Biopsy-proven Renal Cell Carcinoma Research Articles

Can 18 F FDG PET/CT metabolic parameters be used to noninvasively differentiate between different histopathological subtypes and Fuhrman grades of renal cell cancer?

To evaluate relationship between metabolic PET metabolic parameters and size of the primary tumor, various histopathological subtypes of renal cell carcinoma (RCC) and Fuhrman grade of the tumors. Retrospective analysis of 93 biopsy-proven RCC patients who underwent pretreatment flourine 18 flourodeoxyglucose PET/computed tomography ( 18 F FDG PET/CT) was performed. Quantitative PET parameters, size of the primary tumor, histopathological subtypes and Fuhrman grades of the tumor were extracted. We tried to assess if there was any significant difference in the metabolic patterns of various histopathological subtypes of RCCs, Fuhrman grade of the tumors and size of the primary tumor. A significant correlation was noted between the size of primary tumor and maximum standardized uptake value (SUV max ), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) ( P < 0.01, P < 0.001 and P < 0.001, respectively). SUV max values correlated significantly with the histopathological subtype ( P < 0.001). Further sub-analyses was also done by segregating the patients into Low grade (Fuhrman grade 1 and 2) vs. High grade (Fuhrman grade 3 and 4). SUV max , MTV and TLG were significantly different between high grade vs. low grade tumors. ROC analysis yielded cut off values for SUV max , MTV and TLG to differentiate between high grade from low grade tumors. FDG PET/CT with the use of metabolic PET parameters can differentiate between different histopathological subtypes of RCC. Incorporation of metabolic parameters into clinical practice can potentially noninvasively identify patients with low-grade vs. high-grade RCC.

Percutaneous Image-Guided Cryoablation of Endophytic Renal Cell Carcinoma

PurposeEndophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study.Materials and MethodsPatients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC.ResultsFifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications.ConclusionThis study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up.Level of Evidence 3Retrospective cohort study.Graphic

An Updated Systematic Review and Meta-Analysis on the Technical, Oncologic, and Safety Outcomes of Microwave Ablation in Patients with Renal Cell Carcinoma.

Introduction: Percutaneous microwave ablation (MWA) has emerged as a new energy modality for percutaneous renal tumor ablation with potential advantages over radiofrequency and cryoablation. The goal of our study was to determine MWA outcomes for suspicious renal masses, with a subset analysis for biopsy-proven renal cell carcinoma (RCC) and larger (T1b) tumors. Methods: Studies reporting outcomes of MWA for RCC were identified. Random-effects models with inverse-variance weighting were used to pool outcomes, including technical success rate (TSR), technical efficacy rate (TER), local recurrence rate (LRR), cancer-specific survival rate (CSSR), overall survival rate (OSR), and complications. Results: Among 914 studies captured, 27 studies with 1584 patients (1683 malignant renal tumors) were included. The pooled TSR and TER were 99.6% (95% confidence interval [CI], 98.0%-100%) and 96.2% (95% CI, 93.8%-98.2%). The pooled LRR was 3.2% (95% CI, 1.9%-4.7%). At 1, 3, and 5 years, the pooled CSSRs were 100% (95% CI, 99.4%-100%), 100% (95% CI, 98.4%-100%), and 97.7% (95% CI, 94.5%-99.7%), while pooled OSRs were 99.0% (95% CI, 97.5%-99.9%), 96.0% (95% CI, 93.1%-98.3%), and 88.1% (95% CI, 80.3%-94.2%). The pooled minor and major complication rates were 10.3% (95% CI, 7.1%-13.9%) and 1.0% (95% CI, 0.3%-2.1%). In 204 patients with 208 T1b tumors, the pooled TSR and TER were 100% (95% CI, 96.6%-100%) and 85.2% (95% CI, 71.0%-95.8%). The pooled LRR was 4.2% (95% CI, 0.9%-8.9%). At 1, 3, and 5 years, the pooled CSSRs were 98.2% (95% CI, 88.7%-100%), 97.2% (95% CI, 78.5%-100%), and 98.1% (95% CI, 72.3%-100%). At 1 and 3 years, the pooled OSRs were 94.3% (95% CI, 85.7%-99.6%) and 89.3% (95% CI, 68.7%-100%). The pooled minor and major complication rates were 14.8% (95% CI, 7.4%-23.8%) and 2.6% (95% CI, 0%-7.8%). Conclusions: MWA demonstrated favorable short- to intermediate-term oncologic outcomes with low complication rates, including in the T1b subset, with moderate quality of data and heterogeneity of assessed outcomes. This supports MWA as a safe and effective treatment for RCC and a potential viable option for larger tumors.

Advancing Treatment Frontiers: Radiofrequency Ablation for Small Renal Mass-Intermediate-Term Results.

