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Outcomes of renal Ablation for Small Renal Masses

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 Outcomes of Percutaneous Renal Ablation of Small Renal Masses

Ahmed A. Hussein, MD; Mohamed Jalloh, MD; Jeanne Laberge , MD; Janet E. Cowan , MA; Allison S. Glass A, MD; Andrew Callen, MD; June M. Chan , ScD; Kirsten L. Greene, MD, MS; Maxwell V. Meng, MD; Peter R. Carroll, MD, MPH

UCSF Department of Urology and Helen Diller Family Comprehensive Cancer Center

 

Introduction

Complications associated with PN and the high rates of benign histology have led to interest in both surveillance and less invasive techniques, RFA and CA. We assessed disease characteristics and oncological outcomes after RFA and CA for renal masses.

 

 Methods 

 

  • We retrospectively analyzed 127 consecutive patients who underwent 129 percutaneous ablation procedures (86 CA and 43 RFA) for presumed renal tumors at UCSF between 2005 and 2012.

 

  • Sociodemographic factors, tumor characteristics, histopathology, and oncological outcomes were compared between patients treated with RFA and CA.

 

  • Post-ablation outcome was assessed using serial imaging and renal function assessment. Relapse was defined as radiographic evidence of tumor recurrence, complying with AUA guidelines, and the receipt of salvage treatment.

 

  • Outcomes were evaluated with life tables and Cox proportional hazards regression adjusted for age, BMI, type of ablation procedure, maximum tumor size, and number of comorbidities.

 

 Cohort

 

  • Median age was 69 years

 

  • Comorbidity-adjusted estimated 10-year life expectancy was 30%.

 

  • Median follow up of 19 months (IQR 5-37)

 

 

  • Patient and tumor characteristics did not differ by type of ablation.

Outcomes 

 

  • Pathology was benign in 24% of patients.

 

  • Complications were reported in 7 (5%) procedures: skin burn, lower extremity DVT, intraoperative afib, abortion of ablation, and 3 perinephric hematomas.

 

  • 14 patients underwent salvage therapies.

 

  • Relapse-free survival rates were 85% at 12 months and 81% at 36 months and did not differ between CA and RFA (p=0.58).

 

  • The overall survival was 100% at 12 months and 96% at 36 months and did not differ between CA and RFA(p=0.94)

 

  • Larger maximum tumor dimension and prior history of RCC were associated with higher risk of relapse (p<0.01).

 

 

 Conclusions

  • CA and RFA showed comparable outcomes

 

  • Maximum tumor size and prior history of RCC were associated with increased risk of relapse

 

  • Ablation procedures remain viable options in terms of safety and efficacy, especially for older patients, for those with multiple comorbidities, risk of compromised renal function, and multiple or recurrent small tumors, and for patients with tumors thought to be less fit for conventional treatment.