Erken evre renal hücreli kanserde perkütan mikrodalga ablasyon tedavisinin etkinliği ve güvenirliği: Ara dönem sonuçları

Year 2020, Volume: 4 Issue: 11, 1068 - 1072, 01.11.2020

Ömer Faruk Ateş

https://doi.org/10.28982/josam.821632

Abstract

Amaç: Bu çalışmada perkütan mikrodalga ablasyonun (MWA) renal hücreli kanser (RCC) tedavisinde etkinliğini, rezidüel renal fonksiyon açısından ve diğer yan etkiler açısından güvenirliğini ve klinik sonuçlarını değerlendirmeyi amaçladık.
Yöntemler: Bu retrospektif çalışmaya MWA ile tedavi edilen 14 T1a, 5 T1b ve 1 T2 RCC hastası dahil edildi. Hastalara soğutmasız sistem MWA cihazı ile 30W enerji ile sedasyon veya genel anestezi altında, ultrason eşliğinde ortalama 13 dakika boyunca ablasyon uygulanmıştır. 4 cm üzerindeki kitlelerde birden çok anten kullanıldı. Lezyon komşuluğunda hedef dışı organ bulunduğu durumlarda salin ile hidrodiseksiyon yapıldı. Lezyon boyutu, lezyonun yerleşimi, ablasyon süresi, komplikasyonlar, Charlson komorbidite indeksi, Hb ve kreatinin değerleri kaydedildi. Hastalar işlem sonrası 1. Gün, 1. Ay, 3.-6.-12.18. ve 24. aylarda CT ile takip edilmiştir.
Bulgular: Hastaların yaş ortalaması 68,9 (9,8) idi. Ortanca lezyon boyutu 2,8 cm (range, 1,9-7,1 cm) idi. 12 hastada (%60) tümör egzofitik iken 8 hastada (%40) intraparankimal veya endofitikti. Hastaların ortalama Charlson comorbidity index skoru 6,9 (1,8) idi. Tüm hastalarda teknik başarı sağlandı. Ortalama ablation süresi 13 dakikaydı (9-15 mins). 3 hastada (%15) minör komplikasyon gelişti. Hastaların ortanca takip süresi 13,5 ay idi (range 6-24 ay). Kaplan Meier analizinde progresyonsuz sağ kalım 12 ay olarak bulundu. Hiçbir hastada takip sırasında uzak organ metastazı izlenmedi. 2 hastada takip sırasında nüks gözlendi. Kanser-spesifik survival oranı %100 idi.
Sonuç: MWA erken evre RCC’lerde oldukça yüksek teknik başarı ile uygulanabilir. Çalışmamızın sonuçları RCC’lerde MW ablasyonun etkili ve oldukça güvenilir olduğunu göstermektedir. Özellikle cerrahiye uygun olmayan hastalarda ve rezidü RCC’lerde güvenle uygulanabilir.

Keywords

Mikrodalga ablasyon, RCC, RCC ablasyonu, RCC MWA, Girişimsel radyoloji

Effectiveness and reliability of percutaneous microwave ablation therapy in early stage renal cell cancer: Intermediate term results

