Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Efthymiou Evgenia
Dissertation committee:
Kελέκης Νικόλαος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπρούντζος Ηλίας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξοπούλου Ευθυμία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Φιλιππιάδης Δημήτριος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σπηλιόπουλος Σταύρος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Παπακωσταντίνου Ολυμπία, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Βελονάκης Γεώργιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Διαδερμικός θερμοκαυτηριασμός με χρήση μικροκυμάτων (microwave ablation- MWA) νεφροκυτταρικού καρκίνου: μεσοπρόθεσμα και μακροπρόθεσμα αποτελέσματα
Translated title:
Percutaneous microwave ablation (microwave ablation- MWA) of renal cell carcinomas: mid and long term results
Summary:
Introduction
International guidelines advocate the use of percutaneous ablation as an alternative treatment option for small renal cell carcinomas (RCC) with maximum diameter ≤ 3 cm. However, the number of studies regarding the application of microwave ablation (MWA) in the treatment of small renal cell carcinomas remains limited.
Purpose of the study
The aim of the present study was to evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) in the treatment of renal cell carcinomas (RCC) and to evaluate the performance of two different nephrometry scores, RENAL and mRENAL, in the prediction of oncological outcomes as well as to investigate any additional morphometry characteristics affecting the outcome.
Materials and methods
The study included 76 stage T1 (T1N0M0) patients, 84% of them stage T1a and 16% stage T1b. All patients underwent CT-guided MWA. Mean size of the lesions was 3 ± 1.3 cm. The majority of the lesions were exophytic (84.2%), with > 7 mm nearness to the collecting system (55.3%), located posteriorly (72%), and lower to polar lines (56.6%). Mean RENAL and mRENAL scores were 5.7 (SD = 1.9) and 6.1 (SD = 2.1) respectively.
Results
Regarding T1a tumors residual tumor were detected in three patients (3/64) (LCT-primary technical success 95.3 %). All three patients with partial response were retreated with percutaneous ablation; complete response in the follow-up imaging (secondary technical success) was 100%. The primary efficacy rate for T1b tumors was 66.7% (8/12); 2/4 patients were re-treated with ablation combined with trans-arterial embolization, one patient was re-treated with ablation only and one patient refused any further treatment. Statistical analysis revealed a significant predictive ability of both grading systems, RENAL and mRENAL for disease progression, with the cut off limit of 6.5. Progression rates were associated significantly with greater tumor size (> 4 cm), with < 4 mm nearness to the collecting system, for tumors crossing a polar line and with the anterior location. None of the individual characteristics of the RENAL and mRENAL scales significantly influenced the likelihood of complications.
Conclusion
The results of the present study indicate that CT-guided percutaneous MWA is a safe and effective technique for the treatment of T1 renal cell carcinomas. Different morphometric parameters of renal cell carcinomas including RENAL and mRENAL score > 6.5, size >4 cm, proximity to the collecting system (<4 mm) and crossing of polar lines impact the efficacy of MWA and progression survival rates. None of the of these factors have shown an association with the complication rate.
Main subject category:
Health Sciences
Keywords:
Microwave ablation, Renal cell carcinomas, Interventional oncology
