Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities

Outcome study in 70 patients

Erich K. Lang, Kan Karl Zhang, Quan Nguyen, Leann Myers, Mahamed Allaf, Ivan Colon

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. Methods: We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. Results: Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. Conclusion: Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.

Original languageEnglish (US)
Pages (from-to)E256-E261
JournalCanadian Urological Association Journal
Volume9
Issue number5-6
DOIs
StatePublished - May 1 2015
Externally publishedYes

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Cryosurgery
Renal Cell Carcinoma
Comorbidity
Outcome Assessment (Health Care)
Recurrence
Small Cell Carcinoma
Lost to Follow-Up
Nephrons
Freezing
Neoplasms
Hospitalization
Tomography

ASJC Scopus subject areas

  • Urology
  • Oncology

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Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities : Outcome study in 70 patients. / Lang, Erich K.; Zhang, Kan Karl; Nguyen, Quan; Myers, Leann; Allaf, Mahamed; Colon, Ivan.

In: Canadian Urological Association Journal, Vol. 9, No. 5-6, 01.05.2015, p. E256-E261.

Research output: Contribution to journalArticle

Lang, Erich K. ; Zhang, Kan Karl ; Nguyen, Quan ; Myers, Leann ; Allaf, Mahamed ; Colon, Ivan. / Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities : Outcome study in 70 patients. In: Canadian Urological Association Journal. 2015 ; Vol. 9, No. 5-6. pp. E256-E261.
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abstract = "Introduction: The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. Methods: We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. Results: Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. Conclusion: Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.",
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AB - Introduction: The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. Methods: We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. Results: Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. Conclusion: Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.

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