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La radiologia medica

, Volume 117, Issue 4, pp 593–605 | Cite as

CT-guided percutaneous cryoablation of renal masses in selected patients

  • C. SpreaficoEmail author
  • N. Nicolai
  • R. Lanocita
  • C. Morosi
  • M. Catanzaro
  • E. Civelli
  • T. Torelli
  • S. Stagni
  • L. Piva
  • L. F. Frigerio
  • A. Marchianò
  • R. Salvioni
Uro-Genital Radiology / Radiologia Uro-Genitale

Abstract

Purpose

We analysed our experience with computed tomography (CT)-guided percutaneous cryoablation (PCA) in patients who were not surgical candidates or refused surgery for small to medium-sized renal masses.

Materials and methods

Two freezing cycles were applied and separated by a passive warming cycle using 1.7- and 2.4-mm cryoprobes under either general anaesthesia or sedation based on patient positioning and respiratory status. Postoperative monitoring included haematological and biochemistry evaluation and CT scan 24 h after PCA. Follow-up consisted of a multislice CT scan at 1 month and every 3 months in the first year then every 6 months thereafter.

Results

Thirty-seven patients (38 lesions) underwent 40 PCA procedures; 5/37 (13.5%) had a solitary kidney. Median mass size was 35 (range 12–70) mm. No complications occurred during the procedure. Clavien grade ≥2 anaemia occurred in two patients (5.4 %): one patient required 1 U of packed red blood cells; the other required an arterial embolisation. Serum creatinine did not increase in any case. Two patients showed persisting or recurrent disease at 1 and 9 months, respectively, and both could be re-treated with PCA. All other patients showed a hypodense mass 3 months after PCA, with no contrast enhancement. Subsequent examinations showed that lesion sizes decreased and CT densitometry remained stable or increased minimally, also with no contrast enhancement.

Conclusions

PCA proved relatively easy and safe and could be considered an effective alternative for patients who are not surgical candidates or refuse surgery, as well as in patients with medium-sized lesions.

Keywords

Renal cell cancer Percutaneous cryoablation 

Crioablazione percutanea TC-guidata delle masse renali in pazienti selezionati

Riassunto

Obiettivo

Scopo del nostro lavoro è stato valutare la nostra esperienza nella crioablazione percutanea tomografia computerizzata (TC)-guidata (PCA) in pazienti con neoplasie renali di piccola-media dimensione che hanno rifiutato la chirurgia o non candidabili ad essa.

Materiali e metodi

Due cicli di congelamento, separati da un ciclo di riscaldamento passivo, con sonde da 1,7 e 2,4 mm, in anestesia generale o sedazione in base alla posizione e allo stato respiratorio del paziente. Il monitoraggio postoperatorio include esami ematologici e una TC dopo 24 ore. Il follow-up prevede controlli TC con contrasto a 1 mese, quindi ogni 3 mesi nel primo anno e successivamente ogni 6 mesi.

Risultati

Trentasette pazienti (38 lesioni) sono stati sottoposti a 40 PCA; 5/37 (13,5%) presentavano rene unico. Il diametro mediano delle masse era 35 mm (12–70 mm). Non si è presentata nessuna complicazione durante la procedura. Abbiamo riscontrato anemia di grado ≥2 secondo Clavien in 2 casi (5,4%): un caso è stato trattato con trasfusione di emazie concentrate, l’altro con una embolizzazione arteriosa parziale del rene. La creatinina serica non è aumentata in nessun caso. Due pazienti hanno mostrato malattia persistente o recidivante a 1 e 9 mesi: entrambi sono stati ritrattati con PCA con successo. Tutti gli altri pazienti avevano alla TC una massa ipodensa dopo 3 mesi, senza captazione contrastografica. I controlli successivi hanno mostrato una progressiva riduzione dimensionale delle lesioni, con densitometria stabile o in minimo incremento, senza captazione di contrasto.

Conclusioni

La PCA è procedura relativamente facile e sicura e può essere considerata una valida alternativa nei pazienti che non sono candidabili o che rifiutano la chirurgia, anche in tumori di media grandezza.

