Percutaneous cryoablation prolongs survival in early-stage renal cell carcinoma
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Percutaneous cryoablation appeared safe and improved 10-year survival outcomes compared with partial or radical nephrectomy among patients with early-stage renal cell carcinoma, according to study results published in Radiology.
“Renal cell carcinoma is usually diagnosed incidentally at an early stage because of the proliferation of CT and MRI for a variety of indications, which allows physicians to identify asymptomatic kidney cancer,” Christos S. Georgiades, MD, PhD, FSIR, FCIRSE, professor of radiology, oncology and surgery at Johns Hopkins University, told Healio.
“Nowadays, three out of four patients with kidney cancer are diagnosed at a potentially curable stage," Georgiades said. "The only acceptable treatment for these patients was radical or partial nephrectomy, with most patients losing one kidney with surgery. We theorized that the tumor can be effectively treated with cryoablation without removing the kidney. Because renal cell carcinoma is a very slow-growing tumor, we needed long-term results to prove our hypothesis, thus this 10-year study.”
Although use of percutaneous cryoablation as treatment for stage I renal cell carcinoma has increased, data on its efficacy are lacking.
Georgiades and colleagues assessed 10-year OS, RFS and disease-specific survival of percutaneous cryoablation among 134 adults (median age, 68 years; median tumor size, 2.8 cm; 46% men) with stage I renal cell carcinoma.
Researchers additionally compared outcomes after partial nephrectomy and radical nephrectomy among matched cohorts of patients included in the National Cancer Database to assess long-term renal function and the risk for metachronous disease.
Results showed a 10-year OS rate of 72% (95% CI, 62-83) with percutaneous cryoablation compared with 49% (95% CI, 41-57) for partial nephrectomy and 43% (95% CI, 38-49) for radical nephrectomy (P < .001). Researchers observed the benefit across all ages and comorbidity levels.
In addition, 10-year disease-specific survival was 94% (95% CI, 90-98) with percutaneous cryoablation, which was comparable that of both partial and radical nephrectomy.
Ten-year adverse events associated with percutaneous cryoablation included hemodialysis (2.3%) and metachronous renal cell carcinoma (6%). Results of Charlson/Deyo Combined Comorbidity score analysis showed OS decreased as comorbidity index increased.
“These findings confirm cryoablation’s equivalence to surgery for the treatment of stage I kidney cancer, in a scientifically rigorous manner,” Georgiades said. “Cryoablation has far fewer complications and risks compared with surgery, is an outpatient procedure and is performed without an incision or the need for general anesthesia. Importantly, it does not require removing the entire kidney. Percutaneous cryoablation could be considered an option on par, if not primary, with surgery for stage I disease.”
Future research will examine cryoablation combined with immunotherapy for advanced-stage renal cell carcinoma, according to Georgiades.
“There is early encouraging evidence that after cryoablation, inert tumor proteins circulate in the patient’s blood for a few days before they are eliminated. These tumor proteins act as antigens to stimulate the immune system,” Georgiades said. “We theorize that if we treat the patient with immunotherapy shortly after cryoablation, the immune reaction against cancer will be much stronger and will result in an abscopal effect where the immune system attacks and kills cancer in locations remote from the ablation site.”
For more information:
Christos S. Georgiades, MD, PhD, FSIR, FCIRSE, can be reached at Johns Hopkins University, 1800 Orleans St., Zayed 7203, Baltimore, MD 21231; email: g_christos@hotmail.com.
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