Georgiades Christos S, Hong Kelvin, Bizzell Cary, Geschwind Jean-Francois, Rodriguez Ronald
Department of Vascular Interventional Radiology, Johns Hopkins Hospital, 600 North Wolfe Street, Blalock 544, Baltimore, MD 21287, USA.
J Vasc Interv Radiol. 2008 Sep;19(9):1302-10. doi: 10.1016/j.jvir.2008.05.015. Epub 2008 Jul 11.
Image-guided percutaneous cryoablation is a treatment alternative for selected patients with renal cell carcinoma (RCC). The objective of the present study was to present the safety and efficacy of percutaneous cryoablation.
The study included 51 lesions in 46 consecutive patients treated with computed tomography (CT)-guided percutaneous cryoablation. Results were based on 40 RCCs with follow-up. Patients had baseline history and physical and laboratory examinations and renal CT or magnetic resonance (MR) imaging and were followed every 3 months. Biopsy of all lesions was performed before or at the time of the procedure. Efficacy was defined as a complete lack of enhancement on follow-up contrast agent-enhanced CT or MR imaging. Lesion size was also followed and correlated with lack of enhancement. Short- and long-term complications were tabulated.
The technical success rate was 100%, with 20% of cases requiring some form of thermal protection of an adjacent organ. During follow-up (median, 28 weeks; range, 4-81 weeks), the efficacy rate was 100% for lesions smaller than 7 cm. The incidence of significant complications was 18% (8% CTAE), mostly (10%) intercostal or genitofemoral nerve injury. All patients with complications recovered fully, and there were no mortalities. There was no change in creatinine levels, and no patient developed renal failure as a result of cryoablation.
CT-guided percutaneous cryoablation resulted in complete response for lesions as large as 4 cm. It may also be a viable alternative for nonsurgical candidates with lesions as large as 7 cm. It has a high efficacy rate, and its modest complications are not only comparable to those of other treatment modalities, but also appear to be reversible.
影像引导下经皮冷冻消融术是部分肾细胞癌（RCC）患者的一种治疗选择。本研究的目的是阐述经皮冷冻消融术的安全性和有效性。
本研究纳入了46例连续接受计算机断层扫描（CT）引导下经皮冷冻消融术治疗的患者的51个病灶。结果基于40例接受随访的肾细胞癌患者。患者有基线病史、体格检查和实验室检查，以及肾脏CT或磁共振（MR）成像，并每3个月进行一次随访。所有病灶在手术前或手术时进行活检。疗效定义为随访时对比剂增强CT或MR成像完全无强化。还对病灶大小进行了跟踪，并与无强化情况相关联。列出了短期和长期并发症。
技术成功率为100%，20%的病例需要对邻近器官进行某种形式的热保护。在随访期间（中位时间为28周；范围为4 - 81周），小于7 cm的病灶有效率为100%。严重并发症的发生率为18%（8%为美国国立癌症研究所常见不良反应分级标准），主要（10%）为肋间神经或生殖股神经损伤。所有并发症患者均完全康复，无死亡病例。肌酐水平无变化，没有患者因冷冻消融术而发生肾衰竭。
CT引导下经皮冷冻消融术对直径达4 cm的病灶可产生完全缓解。对于病灶直径达7 cm的非手术候选患者，它也可能是一种可行的选择。它具有较高的有效率，其轻微并发症不仅与其他治疗方式相当，而且似乎是可逆的。
