Contrast Enhancement on CT Following Renal Cryoablation – Does It Represent Treatment Failure?

Tommy Kjærgaard Nielsen, Øyvind Østraat, Gratien Andersen, Søren Høyer, Michael Borre

Publikation: KonferencebidragPosterForskningpeer review

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Aim: Renal cryoablation is a valid treatment option for localized pT1a renal cancer. Treatment success is typically defined as absence of contrast enhancement (CE) on follow-up imaging. We investigate the development of lesions that demonstrate CE on follow-up CT after renal cryoablation. Materials and methods: A retrospective review of laparoscopic and percutaneous cryoablation procedures from 2005 to 2012 was conducted. A total of 113 patients with a localized pT1a biopsy verified malignant renal lesion was identified. Of these, 34 patients (12 females and 22 males) experienced postoperative CE. Mean patient age was 43 (59-66) yr. Mean tumor size was 25 (22-28) mm. RCC-subtypes: Clear cell (55 %), Papillary (12%), Chromophobe (3%), Subtype not specified (30%). There was no statistically significant difference between the patient characteristics with or without CE lesions. Results: A total of 28 patients (25%) were found to have CE on the initial follow-up CT and additional 6 patients had delayed CE (defined as no CE on prior CT). Spontaneous resolution of the CE was observed in 12 of the 34 patients (35%). Eleven percent of the patients with CE lesions had salvage therapy (including reablation) after the initial follow-up CT at 6 months compared with 44% and 33% after the second CT and third CT, respectively (p>0.05). Two of the 6 patients with delayed CE were reablated, one had oncological treatment due to performance status and three are still awaiting the next follow-up CT. Conclusion: CE is evident in about 1⁄4 of patients on the initial follow-up CT. At 12 months CE had spontaneously resolved in more than 1⁄3 of patients, but was continuously observed as late as 31 months. There was a tendency towards intervention if persistent CE was evident at 12 months, but later interventions were not uncommon. As there are no clear-cut criteria for monitoring treatment failure, careful evaluation by an experienced radiologist and urologist is recommend. The significance of delayed contrast enhancement is not clearly evident and needs further investigation.
StatusUdgivet - 2013
Begivenhed12th International Kidney Cancer Symposium - Chicago, USA
Varighed: 25 okt. 2013 → …


Konference12th International Kidney Cancer Symposium
Periode25/10/2013 → …