Frequent radiofrequency ablation (RFA) therapy in a case of lung metastases after surgery of bilateral metastases of renal cell carcinoma

Abstract Background To determine safety and efficacy of radiofrequency ablation (RFA) for local treatment of lung metastases of renal cell carcinoma (RCC), sequenced or combined with systemic treatments. Methods Retrospectively, we studied 53 patients treated by RFA for a maximum of six lung metastases of RCC. The endpoints were local efficacy, overall (OS), disease-free (DFS), pulmonary progression-free (PPFS) and systemic treatment-free (STFS) survivals, complications graded by the CTCAE classification and factors associated with survivals. Potential factors analysed were: clinical and pathological data, tumoral staging of TNM classification, primary tumor histology, Fuhrman’s grade, age, number and size of lung metastases and extra-pulmonary metastases pre-RFA. Results One hundred metastases were treated by RFA. Median follow-up time was 61 months (interquartile range 90–34). Five-year OS was 62% (95% confidence interval (CI): 44–75). Median DFS was 9.9 months (95% CI: 6–16). PPFS at 1 and 3 years was 58.9% (95%CI: 44.1–70.9) and 35.2% (95%CI: 21.6–49.1), respectively. We observed 3% major complications (grade 3 and 4 of CTCAE classification). Local efficacy was 91%. Median STFS was 28.3 months. Thirteen patients (25%) with lung recurrence could be treated by another RFA. T3/T4 tumors had significantly worse OS, PPFS and STFS. Having two or more lung metastases increased the risk of pulmonary progression more than threefold. Conclusion Integrated to systemic treatment strategy, RFA is safe and effective for the treatment strategy of lung metastasis from RCC with good OS and long systemic treatment-free survival. RFA offers the possibility of repeat procedures, with low morbidity.

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Hyperprogressive disease after radiotherapy combined with anti-PD-1 therapy in renal cell carcinoma: a case report and review of the literature

BMC Urology ◽

10.1186/s12894-021-00813-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chao Liu ◽

Jingjing Piao ◽

Zhiyang Shang

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

General Condition ◽

Renal Cell ◽

Checkpoint Inhibitors ◽

Lung Metastases ◽

Left Lung ◽

The Third ◽

Bidirectional Regulation ◽

Hyperprogressive Disease

Abstract Background Studies have shown that immune checkpoint inhibitors (ICIs) have limited efficacy and can even increase tumour burden in short time periods. This is usually called hyperprogressive disease (HPD). To date, there are few reports regarding HPD; fewer have analysed the relationship between HPD and radiotherapy combined with ICIs, and their conclusions are controversial. Case presentation A 42-year-old woman was diagnosed with stage IV renal clear cell carcinoma. The patient had previously received sorafenib and pazopanib as first- and second-line therapies, respectively. She received radiotherapy combined with nivolumab. Eighteen days after administration of the third dose of nivolumab, the patient’s general condition deteriorated; this was associated with immune-related adverse events. Computed tomography showed that the diameter of left lung metastases had sharply increased. A biopsy of the lung metastasis showed no infiltration of lymphocytes. The patient’s general condition worsened and she died of the disease on the 70th day after administration of the third dose of nivolumab. Conclusions This report describes the development of HPD following the administration of radiotherapy combined with ICIs in a case of advanced renal cell carcinoma. The case indicates that radiotherapy may show bidirectional regulation effects on anti-tumour immune response. If the immunosuppressive function of radiotherapy is dominant, combined with ICIs, it could result in HPD.

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Commentary on “Cytoreductive radiofrequency ablation in patients with metastatic renal cell carcinoma (RCC) with small primary tumours treated with sunitinib or interferon-α.” Tsimafeyeu I, Zart JS, Chung B, Kidney Cancer Research Bureau, Moscow, Russian Federation.

