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Abstract No. 274: Percutaneous CT guided renal mass RFA vs. cryoablation: doses of sedation medications required
S112 䡲 Wednesday
2:18 PM
Scientific Session 䡲 JVIR
Abstract No. 274
Percutaneous CT guided renal mass RFA vs. cryoablation: doses of sedation medications required
WEDNESDAY: Scientific Sessions
C. Truesdale1, S.W. Stavropoulos1, B. Malkowicz2, T. Clark1, M.C. Soulen1, E. Wehrenberg-Klee1; 1 Interventional Radiology, University of Pennsylvania, Philadelphia, PA; 2Urology, University of Pennsylvania, Philadelphia, PA Purpose: Percutaneous CT-guided ablation of small renal masses (SRM) using moderate sedation is an alternative to surgery, particularly in elderly patients with multiple medical comorbidities. In this patient population, minimizing the amount of sedation used, could make the ablation safer. This study was performed to compare the amount of sedation medications needed to perform CT-guided radiofrequency ablations (RFA) versus cryoablation of renal tumors. Materials and Methods: After obtaining IRB approval, medical records were reviewed in all patients who underwent percutaneous CT-guided RFA and cryoablation of SRMs from Jan 2002 to June 2011. Records reviewed included patient and tumor characteristics, amount of medications used for moderate sedation and complications. In all patients, lidocaine was used for local pain control. Moderate sedation was performed by giving patients titrated doses of midazolam and fentanyl until they were comfortable and not complaining of pain. Additional medications were given if the desired level of sedation was not achieved. The student t test and Fisher exact test were used to analyze the data. Results: The study was made up of 116 patients (82 males and 34 females) who underwent 136 ablations. 71 patients were treated with RFA (mean age 71.3 yrs) and 65 patients had cryoablation (mean age 72.1 yrs). There was no difference in regard to age, sex, ASA distribution, and tumor characteristics between the two groups. RFA was associated with significantly higher dose of fentanyl (RFA 236.43 g; cryoablation 172.27g; p⬍.001). RFA was also associated with a higher dose of midazolam (RFA 4.5mg; cryoablation 3.27mg; p⬍.001). In the RFA patient group, 2 patients required additional sedation with droperidol. Two patients in the RFA cohort required sedation reversal with naloxone and flumazenil. None of the cryoablation patients required sedation reversal. No other sedation related complication occurred. Conclusion: CT-guided percutaneous cryoablation of renal masses was performed with less sedation medication than RFA. This suggests renal cryoablation is less painful than RFA, however, prospective studies with confirmed pain scales are needed to confirm these results.
2:26 PM
Abstract No. 275
Radiofrequency ablation of renal cell carcinoma using a multiple electrode switching system: a phase-II clinical study H. Takaki, K. Yamakado, A. Nakatsuka, J. Uraki, M. Kashima, M. Fujimori, T. Yamanaka, T. Hasegawa; Mie university, Mie, Japan Purpose: This prospective phase-II study evaluated the safety and efficacy of radiofrequency (RF) ablation using multiple electrode switching system for the treatment of renal cell carcinoma (RCC).
Materials and Methods: Patients with pathologically confirmed renal cell carcinoma measuring 10 cm or less were enrolled in this study. RF ablation was performed under the CT fluoroscopic guidance by using a multiple electrode switching system. The primary endpoint was safety that was evaluated by Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. The secondary endpoints were changes in renal function, technique effectiveness rate, local tumor progression rate, and survival. When tumor enhancement disappeared after renal RF ablation on contrast-enhanced CT or MRI, it was defined as technically effective. Results: Thirty-three patients were enrolled in this study. Mean maximum tumor diameter was 2.9⫾0.9 cm (range, 1.5-5.0 cm). Grade-2 adverse events occurred in 3 patients (9.1%, 3/33) after RF ablation; anemia in 2 patients and pneumothorax in one, but severe adverse events (grade-3 or more) were not noted in any patients. Although the increase in the mean serum creatinin level was significant after RF ablation (1.0⫾0.4 vs. 1.2⫾0.5 mg/dl, p⬍0.01), no grade-2 or more creatinin increase was not found. Tumor enhancement disappeared after single session in 31 patients (primary technique effectiveness rate, 93.9%) and after two sessions in 2 patients (secondary technique effectiveness rate, 100%). Local tumor progression was not found in any patients during the mean follow-up period of 16.1 months (range, 11.623.2 months). The 1-year overall and RCC-related survival rates were 96.9% (95% confidence interval, 90.8-100%) and 100%, respectively. Conclusion: RF ablation using a multiple electrode switching system is safe and useful in the treatment of RCC.