Our study aims to discern the immediate and intermediate-term oncological outcomes of the patients with small renal mass and who were surgically unfit or were having a bilateral tumor and underwent radiofrequency ablation (RFA) of the mass. We retrospectively and prospectively analyzed the status of the patients who were diagnosed to have small renal masses and were biopsy-proven renal cell carcinoma (RCC) cases, who underwent RFA at our institute from the year 2013 to 2022. Patients were followed-up for 3 years. Data regarding complications were analyzed for all patients who underwent renal RFA along with the 3-year recurrence-free survival (RFS) rate. A total of 28 patients were eligible for the study based on our inclusion and exclusion criteria. Their renal function was recorded. They underwent RFA and were followed-up for a period of 3 years for RFS. Four patients out of the total had immediate complications, out of which two developed a hematoma. Three-year-follow-ups showed six recurrences, overall having 78.6% RFS. Post-procedural renal function was stable as documented by Estimated glomerular filtration rate. Oncological results of RFA in patients with small renal masses who are surgically unfit are associated with a low risk of immediate and intermediate-term deterioration of renal function.

Treatment Outcomes and Toxicity Profile of MRI-Guided Gated-Real Time Online Adaptive Stereotactic Body Radiotherapy to Patients with Pancreatic Tumors

Stereotactic body radiation therapy (SBRT) to patients with inoperable pancreas cancer has shown promising outcomes. Dose escalation is challenging given the associated risks to nearby organs at risk and requires treatment plan adaptation and motion management. This study reports the treatment related adverse events and treatment outcomes of MRI-guided SBRT utilizing gated-real time online adaptive radiotherapy to patients with pancreatic tumors. This is a single institution retrospective IRB approved study and included patients with pancreatic tumors who were treated with MRI-guided SBRT utilizing gated-real time online adaptive radiotherapy, consecutively between 2019 and 2022. All patients were treated with 0.35T MRI linear accelerator. All patients' charts and radiation plans were reviewed for this study. The study included 25 patients treated consecutively to 125 radiation fractions with MRI-guided SBRT. The study included 15 females and 10 males, 19 white, 2 Asians, 1 Latin American and 2 African Americans. The median age was 74, and all patients had pancreatic adenocarcinoma (92%) except two patients who had biopsy proven renal cell carcinoma metastatic to the pancreas without evidence of disease elsewhere. Most patients (68%) received chemotherapy (FOLFIRINOX or Gemcitabine / Protein-bound paclitaxel) prior to SBRT. The median dose to gross target volume (GTV) was 50 Gy, and to planning target volume (PTV) was 35 Gy. All patients were treated in 5 radiation fractions. Thirteen patients (52%) received elective nodal irradiation (ENI). All patients had at least a single real-time online adaptive replanning (median 3 fractions, range 1-5 fractions). All treatment fractions were gated (100%) with MRI guidance. The 1-, 2-, & 3- year local-regional control (LRC) were 81%, 57%, & 57% respectively (Median 16 months). The 1-, 2-, & 3- year Distant Control (DC) were 81%, 74%, & 56% respectively (Median 14 months). The 1-, 2-, 3-year overall survival (OS) were 77%, 35%, & 24% (Median 21 months). Planning Target Volume (PTV) dose ≥40Gy was significantly associated with improved local-regional control (p = 0.02). Gross Target Volume (GTV) dose <50Gy was significantly associated with lower DC (p = 0.03). ENI showed a trend towards improved local-regional control but was not statistically significant (p = 0.1). None of the patients experienced ≥ grade 3 toxicities. Most common adverse event were grades 1 or 2 fatigue (24%), nausea (16%), and abdominal discomfort (12%). In this cohort, MRI-guided SBRT utilizing gated-real time online adaptive radiotherapy was a safe and effective approach for patients with pancreatic tumors who are not surgical candidates. In this study, dose escalation was significantly associated with improved local-regional (PTV ≥40 Gy) and distant control (GTV ≥50Gy). None of the patients experienced grade ≥3 radiation induced adverse events.

First UK patient cohort treated with stereotactic ablative radiotherapy for primary kidney cancer.