Parole chiave

Carcinoma renale Crioablazione percutanea 

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References/Bibliografia

  1. 1.
    Gill IS, Aron M, Gervais DA, Jewett MA (2010) Clinical practice. Small renal mass. N Engl J Med 362:624–634PubMedCrossRefGoogle Scholar
  2. 2.
    Frank I, Blute ML, Cheville JC et al (2003) Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 170:2217–2220PubMedCrossRefGoogle Scholar
  3. 3.
    Chawla SN, Crispen PL, Hanlon AL et al (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175:425–431PubMedCrossRefGoogle Scholar
  4. 4.
    Cambio AJ, Evans CP (2006) Management approaches to small renal tumours. BJU Int 97:456–460PubMedCrossRefGoogle Scholar
  5. 5.
    Duque JL, Loughlin KR, O’Leary MP et al (1998) Partial nephrectomy: alternative treatment for selected patients with renal cell carcinoma. Urology 58:584–590CrossRefGoogle Scholar
  6. 6.
    Novick AC (2004) Laparoscopic and partial nephrectomy. Cancer Res 10:6322–6327CrossRefGoogle Scholar
  7. 7.
    Weld KJ, Figenshau RS, Venkatesh R et al (2007) Laparoscopic cryoablation for small renal masses: three-year followup. Urology 69:448–451PubMedCrossRefGoogle Scholar
  8. 8.
    Wyler SF, Sulser T, Ruszat R et al (2007) Intermediate-term results of retroperitoneoscopy-assisted cryotherapy for small renal tumors using multiple ultrathin cryoprobes. Eur Urol 51:971–979PubMedCrossRefGoogle Scholar
  9. 9.
    Hafron J, Kaouk JH (2007) Cryosurgical ablation of renal cell carcinoma. Cancer Control 14:211–217PubMedGoogle Scholar
  10. 10.
    Aron M, Gill IS (2007) Minimally invasive nephron-sparing surgery (MINSS) for renal tumors. Part II: probe ablative therapy. Eur Urol 51:248–357Google Scholar
  11. 11.
    Shingleton WB, Sewell PE Jr (2003) Cryoablation of renal tumours in patients with solitary kidneys. BJU Int 92:237–239PubMedCrossRefGoogle Scholar
  12. 12.
    Georgiades CS, Hong K, Marx J et al (2007) Percutaneous cryoablation for renal tumors: safety and short term follow-up. Presented at the CIRSE Annual Meeting 2007 September 8–12; Athens, GreeceGoogle Scholar
  13. 13.
    Campbell SC, Krishnamurthi V, Chow G et al (1998) Renal cryosurgery: experimental evaluation of treatment parameters. Urology 52:29–33PubMedCrossRefGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  15. 15.
    Nguyen CT, Lane BR, Kaouk JH et al (2008) Surgical salvage of renal cell carcinoma recurrence after thermal ablative therapy. J Urol 180:104–109PubMedCrossRefGoogle Scholar
  16. 16.
    Kunkle DA, Egleston BL, Uzzo RG (2008) Excise, ablate or observe: the small renal mass dilemma-a metaanalysis and review. J Urol 179:1227–1234PubMedCrossRefGoogle Scholar
  17. 17.
    Weld KJ, Landman J (2005) Comparison of cryoablation, radiofrequency ablation and highintensity focused ultrasound for treating small renal tumours. BJU International 96:1224–1229PubMedCrossRefGoogle Scholar
  18. 18.
    Laguna MP, Beemster P, Kumar P et al (2009) Perioperative morbidity of laparoscopic cryoablation of small renal masses with ultrathin probes: a European multicentre experience. Eur Urol 56:355–361PubMedCrossRefGoogle Scholar
  19. 19.
    Finley DS, Beck S, Box G et al (2008) Percutaneous and laparoscopic cryoablation of small renal masses. J Urol 180:492–498PubMedCrossRefGoogle Scholar
  20. 20.
    Saliken JC, Donnelly BJ, Rewcastle JC et al (2002) The evolution and state of modern technology for prostate cryosurgery. Urology 60:26–33PubMedCrossRefGoogle Scholar
  21. 21.
    Heuer R, Gill IS, Guazzoni G et al. (2010) A critical analysis of the actual role of minimally invasive surgery and active surveillance for kidney cancer. Eur Urol 57:223–232PubMedCrossRefGoogle Scholar
  22. 22.
    Aron M, Kamoi K, Remer E et al (2010) Laparoscopic renal cryoablation: 8-year, single surgeon outcomes. J Urol 183:889–895PubMedCrossRefGoogle Scholar
  23. 23.
    Permpongkosol S, Link RE, Kavoussi LR et al (2006) Percutaneous computerized tomography guided cryoablation for localized renal cell carcinoma: factors influencing success. J Urol 176:1963–1968PubMedCrossRefGoogle Scholar
  24. 24.
    Atwell TD, Farrell MA, Callstrom MR et al (2007) Percutaneous cryoablation of large renal masses: technical feasibility and short-term outcome. AJR Am J Roentgenol 188:1195–1200PubMedCrossRefGoogle Scholar
  25. 25.
    Weight CJ, Kaouk JH, Hegarty NJ et al (2008) Correlation of radiographic imaging and histopathology following cryoablation and radiofrequency ablation for renal tumors. J Urol 179:1277–1283PubMedCrossRefGoogle Scholar
  26. 26.
    Matin SF (2010) Determining failure after renal ablative therapy for renal cell carcinoma: false-negative and falsepositive imaging findings. Urology 75:1254–1257PubMedCrossRefGoogle Scholar
  27. 27.
    Porter CA 4th, Woodrum DA, Callstrom MR et al (2010) MRI after technically successful renal cryoablation: early contrast enhancement as a common finding. AJR Am J Roentgenol 194:790–793PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • C. Spreafico
    • 1
    Email author
  • N. Nicolai
    • 1
  • R. Lanocita
    • 1
  • C. Morosi
    • 1
  • M. Catanzaro
    • 1
  • E. Civelli
    • 1
  • T. Torelli
    • 1
  • S. Stagni
    • 1
  • L. Piva
    • 1
  • L. F. Frigerio
    • 1
  • A. Marchianò
    • 1
  • R. Salvioni
    • 1
  1. 1.Department of RadiologyNational Cancer InstituteMilanItaly

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