Effectiveness of percutaneous cryoablation for stage IA/B renal cell carcinoma approaches that of gold standard, surgery

Christos S Georgiades

A prospective single-arm, five-year study has found that CT-guided percutaneous cryoablation for renal cell carcinoma offers very high efficacy, approaching that of the gold standard, surgery. Cryoablation also has a more favourable safety profile.

The study published in CardioVascular and Interventional Radiology in January 2014, is authored by Christos S Georgiades, American Medical Center, Nicosia, Cyprus and Ron Rodriguez, University of Texas Health Science Center, San Antonio, Texas.

Georgiades told Interventional News: “Our research confirms in a rigorous way the high efficacy and low complication rate of percutaneous cryoablation for kidney cancer. Though not identical to surgical resection, the long-term efficacy of 97% is as close as it gets. These results support offering this option to patients with stage one kidney cancer. Since nearly ¾ of all patients are diagnosed at this stage and the societal benefits can be significant. Of course, not all patients are good candidates for this procedure and in some, surgery (whether total, or partial nephrectomy, which can be done either in an open fashion, or laparoscopically) remains the best option.” 

The authors noted in the paper that percutaneous cryoablation is becoming an increasingly used and accepted treatment option for renal cell carcinoma. They presented the five-year oncologic outcomes of a prospective trial in which 134 consecutive patients with biopsy proven-proven renal cell carcinoma were treated with with CT-guided percutaneous cryoablation. The median tumour size was 2.8±1.4cm.

The researchers reported that all patients were treated under conscious sedation and that the technical objective was for the ice ball to cover the lesion plus a 5mm margin. Hydro- or air dissection was utilised to aid in technical success as needed. Safety was assessed by the common terminology criteria for adverse events (CTCAE, version 4.0).

The one-, two- three-, four- and five- year efficacy of percutaneous cryoablation for renal cell carcinoma was 99.2, 99.2, 98.9, 98.5 and 97%, respectively. All-cause mortality during the study period was three (no deaths were from RCC), yielding an overall five-year survival of 97.8%. The cancer-specific five-year survival was 100%.

No patient developed metastatic disease during the follow-up period. The overall significant (CTCAE, version 4.0) complication rate was 6%, with the most frequent being transfusion requiring haemorrhage, at 1.6%. There was one 30-day mortality unrelated to the procedure, the authors wrote.

Georgiades emphasised: “What is not immediately apparent from the paper, is the close, patient-centric collaboration between Urology and Interventional Radiology that is very important in achieving such good outcomes.”