Stereotactic ablative radiotherapy (SABR) for primary renal cell carcinoma (RCC) is a promising non-invasive ablative treatment option. A prospective interventional clinical trial published showed that treatment was feasible and well tolerated. We present the first single-institution UK cohort of patients with primary RCC receiving protocol-based SABR with prospective follow-up. We also present a protocol that could be used to facilitate more widespread use of the treatment. Nineteen biopsy-proven primary RCC patients were treated with either 42 Gy in three fractions on alternate days or 26 Gy in a single fraction based on predefined eligibility criteria using either Linear Accelerator or CyberKnife platform. Prospective toxicity data using CTCAE V4.0 and outcome data such as estimated glomerular filtration rate (eGFR) and tumour response using CT thorax, abdomen and pelvis (CT-TAP) were collected at 6 weeks, 3, 6, 12, 18 and 24 months post treatment. The 19 patients had a median age of 76 years (interquartile range [IQR] 64-82 years) and 47.4% were males, and they had a median tumour size of 4.5 cm (IQR 3.8-5.2 cm). Single and fractionated treatment was well tolerated and there were no significant acute side effects. The mean drop from baseline in eGFR at 6 months was 5.4 ml/min and that at 12 months was 8.7 ml/min. The overall local control rate at both 6 and 12 months was 94.4%. Overall survival at 6 and 12 months was 94.7% and 78.3%, respectively. After a median follow-up of 17 months, three patients experienced a Grade 3 toxicity, which was resolved with conservative management. SABR for primary RCC is a safe and feasible treatment for medically unfit patients, which can be delivered in most UK cancer centres using standard Linear Accelerator as well as CyberKnife platforms.

Outcomes of Radiofrequency Ablation for Solitary T1a Renal Cell Carcinoma: A 20-Year Tertiary Cancer Center Experience.

The aim is to determine the long-term oncologic and survival outcomes of the radiofrequency ablation (RFA) of solitary de novo T1a renal cell carcinoma (RCC). We retrospectively reviewed our renal ablation registry and included only patients with new solitary, biopsy-proven T1a RCC (<4 cm) who underwent RFA from January 2001 through December 2020. We collected patient and tumor characteristics. Survival rates were estimated using the Kaplan-Meier method. Of the 243 patients who met our inclusion criteria (160 male and 83 female, median age 68 years), 128 (52.6%) had another primary malignancy other than renal malignancy. Two-hundred forty-three RFA procedures were performed for 243 renal tumors of a median tumor size of 2.5 cm. The median follow-up period was 3.7 years. Most tumors (68.6%) were clear cell RCC. Ten patients (4.1%) experienced Clavien-Dindo Grade III complications. Seven patients(3.1%) developed recurrence at the ablation zone, and 11 (4.5%) developed recurrence elsewhere in the kidney. The 15-year local-recurrence- and disease-free survival were 96.5% and 88.6%, respectively. The 15-year metastasis-free survival and cancer-specific survival were 100%. RFA is a highly effective modality for the management of T1a RCC, with low complication and recurrence rates. Long-term data revealed favorable oncologic and survival outcomes.

SMOC2 promotes an epithelial-mesenchymal transition and a pro-metastatic phenotype in epithelial cells of renal cell carcinoma origin

Renal Cell Carcinoma (RCC) is the most common form of all renal cancer cases, and well-known for its highly aggressive metastatic behavior. SMOC2 is a recently described non-structural component of the extracellular matrix (ECM) that is highly expressed during tissue remodeling processes with emerging roles in cancers, yet its role in RCC remains elusive. Using gene expression profiles from patient samples, we identified SMOC2 as being significantly expressed in RCC tissue compared to normal renal tissue, which correlated with shorter RCC patient survival. Specifically, de novo protein synthesis of SMOC2 was shown to be much higher in the tubular epithelial cells of patients with biopsy-proven RCC. More importantly, we provide evidence of SMOC2 triggering kidney epithelial cells into an epithelial-to-mesenchymal transition (EMT), a phenotype known to promote metastasis. We found that SMOC2 induced mesenchymal-like morphology and activities in both RCC and non-RCC kidney epithelial cell lines. Mechanistically, treatment of RCC cell lines ACHN and 786-O with SMOC2 (recombinant and enforced expression) caused a significant increase in EMT-markers, -matrix production, -proliferation, and -migration, which were inhibited by targeting SMOC2 by siRNA. We further characterized SMOC2 activation of EMT to occur through the integrin β3, FAK and paxillin pathway. The proliferation and metastatic potential of SMOC2 overexpressing ACHN and 786-O cell lines were validated in vivo by their significantly higher tumor growth in kidneys and systemic dissemination into other organs when compared to their respective controls. In principle, understanding the impact that SMOC2 has on EMT may lead to more evidence-based treatments and biomarkers for RCC metastasis.