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2013.12.011 ◽

2014 ◽

Vol 32 (4) ◽

pp. 514-515

Author(s):

Stephen Boorjian

Keyword(s):

Renal Cell Carcinoma ◽

Cancer Research ◽

Radiofrequency Ablation ◽

Cell Carcinoma ◽

Kidney Cancer ◽

Metastatic Renal Cell Carcinoma ◽

Russian Federation ◽

Renal Cell ◽

Interferon Α ◽

Small Primary

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1199 RADIOFREQUENCY ABLATION ACHIEVES COMPARABLE LOCAL ONCOLOGICAL CONTROL TO PARTIAL NEPHRECTOMY FOR T1 RENAL CELL CARCINOMA

The Journal of Urology ◽

10.1016/j.juro.2013.02.2553 ◽

2013 ◽

Vol 189 (4S) ◽

Cited By ~ 2

Author(s):

Sarah Psutka ◽

W. Scott McDougal ◽

Douglas Dahl ◽

Francis McGovern ◽

Peter Mueller ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Radiofrequency Ablation ◽

Cell Carcinoma ◽

Partial Nephrectomy ◽

Renal Cell

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Renal cell carcinoma radiofrequency ablation: evaluation of efficacy based on histological correlation

British Journal of Radiology ◽

10.1259/bjr/19509680 ◽

2008 ◽

Vol 81 (966) ◽

pp. 479-484 ◽

Cited By ~ 8

Author(s):

S MYLONA ◽

S NTAI ◽

E STROUMPOULI ◽

V GLENTZES ◽

S MARTINIS ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Radiofrequency Ablation ◽

Cell Carcinoma ◽

Renal Cell

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Immunotherapy for Lung Metastases of Murine Renal Cell Carcinoma

Journal of Immunotherapy ◽

10.1097/00002371-199907000-00004 ◽

1999 ◽

Vol 22 (4) ◽

pp. 308-314 ◽

Cited By ~ 13

Author(s):

Nobuyasu Nishisaka ◽

Atul Maini ◽

Yoshihisa Kinoshita ◽

Ryoji Yasumoto ◽

Taketoshi Kishimoto ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Lung Metastases

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Comparison of General Anesthesia and Conscious Sedation during Computed Tomography–Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2017.07.003 ◽

2018 ◽

Vol 69 (1) ◽

pp. 24-29 ◽

Cited By ~ 8

Author(s):

Hae Jin Kim ◽

Byung Kwan Park ◽

In Sun Chung

Keyword(s):

Renal Cell Carcinoma ◽

Radiofrequency Ablation ◽

General Anesthesia ◽

Cell Carcinoma ◽

Renal Cell ◽

Conscious Sedation ◽

Tumour Progression ◽

Tumour Size ◽

General Anesthesia Group ◽

The Mean

Purpose Percutaneous radiofrequency ablation is so painful that this treatment requires pain control such as conscious sedation or general anesthesia. It is still unclear which type of anesthesia is better for treatment outcomes of renal cell carcinoma. This study aimed to compare general anesthesia and conscious sedation in treating patients with renal cell carcinoma with radiofrequency ablation. Methods Between 2010 and 2015, 51 patients with biopsy-proven renal cell carcinomas (<4 cm) were treated with computed tomography–guided radiofrequency ablation. General anesthesia was performed in 41 and conscious sedation was performed in 10 patients. Tumour size, local tumour progression, metastasis, major complication, effective dose, glomerular filtration rate difference, and recurrence-free survival rate were compared between these groups. Results The mean tumour size was 2.1 cm in both groups ( P = .673). Local tumour progression occurred in 0% (0 of 41) of the general anesthesia group, but in 40% (4 of 10) of the conscious sedation group ( P = .001). Metastases in these groups occurred in 2.4% (1 of 41) of the general anesthesia group and 20% (2 of 10) of the conscious sedation group ( P = .094). No major complications developed in either group after the first radiofrequency ablation session. The mean effective doses in these groups were 21.7 mSv and 21.2 mSv, respectively ( P = .868). The mean glomerular filtration rate differences in the general anesthesia and conscious sedation groups were −13.5 mL/min/1.73 m2 and −19.1 mL/min/1.73 m2, respectively ( P = .575). Three-year recurrence-free survival rates in these groups were 97.6% and 60.0%, respectively ( P = .001). Conclusions General anesthesia may provide better intermediate outcomes than conscious sedation in treating small renal cell carcinomas with radiofrequency ablation.

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