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

Yıl 2020, , 1068 - 1072, 01.11.2020

Ömer Faruk Ateş

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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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