By Ed Susman
CHICAGO -- December 1, 2008 -- Patients who undergo laparoscopic cryoablation for treatment of renal cell carcinomas experience about a 9% recurrence rate in the same kidney after 5 years.
"After 5 years, we observed that the size of the cryoablated tumour decreased by a mean of 89% and we saw complete tumour involution among 73% of the tumours," said Erick Remer, MD, Cleveland Clinic, Cleveland, Ohio.
Dr. Remer presented study results in an oral presentation here at the Radiological Society of North America (RSNA) 94th Scientific Assembly and Annual Meeting.
"All the ablation sites diminished in size, including [in] patients with local recurrence," he said on November 30.
Dr. Remer and colleagues reviewed outcomes among 84 patients who had undergone cryoablation for kidney cancers and who had 5 years of follow-up. Of the 56 patients with pathologically proven renal cell carcinoma, 3 experienced local progression and 2 others had local progression with metastases; another 3 patients experienced metastatic progression of kidney cancer but did not have a local recurrence. The time to local recurrence occurred as early as 6 months and as late as 58 months in the study, Dr. Remer said.
In the cryoablation procedure, patients underwent ultrasound guided laparoscopic targeting and monitoring of the operation. The cryoprobe was place to the deep tumour margin. The tumours were then frozen, thawed, and frozen again to create an ice ball that extended more than 1 cm beyond the tumour margin.
An analysis of the prognostic factors found that previous treatment for kidney cancer, resulting in either radical or partial renal nephrectomy, was the only factor associated with survival among patients with confirmed renal cell carcinoma, he said. Those with previous nephrectomy surgery had 8.8-times greater likelihood of death when compared with patients who did not have renal nephrectomies (P = .022 for progression-free survival; P = .009 for cancer-specific survival).
Magnetic resonance imaging serial studies that detected recurrence several years after treatment suggest that continued surveillance of the patients is required, Dr. Remer said.
He disclosed that 2 coauthors in the study had financial relationships with Endocare or Hansen medical Inc.
[Presentation title: Long-Term Imaging Follow-Up After Renal Cryoablation. Abstract SSA11-01]
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