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Minimally Invasive Cryoablation Successful in Killing Localised Kidney Cancer Tumours: Presented at SIR

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- March 19, 2008 -- Cryoablation can be a curative treatment option for patients with kidney cancer tumours smaller than 4 cm in diameter, with a success rate of 97%, according to results of 1-year follow-up study presented here at the 33rd Annual Meeting of the Society of Interventional Radiology (SIR 2008).

"Even patients with larger tumours can benefit from this procedure, especially those who cannot have general anaesthesia or surgery," explained lead author Christos Georgiades, MD, PhD, Interventional Radiologist, Radiology Department, Johns Hopkins Hospital, Baltimore, Maryland.

Cryoablation can effectively kill localised kidney tumours for most patients, with the benefits of a fast recovery time and excellent safety profile, according to the researchers.

Percutaneous cryoablation does not require incision or surgery. The procedure consists of directing a needle-like probe to the tumour site using ultrasound or computed tomography (CT), using lethal temperatures to freeze it, then thawing and excising it. The procedure requires minimal sedation rather than general anaesthesia, noted Dr. Georgiades in a presentation on March 17.

Dr. Georgiades and colleagues analysed data from 65 patients referred by the Urology Department at Johns Hopkins Hospital; 35 of these patients were treated with CT-guided percutaneous cryoablation. The 21 men and 14 women had a median age of 67 years (range, 50-88 years).

Median tumour size was 3 cm (range, 1-10 cm) and median number of probes used per tumour was 2 (range, 1-5 probes). A total of 145 cryoprobes were used; 65 core biopsies were performed. Probes were subjected to a freeze-thaw-freeze cycle for 10, 8, and 10 minutes, respectively.

There were 2 treatment failures at 1-year follow-up. One patient had a 10-cm tumour, said Dr. Georgiades. The efficacy of percutaneous cryoablation was 97% for tumours <4 cm in diameter, he said. Comparable efficacy is expected for tumours 4 to 7 cm in diameter, he added.

Short-term complications were asymptomatic haematomas in 13 of the 65 patients; 8 of these were painful and 2 required transfusions, said Dr. Georgiades. Five patients had mild haematuria that resolved within days with no complications. One patient had a transient increase in creatinine levels.

Long-term complications, with a median follow-up of 25 weeks (range, 12-90 weeks), were 5 nerve injuries: 4 intercostal and 1 genitofemoral. All 5 patients had previous neurological problems and recovered after 6 months.

There were no renal failures and no cases of pneumothorax, according to the researchers. One patient developed cryoshock (5 probes) but made a full recovery.

Thirty patients were discharged the day of the procedure, 34 patients were discharged on postoperative day 1, and the patient suffering cryoshock was discharged after 1 week.

"The current gold-standard treatment [for renal cancer] is laparoscopic partial nephrectomy surgery, but...we expect that the two treatments will be shown to be equivalent," said Dr. Georgiades, referring to a comparative study that is ongoing at Johns Hopkins.

"Among the benefits [of percutaneous cryoablation]: there is little pain, and a large tumour area can be covered," commented S. Nahum Goldberg, MD, Associate Professor of Radiology, Harvard Medical School, and Director, Abdominal Intervention and Tumor Ablation, Beth Israel Deaconess Medical Center, Boston, Massachusetts.


[Presentation titles: Efficacy of CT-Guided, Percutaneous Cryoablation for Renal Cell Carcinoma: One Year Follow-Up. Abstract 100. Short & Long Term Complications From Percutaneous Renal Cryoablation. Risks & Mitigating Actions. Abstract 102]

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