Safety and oncologic efficacy of percutaneous MRI-guided cryoablation of intraparenchymal renal cancers - 28/04/21

Doi : 10.1016/j.diii.2021.04.002

Pierre De Marini ^a,⁎ , Roberto Luigi Cazzato ^a, Julien Garnon ^a, Danoob Dalili ^b, Ian Leonard-Lorant ^a, Loïc Leclerc ^a, Pierre-Alexis Autrusseau ^a, Pierre Auloge ^a, Julia Weiss ^a, Thibault Tricard ^c, Hervé Lang ^c, Afshin Gangi ^a,^b
^a Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France
^b School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
^c Department of Urology, University Hospital of Strasbourg, 67091 Strasbourg cedex, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 28 April 2021
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Highlights

•	MR-guided cryoablation of entirely intraparenchymal renal cell cancer yields good oncological results.
•	Most complications of MRI-guided cryoablation of entirely intraparenchymal renal cell cancer are hemorrhages and remain minor allowing a conservative management.
•	The impact of MRI-guided cryoablation of entirely intraparenchymal renal cell cancer on kidney function is acceptable with a mean 16% renal function decrease and only few (3%) patients requiring dialysis after the procedure.

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Abstract

Purpose

The purpose of this study was to evaluate the safety and oncologic efficacy of percutaneous magnetic resonance imaging (MRI)-guided cryoablation of intraparenchymal renal cancer.

Materials and methods

Between February 2009 and August 2019, 31 consecutives patients with 31 entirely intraparenchymal biopsy-proven renal cancers were treated with cryoablation under MRI-guidance in our institution, and were retrospectively included. There were 20 men and 11 women with a mean age of 68.5±12.5 (SD) (range: 40–91years). Patient, tumor- and procedure-related, and follow-up data were retrospectively collected and analyzed. Local recurrence free (LRFS), metastasis free (MFS), disease free (DFS), cancer specific (CSS), and overall survivals (OS) were calculated.

Results

Primary and secondary technical efficacy rates were 94% and 100%, respectively. Median follow-up was 27months. Seven (7/31; 23%) minor complications were noted in 7 patients. Patients showed a significant decline of the estimated glomerular filtration rate (eGFR) between baseline and nadir (mean basal eGFR 65.9±22.4 [SD] mL/min/1.73m² vs. mean nadir eGFR 52.8±26.0 [SD] mL/min/1.73m²; P<0.001), but only two showed a clinically significant renal function decline. Three-year estimates of primary and secondary LRFS, MFS, and DFS were 64% (95% confidence interval [CI]: 47–87%), 89% (95% CI: 78–99%), 83% (95% CI: 77–98%), and 45% (95% CI: 28–73%), respectively. No patients died due to renal cancer evolution (three-year CSS of 100%; 95% CI: 100–100%). One patient died 52months after the percutaneous treatment due to cryoablation-unrelated causes (three-year OS of 100%; 95% CI: 100–100%).

Conclusion

MRI-guided percutaneous cryoablation for intraparenchymal renal cancer offers good oncologic outcomes with acceptable complication rates and renal function worsening.

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Keywords : Cryoablation, Magnetic resonance imaging, Interventional radiology, Kidney, Neoplasms

Abbreviations : CI, CSS, CT, DFS, ECOG-PS, GFR, IQR, ISUP, LRFS, MFS, MRI, OS, OR, RCC, SD