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

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20131199 RADIOFREQUENCY ABLATION ACHIEVES COMPARABLE LOCAL ONCOLOGICAL CONTROL TO PARTIAL NEPHRECTOMY FOR T1 RENAL CELL CARCINOMA Sarah Psutka, W. Scott McDougal, Douglas Dahl, Francis McGovern, Peter Mueller, Debra Gervais, and Adam Feldman Sarah PsutkaSarah Psutka Boston, MA More articles by this author , W. Scott McDougalW. Scott McDougal Boston, MA More articles by this author , Douglas DahlDouglas Dahl Boston, MA More articles by this author , Francis McGovernFrancis McGovern Boston, MA More articles by this author , Peter MuellerPeter Mueller Boston, MA More articles by this author , Debra GervaisDebra Gervais Boston, MA More articles by this author , and Adam FeldmanAdam Feldman Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2553AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radiofrequency ablation (RFA) of small renal masses (SRM) is increasingly offered to select patients with significant comorbidity as an alternative, less invasive, nephron−sparing (NS) therapy. Long−term comparisons of oncologic efficacy between RFA and partial nephrectomy (PN), the current gold standard for T1 renal cell carcinoma (RCC), are lacking. Our objective was to compare long−term oncologic outcomes between patients with clinical T1a and T1b RCC treated with either RFA or PN. METHODS 551 patients underwent NS treatment for SRM between 1998 and 2008. In general, patients selected for RFA had substantial medical comorbidity, were poor surgical candidates, and/or had a projected life-expectancy of less than 10 yrs. Exclusion criteria for this study included history of RCC, multiple synchronous tumors, metastatic disease at presentation, genetic predisposition to RCC, or non−RCC pathology. A total of 380 patients were included in this analysis, including 186 patients who underwent RFA and 194 patients who underwent PN. All patients undergoing RFA had biopsy−proven RCC. Primary endpoints included recurrence−free survival (RFS) and overall survival (OS). RESULTS The mean (range) follow−up for RFA and PN were 4.8 years (0.5−13.1) and 5.4 years (0.5−12.8). Patients undergoing RFA were more likely to have larger tumors (3.1 vs. 2.6 cm, p<0.0001), be older (71.1 vs. 57.4 years, p<0.0001), and have a higher Charlson comorbidity score (5.6 vs. 3.5, p<0.0001). Of the 194 patients undergoing PN, 17 had positive margins (8.8%) and 14 had pT3a disease (7.2%). There were 12 local recurrences (6.5%) after RFA compared to 6 (3.1%) after PN (p=0.12) with mean time to recurrence of 6.3 years for RFA vs. 2.7 years for PN. Statistically, there was no significant difference in RFS between RFA and PN (Figure 1, p=0.07). Overall survival was higher in the PN group (5.2% vs.17.8%, p<0.0001), as was expected given the increased comorbidity and advanced age of patients in the RFA cohort. Death from RCC occurred in 4 patients treated by RFA and 1 treated with PN (p = 0.15). CONCLUSIONS RFS and cancer−specific mortality were comparable following RFA or PN for cT1a and cT1b RCC. For carefully selected patients with significant comorbidity precluding surgical intervention, RFA appears to provide durable oncological control for cT1 RCC in a nephron−sparing manner. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e491 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Psutka Boston, MA More articles by this author W. Scott McDougal Boston, MA More articles by this author Douglas Dahl Boston, MA More articles by this author Francis McGovern Boston, MA More articles by this author Peter Mueller Boston, MA More articles by this author Debra Gervais Boston, MA More articles by this author Adam Feldman Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...