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. 2020 Jul;43(7):1025-1033.
doi: 10.1007/s00270-020-02423-7. Epub 2020 Feb 12.

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

B M Aarts  1   2 , W Prevoo  3   4 , M A J Meier  5 , A Bex  6   7 , R G H Beets-Tan  3   8 , E G Klompenhouwer  3 , F M Gómez  3   9
Affiliations

Percutaneous Microwave Ablation of Histologically Proven T1 Renal Cell Carcinoma

B M Aarts et al. Cardiovasc Intervent Radiol. 2020 Jul.

Abstract

Objectives: To assess the safety and efficacy of percutaneous microwave ablation (MWA) of histologically proven T1 renal cell carcinoma (RCC).

Methods: We analysed patients with a histologically proven RCC (≤ 7 cm) treated by MWA from April 2012-April 2018. Primary and secondary efficacy, local tumour recurrence (LTR), morbidity and mortality were reported. Efficacy was defined as no residual tumour enhancement on follow-up imaging 1 month after the first ablation (primary efficacy) and after re-ablation(s) for residual disease (secondary efficacy). Adverse events (AE) were registered by the Clavien-Dindo classification and the common terminology criteria for AE. Univariable and multivariable logistic regression analyses were performed to investigate a relation among pre-treatment factors incomplete ablation and complications.

Results: In 100 patients, a total of 108 RCCs (85 T1a and 23 T1b) were treated by MWA. Median size was 3.2 cm (IQR 2.4-4.0). Primary efficacy was 89% (95%CI 0.81-0.94) for T1a lesions and 52% (95%CI 0.31-0.73) for T1b lesions (p < 0.001). Fifteen lesions (7 T1a) were re-ablated for residual disease by MWA in one (n = 13) and two (n = 2, both T1b) sessions resulting in secondary efficacy rates of 99% (T1a) and 95% (T1b, p = 0.352). LTR occurred in four tumours (2 T1a, 2 T1b) after 10-60 months. Six (4%) AEs grade > 3-5 were observed (2 T1a, 4 T1b, p = 0.045). Multivariable analysis showed that mR.E.N.A.L. nephrometry was independently associated with incomplete ablation (p = 0.012).

Conclusion: Microwave ablation is safe and effective for T1a and T1b RCC lesions with a significantly lower primary efficacy for T1b lesions.

Keywords: Kidney; Microwave ablation; Percutaneous thermal ablation; Renal cell carcinoma.

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Conflict of interest statement

W. Prevoo was proctor for the Emprint system during the study period. The rest of the authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
A–C Microwave ablation (MWA) of a T1b tumour (A) before MWA (B) during MWA (C) 1 year after MWA: complete ablation. D–F endophytic T1a lesion with a close relation to the collecting system (D). E + F 9 months after complete ablation, hydronephrosis of the kidney visible due to an urinary tract stenosis that occurred 3 months after the MWA (kidney function from 45  to 19 ml/min/1.73m2) (NB this patient is familiar with liver cysts)
See this image and copyright information in PMC

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