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Percutaneous Cryoablation vs Partial or Radical Nephrectomy for Early-Stage Kidney Cancer


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A minimally invasive procedure that destroys cancer cells by freezing them may be an option other than surgery for treating early-stage kidney cancer. The two methods showed similar 10-year survival rates, with cryoablation showing a lower rate of complications, according to a study published by Morkos et al in the journal Radiology.

About 70% of cases of kidney cancers are diagnosed as stage I. Treatment typically involves surgical removal of the tumor from the kidney—partial nephrectomy. Radical nephrectomy, or removal of the entire kidney, is another surgical option.

Percutaneous cryoablation (PCA) has emerged as an alternative to surgery that destroys the tumor by freezing it. In the procedure, an interventional radiologist inserts a hollow needle into the tumor under imaging guidance. Argon gas circulating through the needle freezes a small volume of tissue, including the tumor and a small amount of normal tissue around it. The tumor dies, and over time it turns into scar tissue that is absorbed by the body.

“We have been doing cryoablation with increasing frequency at Johns Hopkins,” said study lead author Christos S. Georgiades, MD, PhD, Professor of Radiology, Oncology, and Surgery in the Department of Vascular and Interventional Radiology at Johns Hopkins University, in a statement. “It’s an outpatient procedure that takes about 30 to 40 minutes to perform. We observe the patient for 3 hours, and then they can go home.”

Study Methodology

For the study, Dr. Georgiades and colleagues looked at 134 patients who underwent cryoablation for early-stage kidney cancer and compared their outcomes over 10 years with those of patients who had either a radical or partial nephrectomy.

Disease-specific survival was 94% at both 5 and 10 years after treatment with cryoablation, a figure comparable to that reported after radical or partial nephrectomy. Overall survival after percutaneous cryoablation was 86% and 72% at 5 and 10 years, respectively.

KEY POINTS

  • Disease-specific survival was 94% at both 5 and 10 years after treatment with cryoablation, a figure comparable to that reported after radical or partial nephrectomy.
  • Overall survival after percutaneous cryoablation was 86% and 72% at 5 and 10 years, respectively.

“For certain patients, cryoablation is equivalent to surgery with fewer side effects,” said Dr. Georgiades. “The risk of significant complications from this procedure is about 6%, compared to between 15% and 20% for surgery. In addition, recovery is much faster than with surgery.”

The study also found that cryoablation was associated with a low 10-year risk of hemodialysis.

Dr. Georgiades emphasized that cryoablation is only appropriate for patients with early-stage kidney cancer that is confined to the kidney and is up to about 4 cm in size.

The study authors concluded, “Percutaneous cryoablation yielded a 10-year disease-specific survival of 94%, equivalent to that reported after radical or partial nephrectomy. Overall survival probability after percutaneous cryoablation at 5 years and 10 years was longer than for radical or partial nephrectomy, especially for patients at higher risk (Charlson/Deyo Combined Comorbidity score ≥ 2).”

Disclosures: For full disclosures of the study authors, visit pubs.rsna.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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