Cryoablation of sternal metastases for pain palliation and local tumor control.

PURPOSE: To determine safety and effectiveness of cryoablation of sternal metastases for pain palliation and local tumor control. MATERIALS AND METHODS: A tumor ablation database was retrospectively reviewed for sternal cryoablation procedures performed between January 2005 and June 2013, which yielded 15 procedures to treat 12 sternal metastases in 12 patients (five men). Median patient age was 57 years (range, 38-80 y). Metastases arose from five primary sites (breast, lung, kidney, ampulla, and thyroid), and median tumor size was 3.8 cm (range, 2.2-7.5 cm). Seven patients (58%) underwent cryoablation for pain palliation, and five (42%) underwent cryoablation for local tumor control of oligometastatic disease. Clinical outcomes (including complications, local tumor control, and pain response) were evaluated retrospectively. RESULTS: Mean pain scores decreased from 7.0 ± 1.9 (median, 7; range, 4-10) at baseline to 1.8 ± 1.2 (median, 1.5; range, 0-4) following cryoablation (P = .00049). Two patients had durable pain palliation, and four had greater than 1 month of pain relief, with a median duration of 5.7 months (range, 1.5-14.7 mo). Two patients in whom recurrent pain developed underwent repeat cryoablation, with durable pain relief. Allowing for a single repeat treatment, local tumor control was achieved in four of five patients (80%) treated for this indication, with median follow-up of 8.4 months (range, 2.6-13.6 mo). In one patient (8%), an infectious complication developed that was successfully treated with antibiotics on an outpatient basis. CONCLUSIONS: Cryoablation is a safe and potentially effective treatment for patients with painful sternal metastases and can achieve local tumor control in select patients.

Ultrasound-guided transhepatic radiofrequency ablation of renal tumors: a safe and effective approach.

PURPOSE: This study was designed to determine the feasibility and safety of ultrasound-guided transhepatic radiofrequency ablation (RFA) of masses in the right kidney. METHODS: Between June 2001 and December 2011, 18 patients who underwent transhepatic renal RFA procedures to treat 19 tumors were retrospectively identified. Complications (Clavien-Dindo classification system) and local tumor control were evaluated for all patients. RESULTS: Median maximal diameter of the treated renal tumors was 1.9 (range 1.1-4.3) cm. No major complication developed during any of the procedures. No hepatic tumor seeding was identified during imaging follow-up. There was a single technical failure (5.3%). Median cross-sectional imaging follow-up was 28 (range 3-121) months. Primary technique failure (local recurrence) occurred in 1 of the 16 tumors with follow-up imaging (5.3%). CONCLUSIONS: Percutaneous ultrasound-guided transhepatic RFA of renal neoplasms is technically feasible, effective, and associated with a low rate of complications. The transhepatic approach may allow safe ablation of renal tumors that would otherwise be difficult to treat.

Percutaneous renal cryoablation after partial nephrectomy: technical feasibility, complications and outcomes.

PURPOSE: Treatment of locally recurrent or de novo tumors in the ipsilateral kidney after partial nephrectomy represents a management dilemma. Percutaneous renal cryoablation offers a minimally invasive treatment option in such cases. We review our single institution experience with percutaneous cryoablation of renal tumors after partial nephrectomy for technical feasibility, complications and outcomes. MATERIALS AND METHODS: Between March 2003 and January 2012, 48 patients underwent percutaneous cryoablation for the treatment of 68 ipsilateral renal tumors after previous partial nephrectomy. Oncologic outcomes, complications (Clavien-Dindo classification system) and renal function were evaluated. RESULTS: Median maximal diameter of the treated renal tumors was 2.5 cm (range 1.2 to 5.4). All cryoablation procedures were considered technically successful. Of the 54 biopsy proven or suspected renal cell carcinomas with 3 or more months of computerized tomography/magnetic resonance imaging followup after cryoablation (median 19, range 3 to 61), 5 cases (9.3%) had local tumor recurrence. Major (grade 3 or greater) complications developed after 3 (5.7%) cryoablation procedures and there were no perioperative deaths. Median change in patient estimated glomerular filtration rate after renal cryoablation was -1.5 ml per minute. No patients required dialysis in the perioperative period, while 2 with stage 4 chronic kidney disease at the time of ablation became dialysis dependent at 5 and 23 months after treatment, respectively. CONCLUSIONS: Percutaneous renal cryoablation after ipsilateral partial nephrectomy is technically feasible, has a low rate of major complications, provides relative preservation of renal function and demonstrates acceptable short-term oncologic outcomes in this challenging population.