Abstract

Aim: Percutaneous tumor ablation is the most important alternative to surgery in early stage renal cell cancers (RCC). Although many studies are conducted with radiofrequency ablation and cryoablation therapy in RCC, the data regarding microwave ablation (MWA) is more limited. In this study, we aimed to evaluate the efficacy of percutaneous MWA in the treatment of RCC, its safety in terms of residual renal function and other complications, and its clinical results.
Methods: In T1b patients, the suitability for MWA was evaluated with a urologist based on characteristics such as size, and location of the mass (intestinal proximity, proximity to the main renal vascular structures and renal pelvis). Fourteen T1a, five T1b and one T2 RCC patients treated with MWA were included in this retrospective study. MWA was preferred when partial nephrectomy was highly risky or contraindicated due to medical comorbidities or the patients refused to undergo surgical treatment. The patients were ablated with uncooled MWA device with 30W energy under sedation or general anesthesia under ultrasound guidance for an average of 13 minutes. Multiple antennas were used for masses larger than 4 cm. Hydrodissection with saline was performed in cases where there was a non-target organ adjacent to the lesion. Lesion size, location of the lesion, ablation time, complications, Charlson comorbidity index, Hb, and creatinine values were recorded. Patients were followed by CT.
Results: The mean age of the patients was 68.9 years, and the median lesion size was 2.8 cm. While the tumor was exophytic in 12 patients, it was intraparenchymal or endophytic in 8 patients. The average Charlson comorbidity index score of the patients was 6.9. Technical success was achieved in all patients. Average ablation time was 13 minutes. Minor complications occurred in 3 patients. The median follow-up period of the patients was 13.5 months. In Kaplan Meier analysis, progression-free survival was 12 months. During follow up, distant organ metastasis was not observed in any of the patients, recurrence was observed in 2, and no patients died.
Conclusion: MWA can be applied in early stage RCCs with very high technical success. The results of our study show that MWA is effective and highly reliable in RCCs. It can be safely applied, especially in patients who are not suitable for surgery and in residual RCCs.

