Abstract
BackgroundTo determine safety and efficacy of radiofrequency ablation (RFA) for local treatment of lung metastases of renal cell carcinoma (RCC), sequenced or combined with systemic treatments.MethodsRetrospectively, we studied 53 patients treated by RFA for a maximum of six lung metastases of RCC. The endpoints were local efficacy, overall (OS), disease-free (DFS), pulmonary progression-free (PPFS) and systemic treatment-free (STFS) survivals, complications graded by the CTCAE classification and factors associated with survivals. Potential factors analysed were: clinical and pathological data, tumoral staging of TNM classification, primary tumor histology, Fuhrman’s grade, age, number and size of lung metastases and extra-pulmonary metastases pre-RFA.ResultsOne hundred metastases were treated by RFA. Median follow-up time was 61 months (interquartile range 90–34). Five-year OS was 62% (95% confidence interval (CI): 44–75). Median DFS was 9.9 months (95% CI: 6–16). PPFS at 1 and 3 years was 58.9% (95%CI: 44.1–70.9) and 35.2% (95%CI: 21.6–49.1), respectively. We observed 3% major complications (grade 3 and 4 of CTCAE classification). Local efficacy was 91%. Median STFS was 28.3 months. Thirteen patients (25%) with lung recurrence could be treated by another RFA. T3/T4 tumors had significantly worse OS, PPFS and STFS. Having two or more lung metastases increased the risk of pulmonary progression more than threefold.ConclusionIntegrated to systemic treatment strategy, RFA is safe and effective for the treatment strategy of lung metastasis from RCC with good OS and long systemic treatment-free survival. RFA offers the possibility of repeat procedures, with low morbidity.
Highlights
To determine safety and efficacy of radiofrequency ablation (RFA) for local treatment of lung metastases of renal cell carcinoma (RCC), sequenced or combined with systemic treatments
The aim of this study was to evaluate results of RFA of lung metastases from kidney cancer in terms of local ablation efficacy, overall survival (OS), disease-free survival (DFS) and systemic treatment-free survival (STFS), and to define the factors associated with better outcomes
The aim of this study was to investigate local efficacy, survivals and occurrence of complications after local treatment by RFA for RCC lung metastases treated over time at our institution, as well as the time without systemic treatment in order to report a potential effect of RFA on systemic treatment sparing
Summary
To determine safety and efficacy of radiofrequency ablation (RFA) for local treatment of lung metastases of renal cell carcinoma (RCC), sequenced or combined with systemic treatments. The most frequent site of metastasis and recurrence is the lung, with more than 50–60% of patients developing lung metastases [3]. Both targeted therapy and immunotherapy have broadened treatment options and improved prognosis [4,5,6], but systemic treatments remain expensive and targeted therapies are known to affect quality of life by their related toxicities. Thermal ablation like radiofrequency (RFA) is effective with few complications and repeatable without distorting lung function [7].
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