Department of Radiology, Radiation Oncology, and Medical Physics, University of Ottawa, Ottawa, Ontario, Canada.
Department of Radiology, The Mayo Clinic, Rochester, MN.
Urology. 2024 Jan;183:141-146. doi: 10.1016/j.urology.2023.10.001. Epub 2023 Oct 11.
To assess the safety, technical success, disease progression, and survival associated with percutaneous image-guided cryoablation of renal cell carcinoma metastasis (mRCC) in the adrenal gland.
Retrospective, single-institution review of adult patients undergoing percutaneous cryoablation for adrenal mRCC between the years of 2007-2021. Technical parameters, technical success, safety, and survival were analyzed according to standard criteria.
Forty-six patients (39 male; mean age 66 ± 8.8 years) with 57 tumors ablated over 51 sessions with a median hospital length of stay of 1 day (range 0-3 days). Forty-four (96%) had primary of clear cell histology. Aim of ablation was curative intent in 39 of 57 tumors (72%) with local tumor control in the remainder. There were 2 (4%) technical failures and technique efficacy was achieved in 52 out of the remaining 55 (95%). There were no Common Terminology Criteria for Adverse Events' immediate complications and 4 of 51 (8%) delayed complications. Twenty-five of 57 (44%) had disease progression anywhere, away from ablation site. One-, 3-, and 5-year recurrence free survival rates were 100%, 89%, and 89% and overall survival was 98%, 85%, and 71%. Fifty-one of 57 (89%) underwent preprocedural alpha blockade with hypertensive crisis in 27 of 56 (54%) available records, of which there were no adverse outcomes.
Percutaneous cryoablation of mRCC to the adrenal glands is safe with robust local control, leading to advocacy for its ongoing use in this patient population. Multi-disciplinary management is recommended for successful treatment.
评估经皮影像引导冷冻消融治疗肾上腺转移肾细胞癌（mRCC）的安全性、技术成功率、疾病进展和生存率。
回顾性分析 2007 年至 2021 年间在我院接受经皮冷冻消融治疗肾上腺 mRCC 的成年患者。根据标准标准分析技术参数、技术成功率、安全性和生存率。
46 例患者（39 例男性；平均年龄 66±8.8 岁）共 57 个肿瘤，共进行 51 次消融，中位住院时间 1 天（范围 0-3 天）。44 例（96%）为原发性透明细胞组织学。39 个肿瘤的消融目的为根治性，其余肿瘤局部肿瘤控制。有 2 例（4%）技术失败，55 例中其余 52 例（95%）达到技术效果。无即时并发症，51 例中有 4 例（8%）延迟并发症。57 例中有 25 例（44%）出现远处消融部位的疾病进展。1、3、5 年无复发生存率分别为 100%、89%和 89%，总生存率为 98%、85%和 71%。57 例中有 51 例（89%）接受了术前α阻断治疗，56 例中有 27 例（54%）有高血压危象记录，无不良结局。
经皮冷冻消融治疗肾上腺 mRCC 安全有效，局部控制良好，倡导在该患者人群中继续使用。建议多学科管理以获得成功的治疗效果。
