PD51-12 COMPARISON OF MID-TERM ONCOLOGICAL OUTCOMES OF ACTIVE SURVEILLANCE AND PERCUTANEOUS CRYOABLATION OF SMALL RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Active Surveillance1 Apr 2018PD51-12 COMPARISON OF MID-TERM ONCOLOGICAL OUTCOMES OF ACTIVE SURVEILLANCE AND PERCUTANEOUS CRYOABLATION OF SMALL RENAL MASSES Paolo Umari, Michele Rizzo, Michele Billia, Nicola Pavan, Gaetano Chiapparrone, Giovanni Liguori, Fulvio Stacul, Monica Zacchero, Paolo De Angelis, Alessandro Volpe, and Carlo Trombetta Paolo UmariPaolo Umari More articles by this author , Michele RizzoMichele Rizzo More articles by this author , Michele BilliaMichele Billia More articles by this author , Nicola PavanNicola Pavan More articles by this author , Gaetano ChiapparroneGaetano Chiapparrone More articles by this author , Giovanni LiguoriGiovanni Liguori More articles by this author , Fulvio StaculFulvio Stacul More articles by this author , Monica ZaccheroMonica Zacchero More articles by this author , Paolo De AngelisPaolo De Angelis More articles by this author , Alessandro VolpeAlessandro Volpe More articles by this author , and Carlo TrombettaCarlo Trombetta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2352AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is considered the standard approach for small renal masses (SRMs). Active surveillance (AS) and ablative therapies represent emerging strategies for older and comorbid patients due to the indolent behaviour of most SRMs and to the high competing risk mortality. Aim of this study was to compare the mid-term oncological outcomes of AS and percutaneous cryoablation (PCA) of small renal masses (SRMs). METHODS Data regarding PCA and AS in patients with a single T1a renal tumors were collected prospectively at two large academic centers. 60 patients underwent PCA and 77 were enrolled in a AS protocol. The minimum follow-up period was 6 months. The most frequent indications for AS were severe comorbidities (48,1%), <15 mm renal masses (23,4%) and advanced age (15,6%). All patients in AS were followed with a standardized protocol including serial imaging (US, CT or MRI) every 6 months during the first 3 years and yearly thereafter. Tumor progression was defined as the reach of a 4 cm threshold in maximum diameter or a tumor volume doubling time <12 months. All PCA procedures were performed with a percutaneous approach. A double freeze-thaw cycle was performed using a mean of 2 sealed argon 17G cryoprobes per patient. Tumor progression after PCA was defined as a new nodular enhancement in the ablation zone or the enlargement of the ablated tumor 3 months after the treatment. RESULTS 14 masses showed dimensional progression during AS and 9 were surgically removed after a median follow-up of 30 months. 3 patients in the PCA group experienced progression and underwent a repeat ablation with a median follow-up of 24 months. Progression free survival (PFS) at 2 years was 94,8% and 95,0% for AS and PCA group, respectively. None of the patients progressed to metastatic disease. Overall survival at 2 years was 93,5% and 95,0% in the AS and PCA group, respectively. In the PCA group the complication rate was 5% (Clavien grade 1-2). CONCLUSIONS There are no good quality studies comparing the oncological outcomes of AS and PCA. Comparing AS to an active treatment is not an easy task due to the different definitions of the oncological endpoints such as PFS. With these limitations this study shows that both AS and PCA represent viable and safe treatment options for elderly and comorbid patients with SRMs. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e980 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Paolo Umari More articles by this author Michele Rizzo More articles by this author Michele Billia More articles by this author Nicola Pavan More articles by this author Gaetano Chiapparrone More articles by this author Giovanni Liguori More articles by this author Fulvio Stacul More articles by this author Monica Zacchero More articles by this author Paolo De Angelis More articles by this author Alessandro Volpe More articles by this author Carlo Trombetta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...