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Huang RS, Chow R, Benour A, Chen D, Boldt G, Wallis CJD, Swaminath A, Simone CB, Lock M, Raman S. Comparative efficacy and safety of ablative therapies in the management of primary localised renal cell carcinoma: a systematic review and meta-analysis. Lancet Oncol 2025; 26:387-398. [PMID: 39922208 DOI: 10.1016/s1470-2045(24)00731-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 12/16/2024] [Accepted: 12/17/2024] [Indexed: 02/10/2025]
Abstract
BACKGROUND Non-invasive and minimally invasive ablative treatments, including stereotactic body radiotherapy (SBRT), radiofrequency ablation, microwave ablation, and cryoablation, have emerged as key treatment options for managing renal cell carcinoma, especially for patients who are unsuitable for surgery. We aimed to compare the clinical efficacy and safety of these emerging treatment methods in patients with localised renal cell carcinoma. METHODS In this systematic review and meta-analysis, we searched PubMed (MEDLINE), Embase, and the Cochrane Library for publications between Jan 1, 2000, and March 1, 2024. Eligible articles were observational studies and randomised controlled trials including at least five adult patients (age ≥18 years) with primary and localised renal cell carcinoma treated with SBRT, radiofrequency ablation, microwave ablation, or cryoablation and that reported on local control outcomes. Two reviewers independently screened titles and abstracts and then full texts of eligible studies were independently evaluated by the same reviewers, with disagreements resolved via discussion or consultation with a third reviewer. Summary estimates were extracted from published reports manually using a standardised data extraction form. The primary endpoint was local control rate at 1 year, 2 years, and 5 years after start of treatment. A meta-analysis was conducted using a DerSimonian and Laird model to summarise local control rates. Publication bias was evaluated using funnel plots and Egger's test. We also recorded the frequency and severity of adverse events after treatment on the basis of the Common Terminology Criteria for Adverse Events (version 5.0) and Clavien-Dindo complication index. The study protocol was prospectively registered with PROSPERO, CRD42024511840. FINDINGS We identified 6668 records, of which 330 were assessed via full-text review, and 133 were included in our systematic review and meta-analysis. The eligible studies included data for 8910 patients (mean age 67·9 years [SD 7·3], 2518 [31·4%] of 8018 patients with available data were female and 5500 [68·6%] were male). Local control rates for SBRT were 99% (95% CI 97-100; I2=6%) at 1 year, 97% (95-99; I2=0%) at 2 years, and 95% (89-98; I2=42%) at 5 years; for radiofrequency ablation were 96% (94-98; I2=73%) at 1 year, 95% (92-98; I2=77%) at 2 years, and 92% (88-96; I2=78%) at 5 years; for microwave ablation were 97% (95-99; I2=74%) at 1 year, 95% (92-98; I2=77%) at 2 years, and 86% (75-94; I2=66%) at 5 years; and for cryoablation were 95% (93-96; I2=61%) at 1 year, 94% (91-96; I2=69%) at 2 years, and 90% (87-93; I2=74%) at 5 years. The proportion of patients who reported grade 3-4 adverse events was 3% (121 of 3726) after cryoablation, 2% (39 of 2503) after radiofrequency ablation, 1% (22 of 2069) after microwave ablation, and 2% (11 of 612) after SBRT. Risk of bias was moderate in most studies (70 [53%] of 133) and no publication bias was observed. INTERPRETATION All investigated ablative methods continue to represent effective treatment choices in renal cell carcinoma, and these findings support multi-disciplinary discussions of these treatment methods, along with surgery and surveillance, to individualise treatment decisions in these patients. Future research should aim to conduct randomised controlled trials across larger patient populations to further elucidate the long-term oncological and survival outcomes associated with these treatments. FUNDING None.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ronald Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ali Benour
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Chen
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gabriel Boldt
- London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Christopher J D Wallis
- Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anand Swaminath
- Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Charles B Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Lock