Abstract CT106: Primary tumor response in T1aN0M0 renal cell carcinoma patients ineligible for surgery and treated with nivolumab and ipilimumab: Results from phase 2 pilot study

Abstract Background: Some patients with primary renal cell carcinoma (RCC) are unable to have surgery for different reasons (functional single kidney with a central, high-complexity RCC, high risk of nephrectomy and dialysis, patients with complex coagulation disorders, etc.). We hypothesize that combination of nivolumab and ipilimumab could eliminate the primary tumor in T1aN0M0 patients ineligible for surgical treatment. Methods: This is a prospective, multicenter, non-randomized phase 2 pilot study. Patients with biopsy-proven clear-cell RCC of ≤4 cm (cT1a), no evidence of any metastases, and unable to have surgery or other nephron-sparing interventions (ablation) or with preference to have no surgery or intervention for any reason received combination of ipilimumab (1 mg/kg intravenously) every 3 weeks for four doses, and nivolumab (240 mg intravenously) every 2 weeks during 16 weeks. The primary endpoint was complete response rate. Simon's two-stage design was used. The null hypothesis that the true complete response rate was 11% and was tested against a one-sided alternative. This design yields a type I error rate of 0.05 and power of 0.9 when the true complete response rate is 60% (alternative hypothesis). The null hypothesis should be rejected if 3 or more responses are observed in 8 patients. Results: Between February 2020 and June 2021, 8 patients were included. Median age was 77.9 years (range 73-89). Patients were Caucasian (100%), predominantly male (75%), 62.5% had centrally located RCC, 25% had ECOG PS 1, and 6 of 8 patients had moderate and severe comorbidities. Median follow-up was 12.7 months (95% CI 5.2-16.5). All patients received immunotherapy during 4 months without grade ≥2 adverse events. No complete responses were observed. Partial responses were found in 2 patients (25%). Median size of the primary tumor at RCC diagnosis and after immunotherapy was 3.11 cm (range 2.2-3.9) and 2.86 cm (range 1.5-4.0), respectively. Any shrinkage of the primary tumor was reported in 4 (50%) patients (change in median sum of diameters -18%). Only one patient had tumor enlargement (+0.5 cm (+13%) after 9 months. SBRT was used in this patient. All other patients are under active surveillance. Next secondary end-point of 3-year progression-free survival will be reported. Conclusions: The activity of immunotherapy against primary tumor was limited in patients with T1aN0M0 RCC ineligible for surgical treatment. Duration of stable disease will be studied with long-term follow-up of these patients. Treatment with nivolumab and ipilimumab was safe in patients with moderate and severe comorbidities. Citation Format: Ilya Tsimafeyeu, Maria Volkova, Rustem Gafanov, Igor Myslevtsev, Andrey Andrianov, Axel Bex. Primary tumor response in T1aN0M0 renal cell carcinoma patients ineligible for surgery and treated with nivolumab and ipilimumab: Results from phase 2 pilot study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT106.

Abstract No. 54 Multi-institutional report of patient characteristics and oncologic outcomes following microwave ablation of biopsy-proven renal cell carcinoma

CT-guided thermal ablation is an option for treatment of small renal masses. The use of microwave ablation (MWA) for these tumors is increasing. We report patient characteristics and oncologic outcomes following microwave ablation of biopsy-proven RCC at 3 high-volume ablation centers.

