Abstract No. 110 Trans-arterial embolization of renal cell carcinoma: a systematic review and meta-analysis

Abstract

To evaluate if trans-arterial embolization (TAE) of the primary tumor in patients with renal cell carcinoma (RCC) improves oncologic outcomes such as progression-free survival (PFS) and overall survival (OS) or symptomatology such as pain and hematuria The systematic review search included PubMed, Ovid/MEDLINE, and Embase for full text English articles including randomized and non-randomized prospective trials as well as prospective and retrospective case series. To be included, prospective trials needed ≥25 patients in each arm while case series and retrospective chart reviews required at least two patients. Evaluated outcomes included PFS, OS, change in tumor size, improvements in pain, improvements in hematuria, and adverse events (AEs). 1,327 articles were retrieved and screened. 9 studies met inclusion criteria (retrospective case series, n = 8; non-randomized prospective trial, n = 1) which included 237 patients (M = 156 (65.8%); F = 56 (23.6%); gender unreported = 25 (10.5%); mean age: 69.4 (range: 38-87)) with a mean tumor diameter of 9.3cm (5.2-10.5). When reported, the TNM stages were stage I (n = 10), II (n = 18), III (n = 36), and IV (n = 121). Median OS ranged from 1-39 months but only one study reported PFS (10.5 months). One study demonstrated a statistically significant improvement in OS with TAE (P = 0.02). A reduction in tumor size was only achieved in 17 patients limiting evaluation. 60 patients had pain and hematuria. After TAE, pain improved in 59 patients (98.3%) and hematuria improved in 57 patients (95%). A meta-analysis for improvements in pain and hematuria demonstrated an event rate of pain improvement of 0.952 (0.788-0.990; P< 0.001) and an event rate for hematuria improvement of 0.923 (0.809-0.971; P< 0.001). AEs included: fever (n = 115), flank pain (n = 72), nausea (n = 58), hematuria (n = 12), hypertension (n = 12), reduced GFR (n = 6), hematoma (n = 6), and ileus (n = 3). TAE of the primary tumor in patients with RCC improves symptomatology such as pain and hematuria, has an acceptable safety profile, and may have benefits to OS. TAE of the primary tumor should be utilized more frequently in patients with RCC, although further studies are needed to better assist in patient selection.