Percutaneous Cryoablation of Clinical T2 Renal Masses–(The Iceman Cometh)
- Journal of Vascular and Interventional Radiology: JVIR
TAKE-HOME MESSAGE— First lets be clear on the stage of these tumors. They were greater than 7 cm and no lymph nodes or metastasis existed. Also the sample size of this study is very small and is from a single institution and is a retrospective report on what some good enterprising radiologists tried against a tumor which is usually highly resistant to chemotherapy and which is starting to see some responses from targeted molecular therapy and monoclonal antibodies ( all tried for the most part in nodal or metastatic disease. These were patients for whom the rimary therapy of stage 1 and 2 is surgery but were deemed not to be ideal surgical candidates
Many of the patients have arterial tumor blood supply super selectively mapped and then clotting of the tumor was attempted. A good portion did not. One can not say whether it helped or hindered( either RX) One can say what they did which is that at this institution they were able to map tumor blood supply and then through the skin freeze the entire tumor mass to death AND have some major consequences, no deaths and excellent survival. This institution is not the only one to try cryotherapy and obviously patients must be carefully selected and radiologists and supporting staff must be well trained and skilled- but the Iceman Cometh and the tumors went away without the GFR glomerular Filtration rate= renal function being permanently or significantly impaired ( Doc Kevin Ryan )
To determine the technical success, safety, and preliminary clinical outcome of percutaneous cryoablation of large (> 7 cm) renal masses.
MATERIALS AND METHODS
Twelve patients underwent percutaneous cryoablation for treatment of renal tumors measuring greater than 7 cm (clinical stage II, T2aN0M0) between 2004 and 2013. Median patient age was 75 years (range, 46-84 y), median Charlson comorbidity index was 5 (range, 4-9), and median maximal tumor diameter was 8.4 cm (range, 7.2-9.7 cm). Seven of the 12 patients underwent superselective intraarterial tumor embolization before cryoablation. Technical success, procedural complications, renal function, and oncologic and survival outcomes were evaluated for each patient.
All cryoablation procedures were technically successful in a single treatment session, with no mortalities at 30 days. Two patients (17%) experienced major complications related to postprocedural hemorrhage. Median change in estimated glomerular filtration rate within 7 days following cryoablation treatment was 11 mL/min (range, 7-14 mL/min). One patient with baseline stage IV chronic kidney disease and a major bleeding complication required temporary dialysis in the periprocedural period. In 11 patients (92%) who had follow-up beyond 3 months after the procedure (mean, 19 mo; range, 4-49 mo), recurrence-free survival and overall survival rates at 2 years were 100% and 91%, respectively.
Percutaneous cryoablation of large (> 7 cm) renal masses was technically successful, with effective preliminary clinical outcomes. However, major complications are more common with cryoablation of stage T2 tumors than is typically encountered with treatment of smaller stage T1 tumors.