PD33-09 MULTI-INSTITUTIONAL REPORT OF PATIENT CHARACTERISTICS AND ONCOLOGIC OUTCOMES FOLLOWING MICROWAVE ABLATION OF BIOPSY-PROVEN RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022PD33-09 MULTI-INSTITUTIONAL REPORT OF PATIENT CHARACTERISTICS AND ONCOLOGIC OUTCOMES FOLLOWING MICROWAVE ABLATION OF BIOPSY-PROVEN RENAL CELL CARCINOMA Leo Dreyfuss, Arighno Das, Kimberly Maciolek, Rand Wilcox Vanden Berg, Glenn Allen, Jonathan Fainberg, Tudor Borza, Shane Wells, Stephen Culp, E. Jason Abel, and Timothy McClure Leo DreyfussLeo Dreyfuss More articles by this author , Arighno DasArighno Das More articles by this author , Kimberly MaciolekKimberly Maciolek More articles by this author , Rand Wilcox Vanden BergRand Wilcox Vanden Berg More articles by this author , Glenn AllenGlenn Allen More articles by this author , Jonathan FainbergJonathan Fainberg More articles by this author , Tudor BorzaTudor Borza More articles by this author , Shane WellsShane Wells More articles by this author , Stephen CulpStephen Culp More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , and Timothy McClureTimothy McClure More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002584.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: CT-guided thermal ablation is an option for the treatment of small renal masses. Patients with comorbidities may not tolerate extirpative surgery for localized renal cell carcinoma (RCC) and microwave ablation (MWA) may be considered. We report patient characteristics and outcomes following MWA of biopsy-proven RCC at three high-volume centers. METHODS: Consecutive patients with localized, non-metastatic, pathologically confirmed RCC treated with MWA at three centers were included. Images were reviewed by abdominal radiologists experienced with ablation. Contrast-enhanced CT was performed immediately following ablation to confirm technical success. Surveillance included abdominal cross-sectional imaging at 3-6 month intervals for 2 years and yearly thereafter. Local recurrence was defined radiographically as enhancing tumor within the ablation site following complete ablation. RESULTS: 541 ablations were performed in 492 patients. Patients with hereditary RCC syndromes (n=15), prior RCC (n=107), multifocal/bilateral tumors (n= 82), and benign/negative biopsy (n=27) were excluded. Final analysis included 370 patients (median age 68; 139 female) with sporadic, biopsy-proven RCC. 307 patients had cT1a tumors and 63 patients had cT1b or greater tumors. Compared with T1a tumors, patients with T1b tumors had higher body mass index, Charlson Comorbidity index, and ECOG performance status (p<0.05) but did not differ in gender or age. T1b tumors were more likely to be clear cell RCC (p=0.010) and high grade (0.028). 32 patients developed recurrences at a median time of 12 (IQR 6-26) months. Local recurrence free survival in the entire cohort was 88.7% at 36 months, 92.1% (95% CI 86.6-95.5) for T1a and 88.1% (95% CI 69.8-95.7) for T1b. Local recurrence free survival improved to 97.3% (95% CI 93.6-98.9) when repeat ablations were included in the analysis. Metastatic free survival was 98.2% at 36 months for all patients, 98.8% (95% CI 96.4-99.6) for T1a and 94.8% (95% CI 80.2-98.7) for T1b. RCC subtype and tumor grade were not associated with local recurrence in patients with T1a tumors. For T1b patients, high tumor grade was predictive of local recurrence (p=0.037). CONCLUSIONS: In this multi-institutional series of biopsy-proven RCC, metastatic spread was rare following MWA. Local control can be achieved for cT1a and cT1b tumors, though multiple ablation sessions may be necessary. Microwave ablation for cT1b masses may be a viable option for patients with medical comorbidities precluding surgical management. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e556 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leo Dreyfuss More articles by this author Arighno Das More articles by this author Kimberly Maciolek More articles by this author Rand Wilcox Vanden Berg More articles by this author Glenn Allen More articles by this author Jonathan Fainberg More articles by this author Tudor Borza More articles by this author Shane Wells More articles by this author Stephen Culp More articles by this author E. Jason Abel More articles by this author Timothy McClure More articles by this author Expand All Advertisement PDF DownloadLoading ...

Association of heavy metals and trace elements in renal cell carcinoma: A case-controlled study.

Trace elements and/or heavy metals are important for various biological activities. However, excess amount of these elements is associated with a variety of diseases, including cancer. We aimed to analyse the alterations of trace elements levels in renal cell carcinoma (RCC) patients. In this observational study, patients with biopsy proven RCC were taken as study group while age- and sex-matched healthy volunteers were taken as control. Blood and urine samples were compared for Arsenic (As), Copper (Cu), Manganese (Mn), Selenium (Se), Cadmium (Cd), Lead (Pb) and Mercury (Hg) levels measured by inductively coupled plasma mass-spectroscopy. Serum glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) antioxidant enzymes and lipid peroxidation (LPO) levels were assessed to know the redox status between 2 groups. A total of 76 RCC cases and 64 controls were recruited in the study. A significantly higher concentration of As, Cu, Mn, Cd, Pb and Hg were observed in the blood of RCC patients as compared to controls. However, blood Se level was significantly lower in RCC patients. In 33 (43.4%) patients, one or more heavy metals were higher in the blood above their permitted level as compared to 10 (15.6%) subjects in control group. RCC patients had a higher urinary Mn and Se levels compared to controls. A significantly lower GSH-Px (182.08 ± 132.91 vs. 236.95 ± 132.94, P = 0.04) and a higher LPO levels (26.02 ± 20.79 vs. 14.06 ± 8.44, P = 0.003) were noted in RCC patients than controls. SOD levels were comparable between two groups. A significantly altered heavy metals concentration is noted in the blood and urine in RCC patients as compared to healthy controls. An associated lower levels of GSH-Px antioxidant enzyme and increased LPO in RCC patients signifies an imbalance in the redox status.

Radiofrequency ablation for renal tumours: A retrospective study from a tertiary centre

ObjectiveThis study aimed to evaluate the safety and efficacy outcomes of percutaneous radiofrequency ablation (RFA) for localised renal cell carcinoma (RCC) in a tertiary hospital patient who remained unfit for surgical intervention. MethodsWe retrospectively analysed survival outcomes for patients with biopsy proven RCC treated by RFA at Royal Perth Hospital between September 2009 and May 2018. Complication data were gathered for all patients that underwent renal RFA along with 2- and 5-year recurrence-free survival (RFS) rate and compared the outcomes with data from previous studies. ResultsA total of 69 patients (73 procedures) were eligible for the study, and those patients had biopsy-proven RCC with a minimum of 2-year follow-up. The complication rate was 8.2% (6/73) and local recurrence rate 9.6% (7/73). Two-year RFS is 95.7% and 5-year RFS is 78.8% on a median 3.82-year follow-up (interquartile range 1.90–5.75 years). ConclusionRFA performed at our centre was found to be safe and effective with low complication rates and durable RFS in line with expectations from existing research. Our study demonstrated that RFA is an alternative modality of treatment for small renal tumours in patients unfit for surgical approach.

