Percutaneous Radiofrequency Ablation versus Percutaneous Cryoablation for Renal Cell Carcinoma: Long-term Functional and Oncologic Outcomes
CUA Online Library. Samarasekera D. 06/24/13; 31265; MP-03.08
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Abstract
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Introduction and Objectives: The incidence of small renal masses (SRMs) continues to increase due to the widespread use of cross-sectional imaging. Thermal ablative therapies represent an alternative to extirpative surgery with minimal morbidity. As a result they have been used in patients with multiple comorbidities. Short-term oncologic efficacy is approaching that of partial nephrectomy. We present our single center experience with percutaneous cryoablation (PCA) and radiofrequency ablation (RFA).
Methods: We retrospectively analyzed our thermal ablation data base and identified 138 patients (160 tumors) who underwent PCA, and 96 patients (121 tumors) who underwent RFA between April 2002 and July 2012. Patient demographics, baseline clinical information, tumor characteristics, renal function, and oncologic outcomes were analyzed. Patients were only included if they had confirmed RCC on biopsy prior to ablation. Recurrent tumor was defined as any enhancing lesion in the ablation bed on follow-up CT or MRI.
Results: Mean age was 66.92±12.11 years for the PCA group versus 65.76±12.10 years for RFA (p=0.448). Mean tumor size was 2.41±0.92 cm versus 2.57±0.98 cm for PCA and RFA, respectively (p=0.188). There were no significant differences in patient demographics, comorbidities, or renal function at baseline. Mean follow-up was 29.0± 20.3 months for PCA vs 53.4 ± 31.2 months for RFA (p<0.001). Estimated glomerular filtration rate (eGFR) at last follow-up was 57.85±24.78 ml/min/1.73m2 for PCA and 54.50±29.04 ml/min/1.73m2 for RFA (p=0.32). Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for PCA vs RFA were 69% vs 67%, 99% vs 93%, 85% vs 68%, and 84% vs 94%, respectively. Nine-year overall and cancer specific survival for RFA was 56% and 91%, respectively.
Conclusions: Long-term thermal ablation survival data is beginning to mature. There was no significant difference in oncologic outcomes between the two treatment modalities, except for local recurrence-free survival which favored the PCA group. Thus, percutaneous RFA is associated with a higher rate of recurrence and retreatment when compared to PCA. However, both PCA and RFA remain a reasonable treatment option for select patients with a small renal mass.
Methods: We retrospectively analyzed our thermal ablation data base and identified 138 patients (160 tumors) who underwent PCA, and 96 patients (121 tumors) who underwent RFA between April 2002 and July 2012. Patient demographics, baseline clinical information, tumor characteristics, renal function, and oncologic outcomes were analyzed. Patients were only included if they had confirmed RCC on biopsy prior to ablation. Recurrent tumor was defined as any enhancing lesion in the ablation bed on follow-up CT or MRI.
Results: Mean age was 66.92±12.11 years for the PCA group versus 65.76±12.10 years for RFA (p=0.448). Mean tumor size was 2.41±0.92 cm versus 2.57±0.98 cm for PCA and RFA, respectively (p=0.188). There were no significant differences in patient demographics, comorbidities, or renal function at baseline. Mean follow-up was 29.0± 20.3 months for PCA vs 53.4 ± 31.2 months for RFA (p<0.001). Estimated glomerular filtration rate (eGFR) at last follow-up was 57.85±24.78 ml/min/1.73m2 for PCA and 54.50±29.04 ml/min/1.73m2 for RFA (p=0.32). Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for PCA vs RFA were 69% vs 67%, 99% vs 93%, 85% vs 68%, and 84% vs 94%, respectively. Nine-year overall and cancer specific survival for RFA was 56% and 91%, respectively.
Conclusions: Long-term thermal ablation survival data is beginning to mature. There was no significant difference in oncologic outcomes between the two treatment modalities, except for local recurrence-free survival which favored the PCA group. Thus, percutaneous RFA is associated with a higher rate of recurrence and retreatment when compared to PCA. However, both PCA and RFA remain a reasonable treatment option for select patients with a small renal mass.