- London Regional Cancer Program, London Health Sciences Centre, Schulich School of Medicine, University of Western Ontario, London, ON, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Vrabel MR, Schulman JA, Gillam FB, Mantooth SM, Nguyen KG, Zaharoff DA. Focal Cryo-Immunotherapy with Intratumoral IL-12 Prevents Recurrence of Large Murine Tumors. Cancers (Basel) 2023; 15:2210. [PMID: 37190138 PMCID: PMC10137033 DOI: 10.3390/cancers15082210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
Focal ablation technologies are routinely used in the clinical management of inoperable solid tumors but they often result in incomplete ablations leading to high recurrence rates. Adjuvant therapies, capable of safely eliminating residual tumor cells, are therefore of great clinical interest. Interleukin-12 (IL-12) is a potent antitumor cytokine that can be localized intratumorally through coformulation with viscous biopolymers, including chitosan (CS) solutions. The objective of this research was to determine if localized immunotherapy with a CS/IL-12 formulation could prevent tumor recurrence after cryoablation (CA). Tumor recurrence and overall survival rates were assessed. Systemic immunity was evaluated in spontaneously metastatic and bilateral tumor models. Temporal bulk RNA sequencing was performed on tumor and draining lymph node (dLN) samples. In multiple murine tumor models, the addition of CS/IL-12 to CA reduced recurrence rates by 30-55%. Altogether, this cryo-immunotherapy induced complete durable regression of large tumors in 80-100% of treated animals. Additionally, CS/IL-12 prevented lung metastases when delivered as a neoadjuvant to CA. However, CA plus CS/IL-12 had minimal antitumor activity against established, untreated abscopal tumors. Adjuvant anti-PD-1 therapy delayed the growth of abscopal tumors. Transcriptome analyses revealed early immunological changes in the dLN, followed by a significant increase in gene expression associated with immune suppression and regulation. Cryo-immunotherapy with localized CS/IL-12 reduces recurrences and enhances the elimination of large primary tumors. This focal combination therapy also induces significant but limited systemic antitumor immunity.
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Affiliation(s)
- Maura R. Vrabel
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
| | - Jacob A. Schulman
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - Francis B. Gillam
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - Siena M. Mantooth
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
| | - Khue G. Nguyen
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
| | - David A. Zaharoff
- ImmunoEngineering Laboratory, Joint Department of Biomedical Engineering, UNC-Chapel Hill and NC State University, Raleigh, NC 27695, USA
- Comparative Medicine Institute, NC State University, Raleigh, NC 27695, USA
- Lineberger Comprehensive Cancer Center, UNC-Chapel Hill, Chapel Hill, NC 27599, USA
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Song S, Yang Q, Gu C, Yu G, Hua B, Gu X, Wang L, Wang Z, Shi G, Xu B. Long-term outcomes of cryoablation for biopsy-proven T1 stage renal cell carcinoma. World J Surg Oncol 2022; 20:284. [PMID: 36064369 PMCID: PMC9446802 DOI: 10.1186/s12957-022-02752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background To summarize our clinical experience of cryoablation in renal cell carcinoma (RCC) of Chinese population and to evaluate the long-term outcomes of laparoendoscopic single-site (LESS) cryoablation (LCA) as well as percutaneous CT-guided cryoablation (PCA) for biopsy-proven T1a and T1b RCC. Methods This was a multi-center, retrospective study investigating T1 stage RCC patients from 2011 to 2021. The patients were treated by LCA or PCA according to individual situation. Overall survival (OS), cancer-related survival (CSS), and progression-free survival (PFS) were evaluated for oncological outcomes, and kidney function, complications, and hospital stay were used to estimate technical outcomes. Results A total of 163 consecutive patients were included. Among them, 59 cases were treated by LCA and PCA was performed in 104 cases. All operations were processed successfully. Mean diameter of the mass was (2.9±1.4) cm; median blood volume was 45ml (10~200 ml). The mean operation time was 84.0 ± 24.5 min. The median postoperative hospital stay was 3 days (1~6 days). Compared with LCA, procedure time of PCA was shortened, the volume of bleeding was reduced, and the hospital stay was decreased. The overall adverse events rate was 9.8% (16/163). The mean preoperative and postoperative eGFR of LCA were 77.6±15.3 ml/min and 75.6±17.4 ml/min, respectively. Analogously, the values of PCA were 78.7±12.9 ml/min and 76.7±14.3 ml/min. Mean follow-up time was 64.2 ± 30.2 months (range, 7–127 months). Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. PFS at 5 and 10 years were 95.5% and 69.2% for LCA and 96.7% and 62.8% for PCA. In total, 26 patients (16.0%) (11 patients from LCA and 15 from PCA) died throughout the follow-up period. OS at 5 and 10 years were 93.8% and 31.4% for LCA, and 97.4% and 52.7% for PCA. Six patients (3.7%) (3 cases from LCA and 3 from PCA) died of metastatic RCC. CCS for LCA were 98.0% and 82.8% at 5 and 10 years, while the data were 100% and 86.4% for PCA. Conclusion LCA and PCA for T1 stage RCC provides satisfactory long-term oncological and renal function preservation outcomes, with acceptable complication rates.
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Affiliation(s)
- Shangqing Song
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Qing Yang
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Chengyuan Gu
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Guopeng Yu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Bao Hua
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Xin Gu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Linhui Wang
- Shanghai Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Zhong Wang
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Guohai Shi
- Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
| | - Bin Xu
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
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Umakoshi N, Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Kajita S, Araki M, Mitsuhashi T, Gobara H, Kanazawa S. Correlation between renal ablation zone in contrast-enhanced CT and non-enhanced MRI during the early period following percutaneous cryoablation. Jpn J Radiol 2022; 40:1087-1095. [PMID: 35556212 PMCID: PMC9529705 DOI: 10.1007/s11604-022-01285-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
Purpose To retrospectively evaluate and correlate the contrast-enhanced computed tomography (CECT) and non-enhanced magnetic resonance imaging (MRI) during the early period following renal cryoablation. Materials and methods Both dynamic CECT and non-enhanced MRI were performed within 4 days following cryoablation in 34 renal tumors in 33 patients. The renal volumes of the unenhanced regions on dynamic CECT (nephrogenic phase, 4 mm thickness) and the regions with signal intensity changes on non-enhanced MRI (fat-suppressed T2-weighted image, 4 mm thickness) were evaluated. Fusion images of the axial, coronal, and sagittal sections of CECT and MRI images were created from the maximum cross-section of the renal tumor, and the match score of each image was visually evaluated on a 5-point scale. Results The mean renal volume of the unenhanced regions on CECT and those with signal intensity changes on non-enhanced MRI following cryoablation were 29.5 ± 19.9 cm3 (range, 4.3–97.4 cm3) and 30.7 ± 19.8 cm3 (range, 6.7–94.0 cm3), respectively; the difference between them was –1.17 cm3 (95% confidence interval [CI] –2.74, 0.40, P = 0.139). The Pearson’s product-moment correlation coefficient (r = 0.975; 95% CI, 0.951, 0.988; P < 0.0001) showed a strong correlation between the volumes. The average match score between CECT and non-enhanced MRI was as high as 4.5 ± 0.5 points (radiologist 1, 4.3 ± 0.5; radiologist 2, 4.7 ± 0.5). Local tumor control rate was 94.1% (32/34 tumors) and recurrence-free survival rate was 82.0% (95% CI: 64.2%, 91.5%) at 5 years. Conclusions The region with signal intensity changes on non-enhanced MRI was strongly correlated with the unenhanced region on CECT during the early period following renal cryoablation.
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Affiliation(s)
- Noriyuki Umakoshi
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan. .,Deptartment of Radiological Technology, Okayama University Graduate School of Health Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Soichiro Kajita
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Motoo Araki
- Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Ki-taku, Okayama, 700-8558, Japan
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