MP49-07 EFFICACY AND SAFETY OF RENAL CRYOABLATION IN THE TREATMENT OF RENAL CELL CARCINOMA: A MULTI-CENTER PROSPECTIVE REGISTRY STUDY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP49)1 Sep 2021MP49-07 EFFICACY AND SAFETY OF RENAL CRYOABLATION IN THE TREATMENT OF RENAL CELL CARCINOMA: A MULTI-CENTER PROSPECTIVE REGISTRY STUDY Stephen J. Savage, Peter E. Clark, and S. Duke Herrell Stephen J. SavageStephen J. Savage More articles by this author , Peter E. ClarkPeter E. Clark More articles by this author , and S. Duke HerrellS. Duke Herrell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002075.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of small renal cell carcinoma (RCC), specifically clinical T1a RCC, includes a variety of treatment options. However, many of the studies supporting these options are retrospective reviews of a single institution—or even single provider—and thus suffer from concerns about the reproducibility of the results across sites. We present the interim analysis results of a rigorous, high-quality prospective registry collecting comprehensive data from multiple institutions and experts on the efficacy of cryoablation for the treatment of renal lesions. METHODS: TRACE (Tracking Renal Tumors After Cryoablation Evaluation) is a multicenter, prospective, observational, open-label, registry study of patients with an enhancing renal mass suspicious for malignancy. Patients were treated with cryoablation and subsequently followed for five years. RESULTS: Over a 6-year period, seven centers enrolled and treated 250 patients with cryoablation. 246 patients with 252 lesions met inclusion criteria. Of those, 145/246 (58.9%) patients with 146 lesions have biopsy-proven RCC. At the time of this interim analysis, the median follow-up was 42.4 months (0.03-78.29). Overall median lesion size was 2.5 cm. Cryoablation was completed in 245/246 (99%) cases, with 99 procedures performed laparoscopically, 146 percutaneously, and one with an open procedure. There were 42 treatment-related adverse events and 11 serious adverse events totaling 53 adverse events in 40/246 (16.3%) patients. Of these adverse events, 11.3% (6/53) were Clavien-Dindo class III, with no class IV or V events. Only minimal change in renal function was noted in the 12-month period post treatment. The median estimated glomerular filtration rate decreased 3.85 mL/min with a median increase in creatinine of 0.06 mg/dL. The 36-month Kaplan-Meier estimate of time to recurrence, disease specific survival and overall survival for the RCC population was 94.8%, 100% and 91.9%, respectively. CONCLUSIONS: This rigorous, multicenter prospective study provides high-quality, reproducible evidence supporting the efficacy of cryoablation as a primary treatment for clinically suspicious renal masses. Source of Funding: This study was sponsored by BTG International/Boston Scientific Corporation © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e877-e878 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen J. Savage More articles by this author Peter E. Clark More articles by this author S. Duke Herrell More articles by this author Expand All Advertisement Loading ...

Stereotactic Body Radiotherapy for Frail Patients with Primary Renal Cell Carcinoma: Preliminary Results after 4 Years of Experience.

Simple SummarySurgical therapy is currently the standard of care for the treatment of primary renal cell carcinoma (RCC). Alternative strategies such as stereotactic body radiotherapy (SBRT) have emerged as potentially curative treatment approaches. In this study, we show a promising short-term local control effect of SBRT in the management of primary RCC. The treatment was well tolerated with no high-grade side effects. The main advantages are the outpatient management without anesthesia and the non-invasive approach. Thus, SBRT appears to be a promising alternative to surgery, or ablative therapy, to treat primary RCC in patients with poor physical health. Future studies are needed to definitively assess the place of SBRT in the RCC treatment portfolio.Introduction: The aim of this study was to report the oncological outcomes and toxicity of stereotactic body radiotherapy (SBRT) to treat primary renal cell carcinoma (RCC) in frail patients unfit for surgery or standard alternative ablative therapies. Methods: We retrospectively enrolled 23 patients who had SBRT for primary, biopsy-proven RCC at our tertiary center between October 2016 and March 2020. Treatment-related toxicities were defined using CTCAE, version 4.0. The primary outcome was local control which was defined using the Response Evaluation Criteria in Solid Tumors. Results: The median age, Charlson score and tumor size were 81 (IQR 79–85) years, 7 (IQR 5–8) and 40 (IQR 28–48) mm, respectively. The most used dose fractionation schedule was 35 Gy (78.3%) in five or seven fractions. The median duration of follow-up for all living patients was 22 (IQR 10–39) months. Local recurrence-free survival, event-free survival, cancer-specific survival and overall survival were 96 (22/23), 74 (18/23), 96 (22/23) and 83% (19/23), respectively. There were no grade 3–4 side effects. No patients required dialysis during the study period. No treatment-related deaths or late complications were reported. Conclusion: SBRT appears to be a promising alternative to surgery or ablative therapy to treat primary RCC in frail patients.

