Journal Club: Combined transarterial embolization, percutaneous image-guided ablation for T1B, central renal tumors treatment in high surgical risk patients
Written By : Dr. Nandita Mohan
Published On 2024-11-07 16:00 GMT | Update On 2024-11-07 16:00 GMT
A combination of transarterial embolization and percutaneous CT-guided ablation was an effective, well-tolerated, and safe treatment for patients with T1b and central renal tumors, reveals a recent research seen in the American Journal of Interventional Radiology published by Scientific Scholar.
Annually, over 430,000 new cases of renal cell carcinoma (RCC) are diagnosed worldwide, and almost 180,000 patients die from the disease. Renal cancer incidence has increased at least partially due to incidental detection of renal masses when abdominal imaging is performed for unrelated reasons. Surgical removal is the gold standard for localized RCC. However, many patients have an unacceptable risk for surgery due to old age and multiple comorbidities.
Hence, the present study was carried out to assess the technical success, efficacy, and complications of the combination of transarterial embolization (TAE) followed by percutaneous ablation in treating stage cT1b and central renal tumors.
An institutional registry was reviewed for patients who underwent transarterial embolization followed by percutaneous computed tomography (CT)-guided renal ablation from 2007 to 2018. Twenty-eight consecutive patients with tumor size ranging from 25 to 58 mm, including 24 patients with T1b tumors and four with central T1a tumors, were identified. Nineteen patients had TAE followed by cryoablation (CA), and nine patients had transarterial embolization followed by radiofrequency ablation (RFA). Technical success, local tumor control, and post-procedure complications were retrospectively reviewed.
The results showed that all procedures were technically successful. Local tumor control was achieved in 92.9% patients at a median follow-up of 26 months. Local tumor recurrence was found in two of 28 patients, with a median time to local recurrence of 15 months. The recurrences occurred in one patient who had transarterial embolization plus cryoablation and in one patient who had transarterial embolization plus radiofrequency ablation. Self-limited hematoma and hematuria were minor complications observed in 3 patients. Only one patient had a major complication. This patient developed ureteral obstruction and perirenal abscess requiring ureteral stent and percutaneous drainage without long-term sequela.
Therefore, the authors concluded that a combination of transarterial embolization and percutaneous CT-guided ablation was an effective, well-tolerated, and safe treatment for patients with T1b and central renal tumors.
However, for patients suitable for surgical treatment, prospective studies are needed to direct compare TAE plus percutaneous ablation versus percutaneous ablation only and determine if these techniques have the same oncologic effectiveness as partial nephrectomy and if a minimally invasive percutaneous approach can reduce surgical morbidity associated with partial nephrectomy.
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