽  
Peter Mueller ◽  
W. Scott McDougal ◽  
Debra Gervais ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Radiofrequency Ablation ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Disease Free Survival ◽  
Oncologic Outcomes ◽  
Free Survival ◽  
Disease Free

384 Background: Long-term oncologic outcomes for radiofrequency ablation (RFA) of renal cell carcinoma (RCC) are limited. The objective of this study was to assess the long-term oncological efficacy of RFA for treatment of renal cell carcinoma. Methods: Between 1998 and 2008, 311 biopsy-proven RCC were treated with RFA in 274 patients. Exclusion criteria included history of prior RCC or known metastatic RCC at time of RFA (n=92). 26 patients were lost to follow-up prior to their 6-month imaging study. We retrospectively reviewed the long-term oncologic outcomes for 193 patients. Mean follow-up was 4.6 yrs (range 1–12, SD 2.3). Results: Median age was 71 years (IQR: 63 –79 years). Median Charlson Score was 5.46 (IQR: 5–6). Median size of tumor treated was 3 cm (IQR: 2–3.9 cm, range 1–7.1cm) and 64 of these tumors (33%) were endophytic. Tumor breakdown by stage was T1a: n=153 (79%), T1b: n=37 (19%), and T2: n=3 (2%). Initial treatment success rate was 89%. There were 6 local recurrences (3%) in 4 patients with T1b disease and 2 patients with T2 disease with an average time-to-recurrence of 2.9 years (SD 0.7). 95% of patients with T1a RCC were disease free at last follow-up, in comparison to 81% of those with T1b and 33% of those with T2 disease (p=0.008). At last follow-up 178 (92%) patients were disease-free. 16 (8.2%) developed metastatic disease and 4 patients (2%) died of RCC. Mean disease-free survival was 4.3 years (SD 2.4). Conclusions: In patients who are poor surgical candidates, RFA results in durable local control and a low risk of disease recurrence in T1 RCC. Higher stage, however, correlates with a decreased disease free survival and alternate treatments should be considered when counseling these patients.

Long-term outcome of sunitinib in metastatic renal cell carcinoma: Single center experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15606-e15606
Author(s):  
Marco Maruzzo ◽  
Umberto Basso ◽  
Fable Zustovich ◽  
Pasquale Fiduccia ◽  
Antonella Brunello ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Standard Dose ◽  
First Line ◽  
Term Outcome ◽  
Long Term Outcome

e15606 Background: The multi-target tyrosine-kinase inhibitor sunitinib has been widely used in first or subsequent lines of treatment for metastatic renal cell carcinoma (mRCC). Since results of registrative clinical trials may be overestimated due to patient selection, outcome data of sunitinib in the routine clinical practice are warranted. Methods: We retrospectively reviewed clinical data of all consecutive mRCC patients starting sunitinib from March 2006 to September 2012 at our Institution. Results: Eligible were 106 pts, median age 63 years (range 27-89), 70% males, 89% clear cell histology, 87% prior nephrectomy. Sunitinib was prescribed either as first (70%) or second or further line of treatment after cytokines or targeted therapies. Patients received a median of 8 sunitinib cycles (1-49). Median PFS and OS in the first line were 15.0 mo (95% CI= 9.8-20) and 35 mo. PFS and OS in the second or further line were 15 mo (11.7-18.2) and 25 mo. Motzer risk score retained its prognostic relevance both in the first and in the second of further line. Patients who received at least 4 cycles at standard dose (50 mg/d 4 wks on/2wks off) had a significantly better PFS and OS compared to patients who did not (PFS 23.0 vs 12.0 mo p=0.012, OS 49.0 vs 16.0 mo p=0.006). First line pts progressing within three months from starting sunitinib were 18.9% (primary refractory), while 25.7% pts were treated for more than 24 mo (long term responders). Grade 3 or 4 toxicities have been recorded in 35% of pts but only 7 pts (6.6%) discontinued the treatment due to unacceptable toxicities. Conclusions: Sunitinib is active and feasible in a broader population of mRCC pts, with apparently superior PFS and OS results compared to pivotal trials. Better management of drug toxicities, less strict criteria for radiological progression, and availability of further sequential treatments may explain such results. Pts receiving at least 4 full dose cycles achieved statistically significant better outcomes.

Long-term response in metastatic renal cell carcinoma patients receiving first-line therapy with VEGF TKIs.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 436-436
Author(s):  
Srinivas Kiran Tantravahi ◽  
Shiven B. Patel ◽  
Sowmya Ravulapati ◽  
Julia A. Batten ◽  
Joseph Merriman ◽  
...  
Keyword(s):  
Renal Cell ◽  
Clinical Characteristics ◽  
Progression Free Survival ◽  
Categorical Variables ◽  
Survival Outcomes ◽  
First Line ◽  
Chi Square ◽  
First Line Therapy ◽  
Term Response

436 Background: A subset of metatstatic renal cell carcincoma (mRCC) patients (pts) on first-line (1st) vascular endothelial growth factor inhibitors (VEGF TKIs) will have a long-term response (LTR) defined as a progression free survival (PFS) of >18 months (mos) on continuous therapy, and may be candidates for intermittent VEGF TKI therapy. Methods: From our institutional dataset of mRCC pts, we identified pts receiving 1st VEGF TKIs and who achieved a LTR. Data on clinical characteristics and survival outcomes were compared between those with LTRs and rest of the patients (control). Continuous and categorical variables were assessed by Wilcoxon rank sum and chi-square, respectively; and survival outcomes were compared by log-rank tests. Results: Of 89 pts, 24 (33%) had LTRs, of whom 5 pts have discontinued treatment (range 1-5 years) without subsequent disease progression, and 4 pts took treatment breaks for 3-9 mos. Baseline pts or disease characteristics were not predictive of LTRs (Table). Conclusions: A subset of mRCC pts receiving 1st VEGF TKIs achieve a LTR, and are not currently identifiable by baseline clinical characteristics including prognostic risk categorization. Identification of biomarkers predictive of LTR may allow intermittent or even deferred therapy with VEGF TKIs minimizing toxicity and cost. [Table: see text]

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