Fat Necrosis Mimicking Renal Cell Carcinoma Recurrence Following Cryotherapy, Partial Nephrectomy, and Nephrectomy

ObjectiveTo present our experience with three patients surgically treated for suspected recurrent renal cell carcinoma whose final pathology was consistent with tumefactive fat necrosis. MethodsThree patients underwent definitive therapy for biopsy proven renal cell carcinoma (cryoablation, partial nephrectomy, and nephrectomy) and later demonstrated evidence of recurrent renal cell carcinoma on follow up imaging. All three patients underwent surgical resection of the suspected recurrences with final pathology consistent with tumefactive fat necrosis. ResultsThe three patients were 60, 74, and 39-years old, respectively. The previous definitive therapies for renal cell carcinoma were percutaneous ablation, RAPN, and nephrectomy. Each patient had previous surgical pathology that confirmed prior renal cell carcinoma. Signs of recurrence on diagnostic imaging occurred 2 years, 23 months, and 8 months post-definitive therapy. ConclusionIn patients with a history of renal cell carcinoma, consideration of fat necrosis should be taken into account upon seeing imaging concerning for tumor recurrence. Continued analysis of cases with such a diagnosis will be beneficial in recognizing this possibility to avoid unnecessary surgery or therapy when possible.

Abstract No. 467 Analysis of healthcare cost and resource utilization associated with thermal ablation of renal cell carcinoma

To compare hospital expenditures and resource utilization associated with radiofrequency (RFA), cryoablation (CA), and microwave (MWA) for cT1N0M0 renal cell carcinoma (RCC) A retrospective evaluation was conducted in 470 of computer tomography (CT)-guided thermal ablations of biopsy-proven RCC treated with between October 2006 and June 2019. Components of direct and indirect costs were tabulated and compared across the three different ablation modalities. Deterministic sensitivity analysis was performed to evaluate the effect of the individual cost components in the overall cost of ablative treatment. In-hospital resource utilization incurred from the start of the procedure to 30 days after hospital discharge was examined for each ablative technique. Continuous variables were analyzed using the one-way ANOVA test, and categorical variables were analyzed using Pearson’s chi-squared test and the Kruskal-Wallis test. A total of 470 T1N0M0 RCCs with a mean size of 3.2 cm (range, 0.5–6.9 cm) were treated with MWA (n = 86, 18%), RFA (n = 344, 73%) or CA (n = 40, 9%). Baseline patient or tumor characteristics did not differ significantly between the three groups. The median cost of MWA was significantly lower than that of RFA and CA with a cost advantage of $3835 and $2714, respectively (P = 0.0001). The number of ablation probes used was a major determinant of the overall cost, and MWA used the least number of probes (P = 0.0001). Additionally, MWA was associated with the lowest utilization of procedure room time, anesthesia medications, and radiation dose when compared to RFA and CA (P = 0.001, P = 0.001, and P = 0.001, respectively). Hospital spending and resource utilization in the 30 days immediately after the procedure are similar among the three ablative techniques. Microwave ablation is associated with lowest procedural costs and resource utilization compared to RFA and CA for the treatment of T1 RCC. These findings may incentivize wider use of MWA to optimize value-based care in ablation practice.

Effect of iodinated contrast material on post-operative eGFR when administered during renal mass ablation.