Introduction and Objectives: The incidence of small renal masses (SRMs) continues to increase due to the widespread use of cross-sectional imaging. Thermal ablative therapies represent an alternative to extirpative surgery with minimal morbidity. As a result they have been used in patients with multiple comorbidities. Short-term oncologic efficacy is approaching that of partial nephrectomy. We present our single center experience with percutaneous cryoablation (PCA) and radiofrequency ablation (RFA).
Methods: We retrospectively analyzed our thermal ablation data base and identified 138 patients (160 tumors) who underwent PCA, and 96 patients (121 tumors) who underwent RFA between April 2002 and July 2012. Patient demographics, baseline clinical information, tumor characteristics, renal function, and oncologic outcomes were analyzed. Patients were only included if they had confirmed RCC on biopsy prior to ablation. Recurrent tumor was defined as any enhancing lesion in the ablation bed on follow-up CT or MRI.
Results: Mean age was 66.92±12.11 years for the PCA group versus 65.76±12.10 years for RFA (p=0.448). Mean tumor size was 2.41±0.92 cm versus 2.57±0.98 cm for PCA and RFA, respectively (p=0.188). There were no significant differences in patient demographics, comorbidities, or renal function at baseline. Mean follow-up was 29.0± 20.3 months for PCA vs 53.4 ± 31.2 months for RFA (p<0.001). Estimated glomerular filtration rate (eGFR) at last follow-up was 57.85±24.78 ml/min/1.73m2 for PCA and 54.50±29.04 ml/min/1.73m2 for RFA (p=0.32). Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for PCA vs RFA were 69% vs 67%, 99% vs 93%, 85% vs 68%, and 84% vs 94%, respectively. Nine-year overall and cancer specific survival for RFA was 56% and 91%, respectively.
Conclusions: Long-term thermal ablation survival data is beginning to mature. There was no significant difference in oncologic outcomes between the two treatment modalities, except for local recurrence-free survival which favored the PCA group. Thus, percutaneous RFA is associated with a higher rate of recurrence and retreatment when compared to PCA. However, both PCA and RFA remain a reasonable treatment option for select patients with a small renal mass.
Methods: We retrospectively analyzed our thermal ablation data base and identified 138 patients (160 tumors) who underwent PCA, and 96 patients (121 tumors) who underwent RFA between April 2002 and July 2012. Patient demographics, baseline clinical information, tumor characteristics, renal function, and oncologic outcomes were analyzed. Patients were only included if they had confirmed RCC on biopsy prior to ablation. Recurrent tumor was defined as any enhancing lesion in the ablation bed on follow-up CT or MRI.
Results: Mean age was 66.92±12.11 years for the PCA group versus 65.76±12.10 years for RFA (p=0.448). Mean tumor size was 2.41±0.92 cm versus 2.57±0.98 cm for PCA and RFA, respectively (p=0.188). There were no significant differences in patient demographics, comorbidities, or renal function at baseline. Mean follow-up was 29.0± 20.3 months for PCA vs 53.4 ± 31.2 months for RFA (p<0.001). Estimated glomerular filtration rate (eGFR) at last follow-up was 57.85±24.78 ml/min/1.73m2 for PCA and 54.50±29.04 ml/min/1.73m2 for RFA (p=0.32). Five-year overall, cancer specific, recurrence free, and metastasis-free survival rates for PCA vs RFA were 69% vs 67%, 99% vs 93%, 85% vs 68%, and 84% vs 94%, respectively. Nine-year overall and cancer specific survival for RFA was 56% and 91%, respectively.
Conclusions: Long-term thermal ablation survival data is beginning to mature. There was no significant difference in oncologic outcomes between the two treatment modalities, except for local recurrence-free survival which favored the PCA group. Thus, percutaneous RFA is associated with a higher rate of recurrence and retreatment when compared to PCA. However, both PCA and RFA remain a reasonable treatment option for select patients with a small renal mass.
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