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Active Surveillance for Residual Tumor in RCC Patients Undergoing Thermal Ablation
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This retrospective study examined growth kinetics and oncologic outcomes in 17 patients with renal cell carcinoma (RCC) undergoing active surveillance (AS) for residual tumor after percutaneous thermal ablation. Re-intervention was required in 4 patients (1 thermal ablation and 3 nephrectomies). The rates of RCC metastasis, overall survival, and RCC-specific survival did not significantly differ between AS and routine follow-up groups. Only 1 patient died in the AS group, and this patient had refused further treatment after evidence of RCC progression.
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Overall and cancer-specific outcomes were comparable between RCC patients on surveillance and those on routine follow-up following thermal ablation. The authors conclude that surveillance is a safe strategy for RCC patients who are not amenable to further treatment.
– Michael Johnson, MD
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To evaluate growth kinetics and oncologic outcomes of patients with renal tumors undergoing active surveillance (AS) for residual viable tumor following percutaneous ablation.
MATERIALS AND METHODS
Following percutaneous thermal ablation, residual tumor was detected in 21/133 (16%) patients on initial follow-up imaging, and AS was undertaken in 17/21 (81%) patients. Initial tumor volumes and volumes after ablation were assessed from cross-sectional imaging to calculate volumetric growth rate (VGR) and volume doubling time (VDT) of residual tumor. The rate of metastasis, overall survival, and renal cell carcinoma (RCC)-specific survival were compared between patients in the AS group and in the routine follow up group of patients who did not have residual tumor.
RESULTS
Median tumor volume prior to ablation, after first ablation, and at final follow-up were 25 cm(3), 6 cm(3), and 6 cm(3), respectively, in patients with residual tumor. Stable, mild, and moderate VGR occurred in 8/17 (47%), 4/17 (24%), and 5/17 (29%) cases, respectively. The 4 cases with fastest VDT underwent delayed intervention with ablation (n = 1) and nephrectomy (n = 3) without subsequent residual, recurrence, or metastasis. There was no significant difference in the rates of RCC metastasis, overall survival, or RCC-specific survival between AS and routine follow-up groups. Metastatic RCC and subsequent death occurred in 1 patient in the AS group, after the patient had refused offers for retreatment for local progression over 60.7 months of follow-up.
CONCLUSIONS
In cases when patients are not amenable to further intervention, AS of residual tumor may be an acceptable alternative and allows for successful delayed intervention when needed.
Additional Info
Disclosure statements are available on the authors' profiles:
Tumor Growth Kinetics and Oncologic Outcomes of Patients Undergoing Active Surveillance for Residual Renal Tumor Following Percutaneous Thermal Ablation
J Vasc Interv Radiol 2016 Sep 01;27(9)1397-1406, JX Chen, D Maass, TJ Guzzo, SB Malkowicz, AJ Wein, MC Soulen, TW Clark, GJ Nadolski, SW StavropoulosFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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Thermal ablation, with either radiofrequency or cryoablation, is an option for the treatment of clinically localized renal masses. Although approximately 15% of patients from this single-institution study by Chen and colleagues had residual tumor after an initial episode of treatment, the rate of metastatic progression and death from renal cell carcinoma was exceedingly low. These data are consistent with findings from a recent, large systematic review, which demonstrated equivalent long-term cancer-specific survival associated with thermal ablation when compared with radical and partial nephrectomy for cT1a (<4 cm) tumors, but an inferior primary efficacy—that is, more thermal ablation patients required repeat treatments but were cured in the long-run. Importantly, Chen and colleagues demonstrate that the volumetric growth rate of residual tumor after ablation did not impact long-term outcomes if patients were expeditiously retreated.