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Prophylactic arterial embolization of renal tumors to reduce hemorrhagic complications following cryoablation
S198
Scientific e-Posters
a review of the electronic medical record and relevant imaging. Conditional logistic regression was used to test for a difference in the complication rates while controlling for the matched pair design. Results: 45 pre-embolized patients (mean age 72 ⫾ 12 years; 71% male) were matched to 45 non-embolized controls (71 ⫾ 13 years, 80% male). Mean tumor size was 5.2 ⫾ 1.7 cm (range: 1.7-9.7 cm). Overall, 71% of pairs were matched identically on the basis of tumor size, with 95% matched within 5 mm; the largest difference in size was 9 mm. Three hemorrhagic complications (6.7%) occurred in the preembolization group and six (13.3%) in the control group. The odds ratios for developing a hemorrhagic complication were 60% lower in the pre-embolization group; however, the effect was not statistically significant in this sample (OR ¼ 0.40; 95% CI: 0.08–2.06; p ¼ 0.27). Conclusions: While the OR did not reach statistical significance in this sample due to limited power, the magnitude of the effect warrants further investigation given the potential clinical significance of any reduction in hemorrhagic complications. A prospective study, which would benefit from randomization to balance the sample and account for putative confounding variables, is supported by these data.
Abstract No. 462 Percutaneous cryoablation of centrally located renal cell carcinoma
Scientific e-Posters
M. Haddad1, A. Weisbrod1, G. Schmit1, A. Kurup1, M. Callstrom1, C. Lohse1, S. Boorjian1, R. Thompson1, T. Atwell1; 1Mayo Clinic, Rochester, MN Purpose: Evaluate whether percutaneous cryoablation is an efficacious and safe treatment for centrally located renal cell carcinoma (RCC). Materials: Outcomes were analyzed following 172 percutaneous cryoablation procedures performed from 2003 to 2015 to treat centrally located (i.e. extending to the renal sinus fat) RCC’s. Cryoablation procedures (n = 24) that included concurrent treatment of non-central tumors or with radiofrequency ablation were excluded from complication analysis. Tumor characteristics, oncologic outcomes, and complications were evaluated. Results: One hundred seventy-six central RCC’s with a median size of 3.5 cm (1.0-9.7cm) were treated in 169 patients during 172 cryoablation procedures. 122 (69%) RCC’s were cT1a clear cell RCC, 44(25%) were cT1b clear cell RCC, and 10(6%) were cT2a clear cell RCC. Technical failure was observed in 3 (1.7%) RCC’s. One hundred sixtyone RCC’s were followed for 3 months or longer, and of these, 8 (5.0%) recurred at a mean of 2.4 years following cryoablation. The median follow-up duration of the 151 RCC’s that did not recur was 2.6 years (range 0.25-11.25). Estimated recurrence-free survival rates (95% CI; number still at risk) at 1, 3, and 5 years following cryoablation were 98.6% (97.6-100;138)), 94.8% (92.7-100;76), and 89.8% (85.7-100;29), respectively. Median hospital stay was 1 night. Clavien-Dindo grade 3 or greater complications occurred following 23 of the 148 (15.5%) evaluated procedures. The most frequent major complication was related to hemorrhage. Major complications were associated with tumor size and number of probes used.
’
JVIR
Conclusions: Percutaneous cryoablation of RCC’s extending centrally into the kidney is associated with a reasonable rate of local tumor control, although complications are more frequent than previously published. The relatively high major complication rate warrants a higher level of peri-procedural care, especially in larger tumors that require a greater number of probes.
Abstract No. 463 Ethanol ablation of metastatic papillary thyroid cancer lymph nodes S. Young1, T. Sanghvi2, N. Hoven2, C. Dietz2; 1University of Minnesota, Edina, MN; 2University of Minnesota, Minnespolis, MN Purpose: Thyroid cancer is the most common endocrine malignancy and papillary thyroid cancer is the most common histologic type of thyroid cancer. While traditional therapy includes surgery, Iodine 131 (I131) treatment, and external beam radiation, some patients experience recurrence in the form of head and neck lymphadenopathy. When reoccurrences occur in the lymph nodes of the head and neck region repeated surgeries are associated with significant morbidity. This has lead previous authors to examine using ethanol ablation of lymph node recurrence. Unfortunately, the available data in this area is still very limited with only a few small patient cohorts available. The aim of this project is to retrospectively review outcomes of patients with thyroid cancer reoccurrence in head and neck lymph nodes treated with ethanol ablation. Materials: This study was approved by our institutional IRB. We retrospectively reviewed 17 patients who underwent ethanol ablation of 32 different lymph nodes for metastatic thyroid cancer at a single academic medical center. The patients’ charts were evaluated for prior treatment related variables, clinical outcomes, and complications. Results: All patients had undergone prior I131 therapy and thyroid resections with the mean number of surgeries being 1.58 (range 1-4). The mean number of ethanol ablation treatments per lymph node was 1.94 (range 1-6). Of the 32 lymph nodes all demonstrated local treatment response and disease control. Six of seventeen patients (35%) suffered distal recurrence. One patient demonstrated a major complication of laryngeal paralysis secondary to recurrent laryngeal nerve injury. No minor complications were reported. Conclusions: Ethanol ablation of metastatic lymph nodes from thyroid cancer is a promising treatment strategy with reduced associated morbidity as compared to surgery. While local disease control seems possible it is as of yet known how effective this strategy will be on long-term survival outcomes.
