Daily Bulletin 2015

Cryoablation Shows Potential as Safe, Cost-Effective Treatment for Kidney Cancer

Monday, Nov. 30, 2015

Hussein D. Aoun, M.D.

Hussein D. Aoun, M.D.

CT-guided percutaneous renal cryoablation should receive more consideration as an option for treating cancerous kidney tumors because it is a safe and lower-cost treatment option, according to a researcher who followed up with patients for as long as seven years.

During his Sunday session, Hussein D. Aoun, M.D., presented the results of research showing that the cryotherapy procedure resulted in few complications and had almost no recurrence rates.

"It is time for a paradigm shift to include percutaneous cryoablation as a standard of care," said Dr. Aoun, an interventional radiologist with the Karmanos Cancer Center at Wayne State University in Michigan. Dr. Aoun strongly advocates for the procedure because he says multiple studies have shown it is less invasive, less costly and less painful than other techniques.

Following up on 372 tumors removed under 348 procedures, the study concluded that the technique was safe and effective for all but a few of the 294 patients treated.

"Plus, with CT, you have excellent visualization," Dr. Aoun said, noting that laparoscopic and surgical removal do not allow a physician to visualize a tumor before the procedure. "You can really see the ice ball engulf the tumor."

Several studies have shown that percutaneous cryoablation can be effective, and his study shows there is no evidence of long-term complications. His research followed many patients for several years to evaluate any health effects from the procedure. The mean follow-up was 2.3 years with 106 tumors having a longer than three-year follow-up, 54 tumors having longer than five-year follow-up and 20 tumors having longer than seven year follow-up.

The study's long-term follow-up has been important because life expectancy should be factored into treatment options, Dr. Aoun said. Because percutaneous cryoablation is less traumatizing than open surgery, it might be a better option for an older person.

All the procedures were performed under conscious sedation and were virtually painless during and after the procedure. "Most go home the same day," Dr. Aoun said.

The study demonstrated a 99.7 percent efficacy rate of renal cancer under the long-term follow up. The initial local recurrence rate was 2.4 percent with 9 tumors out of 372 recurring. Some of those recurrences were attributed to equipment failures and others were tract recurrences. Of the local recurrences, all but one was able to be re-ablated, which resulted in the 99 percent efficacy conclusion.

The procedure was determined to be safe as only 10, or 2.9 percent, of the procedures resulted in major complications, which were classified as grade 3. Three of the major complications were related to hemorrhage requiring transfusion.

The average tumor and ablation size was 3.1 cm and 5.0 cm, respectively, with the largest tumor measuring 10.3 cm.

Although some have suggested that patient weight is a factor in the efficacy of percutaneous renal cryoablation, Dr. Aoun's study did not find a correlation.

Although the study focused on renal cryoablation, Dr. Aoun performs cryoablation on many organs and soft tissue.

"The rising cost of healthcare mandates consideration of renal cryoablation as a cost effective treatment option," Dr. Aoun said.

Question of the Day:

We just purchased a new CT scanner from a different vendor and it's like trying to learn a new language to understand their parameters. How do I learn the new nomenclature?

Tip of the day:

Even if it is your personal lead apron, if it is stored on-site at the clinic, it must be checked annually as part of a quality assurance program.

The RSNA 2015 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Oak Brook, IL 60523.