To evaluate the effect of intravenous iodinated contrast on estimated glomerular filtration rate (eGFR) when administered immediately after thermal ablation of clinically localized T1a (cT1a) renal cell carcinoma (RCC). This HIPAA-compliant, dual-center retrospective study was performed under a waiver of informed consent. Three hundred forty-two consecutive patients with cT1a biopsy-proven RCC were treated with percutaneous ablation between January 2010 and December 2017. Immediate post-ablation contrast-enhanced CT was the routine standard of care at one institution (contrast group), but not the other (control group). One-month pre- and 6-month post-ablation eGFR were compared using the Wilcoxon signed-rank test or the Kruskal-Wallis test. Multivariate linear regression was used to determine the effect of contrast on eGFR. A 1:1 propensity score matching was performed for all patients with a logistic model using patient, tumor, and procedural covariates. In total, 246 patients (158 M; median age 69 years, IQR 62-74) were included. Median tumor diameter (2.4 vs 2.5, p = 0.23) and RENAL nephrometry scores (6 vs 6, p = 0.92), surrogates for ablation zone size, were similar. Baseline kidney function was similar for the control and contrast groups, respectively (median eGFR: 70 vs 74 mL/min/1.73 m2, p = 0.29). There was an expected mild decline in eGFR after ablation (control: 70 vs 60 mL/min/1.73 m2, p < 0.001; contrast: 75 vs 71 mL/min/1.73 m2, p = 0.001). Intravenous iodinated contrast was not associated with a decline in eGFR on multivariate linear regression (1.91, 95% CI - 3.43-7.24, p = 0.46) or 1:1 propensity score-matched model (- 0.33, 95% CI - 6.81-6.15, p = 0.92). Intravenous iodinated contrast administered during ablation of cT1a RCC has no effect on eGFR. • Intravenous iodinated contrast administered during thermal ablation of clinically localized T1a renal cell carcinoma has no effect on kidney function. • Thermal ablation of clinically localized T1a renal cell carcinoma results in a mild decline in kidney function. • A decline in kidney function is similar for radiofrequency and microwave ablation of clinically localized T1a renal cell carcinoma.

Overall Survival of Biopsy-confirmed T1B and T2A Kidney Cancers Managed With Observation: Prognostic Value of Tumor Histology.

The natural history of T1b (4-7 cm) or T2a (> 7-10 cm) kidney cancers managed with observation is not well-understood. The aim of our study was to determine if the addition of histologic subtype to a predictive model of overall survival (OS) that includes covariates for competing risks in observed, biopsy-proven, T1b and T2a renal cell carcinomas (RCCs) improves the model's performance. We queried the National Cancer Database for patients with biopsy-proven stage T1b or T2a RCC and managed nonoperatively between 2004 and 2015. OS was estimated by Kaplan-Meier curves based on histologic subtype. The concordance index (c-index) from a Cox proportional hazards model was used to estimate the extent to which histologic subtypes predict survival for each stage when included in a model along with competing risks of age, gender, race/ethnicity, insurance status, area-level socioeconomic indicators, Charlson-Deyo index, and tumor grade. A total of 937 patients (754 with T1b and 185 with T2a) with biopsy-proven RCC were identified. Kaplan-Meier analysis suggested differences in OS by histologic subtype where sarcomatoid, followed by clear cell, papillary, and chromophobe, had the highest mortality risk at 1, 3, and 5 years. However, there was marginal improvement in the multivariable model of OS using competing risks and histology (c-index, 0.64 and 0.697) compared with competing risks alone (c-index, 0.631 and 0.671) for T1b and T2a RCCs, respectively. In patients with T1b or T2a RCC managed with observation, incorporation of histologic subtype into a risk-stratification model to determine prognostic OS did not improve modeling of OS compared with variables representing competing risks. Histologic subtype of observed T1b and T2a RCC appears to have prognostic OS value when not considering competing risks. These findings may impact the usefulness of renal biopsy to inform decision-making when managing patients with T1b and T2a renal tumors with observation.

Oncologic outcomes and safety of percutaneous cryoablation for biopsy-proven renal cell carcinoma up to 4cm in diameter: a prospective observational study.

Percutaneous cryoablation is widely used for the treatment of renal cell carcinoma. We prospectively evaluated the oncologic outcomes and safety of percutaneous cryoablation for the treatment of tumors ≤ 4cm in diameter. We included patients aged ≥ 20years, who had histologically proven renal cell carcinoma, tumor diameter ≤ 4cm, a performance status of ≤ 1, acceptable laboratory parameters, were inoperable or refused to undergo surgery, and had signed a written informed consent. The primary endpoint was the cause-specific survival rate. The secondary endpoints were overall and progression-free survival, and adverse event frequency and grade. All procedures were percutaneously performed under computed tomography fluoroscopy guidance. From October 2013 to October 2015, 33 patients (mean age: 68 ± 14years; sex: six women, 27 men) were enrolled. The mean tumor diameter was 2.1 ± 0.6 (range 1.0-3.4) cm. The median follow-up period was 60.1 (range 18.4-76.6) months. One patient died of non-renal cell carcinoma-related disease 46months after percutaneous cryoablation. The cause-specific and overall survival rates were 100% and 96.8% at 3years, and 100% and 96.8% at 5years, respectively. There was no local tumor progression or distant metastasis. The incidence of severe urological (urinary fistula and perinephric infection) and non-urological adverse events (increased creatine kinase and skin ulceration) was 6% each. Percutaneous cryoablation for renal cell carcinoma ≤ 4cm in diameter achieved good tumor control with a low complication frequency.