Abstract No. 464 Computed tomography–guided microwave ablation of renal cell carcinoma: assessment of short-term efficacy and safety W. Zhou1, R. Arellano2; 1Tufts University School of Medicine, Boston, MA; 2Massachusetts General Hospital, Boston, MA
Scientific e-Posters
a review of the electronic medical record and relevant imaging. Conditional logistic regression was used to test for a difference in the complication rates while controlling for the matched pair design. Results: 45 pre-embolized patients (mean age 72 ⫾ 12 years; 71% male) were matched to 45 non-embolized controls (71 ⫾ 13 years, 80% male). Mean tumor size was 5.2 ⫾ 1.7 cm (range: 1.7-9.7 cm). Overall, 71% of pairs were matched identically on the basis of tumor size, with 95% matched within 5 mm; the largest difference in size was 9 mm. Three hemorrhagic complications (6.7%) occurred in the preembolization group and six (13.3%) in the control group. The odds ratios for developing a hemorrhagic complication were 60% lower in the pre-embolization group; however, the effect was not statistically significant in this sample (OR ¼ 0.40; 95% CI: 0.08–2.06; p ¼ 0.27). Conclusions: While the OR did not reach statistical significance in this sample due to limited power, the magnitude of the effect warrants further investigation given the potential clinical significance of any reduction in hemorrhagic complications. A prospective study, which would benefit from randomization to balance the sample and account for putative confounding variables, is supported by these data.
Abstract No. 462 Percutaneous cryoablation of centrally located renal cell carcinoma
Scientific e-Posters
M. Haddad1, A. Weisbrod1, G. Schmit1, A. Kurup1, M. Callstrom1, C. Lohse1, S. Boorjian1, R. Thompson1, T. Atwell1; 1Mayo Clinic, Rochester, MN Purpose: Evaluate whether percutaneous cryoablation is an efficacious and safe treatment for centrally located renal cell carcinoma (RCC). Materials: Outcomes were analyzed following 172 percutaneous cryoablation procedures performed from 2003 to 2015 to treat centrally located (i.e. extending to the renal sinus fat) RCC’s. Cryoablation procedures (n = 24) that included concurrent treatment of non-central tumors or with radiofrequency ablation were excluded from complication analysis. Tumor characteristics, oncologic outcomes, and complications were evaluated. Results: One hundred seventy-six central RCC’s with a median size of 3.5 cm (1.0-9.7cm) were treated in 169 patients during 172 cryoablation procedures. 122 (69%) RCC’s were cT1a clear cell RCC, 44(25%) were cT1b clear cell RCC, and 10(6%) were cT2a clear cell RCC. Technical failure was observed in 3 (1.7%) RCC’s. One hundred sixtyone RCC’s were followed for 3 months or longer, and of these, 8 (5.0%) recurred at a mean of 2.4 years following cryoablation. The median follow-up duration of the 151 RCC’s that did not recur was 2.6 years (range 0.25-11.25). Estimated recurrence-free survival rates (95% CI; number still at risk) at 1, 3, and 5 years following cryoablation were 98.6% (97.6-100;138)), 94.8% (92.7-100;76), and 89.8% (85.7-100;29), respectively. Median hospital stay was 1 night. Clavien-Dindo grade 3 or greater complications occurred following 23 of the 148 (15.5%) evaluated procedures. The most frequent major complication was related to hemorrhage. Major complications were associated with tumor size and number of probes used.
’
JVIR
Conclusions: Percutaneous cryoablation of RCC’s extending centrally into the kidney is associated with a reasonable rate of local tumor control, although complications are more frequent than previously published. The relatively high major complication rate warrants a higher level of peri-procedural care, especially in larger tumors that require a greater number of probes.
Abstract No. 463 Ethanol ablation of metastatic papillary thyroid cancer lymph nodes S. Young1, T. Sanghvi2, N. Hoven2, C. Dietz2; 1University of Minnesota, Edina, MN; 2University of Minnesota, Minnespolis, MN Purpose: Thyroid cancer is the most common endocrine malignancy and papillary thyroid cancer is the most common histologic type of thyroid cancer. While traditional therapy includes surgery, Iodine 131 (I131) treatment, and external beam radiation, some patients experience recurrence in the form of head and neck lymphadenopathy. When reoccurrences occur in the lymph nodes of the head and neck region repeated surgeries are associated with significant morbidity. This has lead previous authors to examine using ethanol ablation of lymph node recurrence. Unfortunately, the available data in this area is still very limited with only a few small patient cohorts available. The aim of this project is to retrospectively review outcomes of patients with thyroid cancer reoccurrence in head and neck lymph nodes treated with ethanol ablation. Materials: This study was approved by our institutional IRB. We retrospectively reviewed 17 patients who underwent ethanol ablation of 32 different lymph nodes for metastatic thyroid cancer at a single academic medical center. The patients’ charts were evaluated for prior treatment related variables, clinical outcomes, and complications. Results: All patients had undergone prior I131 therapy and thyroid resections with the mean number of surgeries being 1.58 (range 1-4). The mean number of ethanol ablation treatments per lymph node was 1.94 (range 1-6). Of the 32 lymph nodes all demonstrated local treatment response and disease control. Six of seventeen patients (35%) suffered distal recurrence. One patient demonstrated a major complication of laryngeal paralysis secondary to recurrent laryngeal nerve injury. No minor complications were reported. Conclusions: Ethanol ablation of metastatic lymph nodes from thyroid cancer is a promising treatment strategy with reduced associated morbidity as compared to surgery. While local disease control seems possible it is as of yet known how effective this strategy will be on long-term survival outcomes.
Abstract No. 464 Computed tomography–guided microwave ablation of renal cell carcinoma: assessment of short-term efficacy and safety W. Zhou1, R. Arellano2; 1Tufts University School of Medicine, Boston, MA; 2Massachusetts General Hospital, Boston, MA