2:34 PM
Abstract No. 276
Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): effect of renal parenchymal volume loss on estimated glomerular filtration rate B.D. Hnatiuk1, H. Ajzenberg2, M.A. Jewett2, J.R. Kachura1; 1Medical Imaging, Toronto General Hospital, Toronto, ON, Canada; 2Surgery, Princess Margaret Hospital, Toronto, ON, Canada Purpose: The amount of normal renal tissue lost during nephron-sparing treatments of early stage RCC is poorly understood. The impact on renal function of partial nephrectomy is known but is less well defined with thermal ablation. The purpose of our study was to quantify the degree of renal parenchymal volume (RPV) loss and the decrease in estimated glomerular filtration rate (eGFR) after RFA of RCC, and to determine their correlation. Materials and Methods: Patients who had RFA for RCC from July 2009 to August 2010 were retrospectively reviewed. RPV was calculated using volumetric analysis tools on a Vitrea workstation (Toshiba Medical Systems) by manually tracing the renal parenchymal outline excluding tumor and/or ablation zone on each axial slice on pre- and post-RFA CT scans. A model to predict postoperative eGFR was based on multiplying the preoperative eGFR by the percent of functional volume preservation. Results: The patient cohort consisted of 20 patients (17 M, 3 F) with mean age 70 years (range 52-82) and mean tumor diameter 2.8 cm (range 1.5-4.0). There were 16 clear cell and 4 papillary RCCs. All RFA procedures were performed on an outpatient basis using a 3.5 cm (n⫽10) or a 4 cm (n⫽10) LeVeen electrode
2:18 PM
Scientific Session 䡲 JVIR
Abstract No. 274
Percutaneous CT guided renal mass RFA vs. cryoablation: doses of sedation medications required
WEDNESDAY: Scientific Sessions
C. Truesdale1, S.W. Stavropoulos1, B. Malkowicz2, T. Clark1, M.C. Soulen1, E. Wehrenberg-Klee1; 1 Interventional Radiology, University of Pennsylvania, Philadelphia, PA; 2Urology, University of Pennsylvania, Philadelphia, PA Purpose: Percutaneous CT-guided ablation of small renal masses (SRM) using moderate sedation is an alternative to surgery, particularly in elderly patients with multiple medical comorbidities. In this patient population, minimizing the amount of sedation used, could make the ablation safer. This study was performed to compare the amount of sedation medications needed to perform CT-guided radiofrequency ablations (RFA) versus cryoablation of renal tumors. Materials and Methods: After obtaining IRB approval, medical records were reviewed in all patients who underwent percutaneous CT-guided RFA and cryoablation of SRMs from Jan 2002 to June 2011. Records reviewed included patient and tumor characteristics, amount of medications used for moderate sedation and complications. In all patients, lidocaine was used for local pain control. Moderate sedation was performed by giving patients titrated doses of midazolam and fentanyl until they were comfortable and not complaining of pain. Additional medications were given if the desired level of sedation was not achieved. The student t test and Fisher exact test were used to analyze the data. Results: The study was made up of 116 patients (82 males and 34 females) who underwent 136 ablations. 71 patients were treated with RFA (mean age 71.3 yrs) and 65 patients had cryoablation (mean age 72.1 yrs). There was no difference in regard to age, sex, ASA distribution, and tumor characteristics between the two groups. RFA was associated with significantly higher dose of fentanyl (RFA 236.43 g; cryoablation 172.27g; p⬍.001). RFA was also associated with a higher dose of midazolam (RFA 4.5mg; cryoablation 3.27mg; p⬍.001). In the RFA patient group, 2 patients required additional sedation with droperidol. Two patients in the RFA cohort required sedation reversal with naloxone and flumazenil. None of the cryoablation patients required sedation reversal. No other sedation related complication occurred. Conclusion: CT-guided percutaneous cryoablation of renal masses was performed with less sedation medication than RFA. This suggests renal cryoablation is less painful than RFA, however, prospective studies with confirmed pain scales are needed to confirm these results.