Keywords

microwave ablation, rcc, rcc ablation, rcc mwa, Interventional radiology

References

• 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018;68(6):394-424.
• 2. Wong MC, Goggins WB, Yip BH, Fung FD, Leung C, Fang Y, et al. Incidence and mortality of kidney cancer: temporal patterns and global trends in 39 countries. Scientific reports. 2017;7(1):1-10.
• 3. Ljungberg B, Bensalah K, Bex A, Canfield S, Dabestani S, Hofmann F, et al. EAU guidelines on renal cell carcinoma. European Association of Urology. 2018;1.
• 4. Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European association of urology guidelines on renal cell carcinoma: the 2019 update. European urology. 2019;75(5):799-810.
• 5. Motzer RJ, Jonasch E, Agarwal N, Bhayani S, Bro WP, Chang SS, et al. Kidney cancer, version 2.2017, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2017;15(6):804-34.
• 6. Uhlig J, Strauss A, Rücker G, Hosseini ASA, Lotz J, Trojan L, et al. Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis. European radiology. 2019;29(3):1293-307.
• 7. Filippiadis D, Mauri G, Marra P, Charalampopoulos G, Gennaro N, De Cobelli F. Percutaneous ablation techniques for renal cell carcinoma: current status and future trends. International Journal of Hyperthermia. 2019;36(2):21-30.
• 8. Lin Y, Liang P, Yu X-L, Yu J, Cheng Z-g, Han Z-Y, et al. Percutaneous microwave ablation of renal cell carcinoma is safe in patients with renal dysfunction. International Journal of Hyperthermia. 2017;33(4):440-5.
• 9. Zhou W, Herwald SE, McCarthy C, Uppot RN, Arellano RS. Radiofrequency ablation, cryoablation, and microwave ablation for T1a renal cell carcinoma: a comparative evaluation of therapeutic and renal function outcomes. Journal of Vascular and Interventional Radiology. 2019;30(7):1035-42.
• 10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Clinical Epidemiology. 1987;40(5):373-83.
• 11. Laeseke PF, Lee Jr FT, Sampson LA, van der Weide DW, Brace CL. Microwave ablation versus radiofrequency ablation in the kidney: high-power triaxial antennas create larger ablation zones than similarly sized internally cooled electrodes. Journal of Vascular and Interventional Radiology. 2009;20(9):1224-9.
• 12. Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics. 2005;25(suppl_1):S69-S83.
• 13. Zhou W, Arellano RS. Thermal ablation of T1c renal cell carcinoma: a comparative assessment of technical performance, procedural outcome, and safety of microwave ablation, radiofrequency ablation, and cryoablation. Journal of Vascular and Interventional Radiology. 2018;29(7):943-51.
• 14. Wright AS, Sampson LA, Warner TF, Mahvi DM, Lee J, Fred T. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236(1):132-9.
• 15. Hoffmann R-T, Jakobs TF, Kubisch CH, Trumm C, Weber C, Siebels M, et al. Renal cell carcinoma in patients with a solitary kidney after nephrectomy treated with radiofrequency ablation: mid term results. European journal of radiology. 2010;73(3):652-6.
• 16. Maaref Y, Pakravan H, Jafarpur K. Numerical Analysis of the Heat Sink Effect of Blood Vessels on Hepatic Radiofrequency and Microwave Ablation. Modares Mechanical Engineering. 2019;19(7):1711-20.
• 17. Brace CL, Laeseke PF, Sampson LA, Frey TM, van der Weide DW, Lee Jr FT. Microwave ablation with multiple simultaneously powered small-gauge triaxial antennas: results from an in vivo swine liver model. Radiology. 2007;244(1):151-6.
• 18. Liang P, Dong B, Yu X, Yu D, Wang Y, Feng L, et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation. Radiology. 2005;235(1):299-307.
• 19. Glassberg MB, Ghosh S, Clymer JW, Qadeer RA, Ferko NC, Sadeghirad B, et al. Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. OncoTargets and therapy. 2019;12:6407.
• 20. Lee SJ, Choyke LT, Locklin JK, Wood BJ. Use of hydrodissection to prevent nerve and muscular damage during radiofrequency ablation of kidney tumors. Journal of vascular and interventional radiology. 2006;17(12):1967-9.
• 21. Cheng Z, Yu X, Han Z, Liu F, Yu J, Liang P. Ultrasound-guided hydrodissection for assisting percutaneous microwave ablation of renal cell carcinomas adjacent to intestinal tracts: a preliminary clinical study. International Journal of Hyperthermia. 2018;34(3):315-20.
• 22. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. Journal of the National Cancer Institute. 2006;98(18):1331-4.
• 23. Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU international. 2014;113(3):416-28.
• 24. Talenfeld AD, Gennarelli RL, Elkin EB, Atoria CL, Durack JC, Huang WC, et al. Percutaneous ablation versus partial and radical nephrectomy for T1a renal cancer: a population-based analysis. Annals of internal medicine. 2018;169(2):69-77.
• 25. Guan W, Bai J, Liu J, Wang S, Zhuang Q, Ye Z, et al. Microwave ablation versus partial nephrectomy for small renal tumors: Intermediate‐term results. Journal of surgical oncology. 2012;106(3):316-21.
• 26. Shangqian W, Chao Q, Zhihang P, Qiang C, Pu L, Pengfei S, et al. Radiofrequency ablation versus partial nephrectomy for the treatment of clinical stage 1 renal masses: a systematic review and meta-analysis. LWW; 2014.
• 27. Tracy CR, Raman JD, Donnally C, Trimmer CK, Cadeddu JA. Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer. 2010;116(13):3135-42.
• 28. Lyrdal D, Andersson M, Hellström M, Sternal J, Lundstam S. Ultrasound-guided percutaneous radiofrequency ablation of small renal tumors: clinical results and radiological evolution during follow-up. Acta Radiologica. 2010;51(7):808-18.
• 29. Zagoria RJ, Pettus JA, Rogers M, Werle DM, Childs D, Leyendecker JR. Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology. 2011;77(6):1393-7.
• 30. Castle SM, Salas N, Leveillee RJ. Initial experience using microwave ablation therapy for renal tumor treatment: 18-month follow-up. Urology. 2011;77(4):792-7.
• 31. Wells SA, Wheeler KM, Mithqal A, Patel MS, Brace CL, Schenkman NS. Percutaneous microwave ablation of T1a and T1b renal cell carcinoma: short-term efficacy and complications with emphasis on tumor complexity and single session treatment. Abdominal Radiology. 2016;41(6):1203-11.
• 32. Johnson BA, Sorokin I, Cadeddu JA. Ten-year outcomes of renal tumor radio frequency ablation. The Journal of urology. 2019;201(2):251-8.
• 33. Chang X, Zhang F, Liu T, Ji C, Zhao X, Yang R, et al. Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes. The Journal of urology. 2015;193(2):430-5.