2:26 PM
Abstract No. 275
Radiofrequency ablation of renal cell carcinoma using a multiple electrode switching system: a phase-II clinical study H. Takaki, K. Yamakado, A. Nakatsuka, J. Uraki, M. Kashima, M. Fujimori, T. Yamanaka, T. Hasegawa; Mie university, Mie, Japan Purpose: This prospective phase-II study evaluated the safety and efficacy of radiofrequency (RF) ablation using multiple electrode switching system for the treatment of renal cell carcinoma (RCC).
Materials and Methods: Patients with pathologically confirmed renal cell carcinoma measuring 10 cm or less were enrolled in this study. RF ablation was performed under the CT fluoroscopic guidance by using a multiple electrode switching system. The primary endpoint was safety that was evaluated by Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. The secondary endpoints were changes in renal function, technique effectiveness rate, local tumor progression rate, and survival. When tumor enhancement disappeared after renal RF ablation on contrast-enhanced CT or MRI, it was defined as technically effective. Results: Thirty-three patients were enrolled in this study. Mean maximum tumor diameter was 2.9⫾0.9 cm (range, 1.5-5.0 cm). Grade-2 adverse events occurred in 3 patients (9.1%, 3/33) after RF ablation; anemia in 2 patients and pneumothorax in one, but severe adverse events (grade-3 or more) were not noted in any patients. Although the increase in the mean serum creatinin level was significant after RF ablation (1.0⫾0.4 vs. 1.2⫾0.5 mg/dl, p⬍0.01), no grade-2 or more creatinin increase was not found. Tumor enhancement disappeared after single session in 31 patients (primary technique effectiveness rate, 93.9%) and after two sessions in 2 patients (secondary technique effectiveness rate, 100%). Local tumor progression was not found in any patients during the mean follow-up period of 16.1 months (range, 11.623.2 months). The 1-year overall and RCC-related survival rates were 96.9% (95% confidence interval, 90.8-100%) and 100%, respectively. Conclusion: RF ablation using a multiple electrode switching system is safe and useful in the treatment of RCC.
2:34 PM
Abstract No. 276
Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): effect of renal parenchymal volume loss on estimated glomerular filtration rate B.D. Hnatiuk1, H. Ajzenberg2, M.A. Jewett2, J.R. Kachura1; 1Medical Imaging, Toronto General Hospital, Toronto, ON, Canada; 2Surgery, Princess Margaret Hospital, Toronto, ON, Canada Purpose: The amount of normal renal tissue lost during nephron-sparing treatments of early stage RCC is poorly understood. The impact on renal function of partial nephrectomy is known but is less well defined with thermal ablation. The purpose of our study was to quantify the degree of renal parenchymal volume (RPV) loss and the decrease in estimated glomerular filtration rate (eGFR) after RFA of RCC, and to determine their correlation. Materials and Methods: Patients who had RFA for RCC from July 2009 to August 2010 were retrospectively reviewed. RPV was calculated using volumetric analysis tools on a Vitrea workstation (Toshiba Medical Systems) by manually tracing the renal parenchymal outline excluding tumor and/or ablation zone on each axial slice on pre- and post-RFA CT scans. A model to predict postoperative eGFR was based on multiplying the preoperative eGFR by the percent of functional volume preservation. Results: The patient cohort consisted of 20 patients (17 M, 3 F) with mean age 70 years (range 52-82) and mean tumor diameter 2.8 cm (range 1.5-4.0). There were 16 clear cell and 4 papillary RCCs. All RFA procedures were performed on an outpatient basis using a 3.5 cm (n⫽10) or a 4 cm (n⫽10) LeVeen electrode