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Percutaneous CT-Guided Cryotherapy of Renal
Masses: Long-term Follow-up and Morbidity.
Hussein D. Aoun, M.D
Wayne State University / Detroit Medical Center
Department of Radiology
Peter J. Littrup, M.D.
Professor of Radiology. Urology & Radiation Oncology:
Wayne State University/ Karmanos Cancer Institute
Why ICE?Why ICE?
• Cryotherapy = ‘Freezing’ needles accurately placed and monitored to sculpt treatment zone.
• Cryo:– Historical established: 7-yr. prostate data – it works with low
morbidity!
– Painless with minimal sedation.
– CT visible ice.
– Preservation of collagenous architecture
~ healing potential…
Cryotherapy Technology Cryotherapy Technology Transition:Transition:
Laparotomy to Percutaneous Laparotomy to Percutaneous
Percutaneous Freeze PlanningPercutaneous Freeze Planning00oo Visible MarginVisible Margin by CT/US/MRI by CT/US/MRI
~2.5 cm~2.5 cm ~4.5 cm~4.5 cm
IsothermsIsotherms, , tissue typestissue types and and heat loadheat load are important for necrosisare important for necrosis
-20-20oo ~ ~ Lethal for ‘watery’ tumors Lethal for ‘watery’ tumors
~ 4 mm inside ice ~ 4 mm inside ice -40-40oo ~ Lethal for fibrous tumors ~ Lethal for fibrous tumors
~ 8 mm inside ice~ 8 mm inside ice
-150-150oo ~ Probe surface temp ~ Probe surface temp
Renal Cryotherapy: 3/2008Renal Cryotherapy: 3/2008Methods & MaterialsMethods & Materials::
100100 masses, masses, 9090 patients patients in in 9898 procedures procedures
• 23 Saline & 4 balloons – Bowel Protection23 Saline & 4 balloons – Bowel Protection
• All outpatients – low pain during/afterAll outpatients – low pain during/after
• Complications - 3% CTCAE grade Complications - 3% CTCAE grade >> 3 3
• Mean F/U: 1.3 yrs; 47 >12mo; up to 5 yrs.Mean F/U: 1.3 yrs; 47 >12mo; up to 5 yrs.
• Recurrences – 4% - all early; probe fail/VHLRecurrences – 4% - all early; probe fail/VHL
Average Tumor Size: 3.1cm {1.2-7.6}Average Tumor Size: 3.1cm {1.2-7.6}Average Ice Ball Size: 5.5 cm {3.1-Average Ice Ball Size: 5.5 cm {3.1-
9.7}9.7}
Con-ArterialCon-Arterial
Ablation Zone Follow-up: SizeAblation Zone Follow-up: Size• CT/MR (-, +, delay) - 1, 3, 6, 12, 18, 24 monthsCT/MR (-, +, delay) - 1, 3, 6, 12, 18, 24 months
Long - Term Change of Ablation Zone Size
0
1
2
3
4
5
6
Tumor Ice Ball 1 3 6 12 18 24
Time after Cryotherapy (Months)
Av
g.
Dia
me
ter
(cm
)
Renal Cryotherapy: KCI Renal Cryotherapy: KCI Results: Local RecurrencesResults: Local Recurrences
• 6% (6/100) of 6% (6/100) of massesmasses• 7% 7% (6/90) of (6/90) of patientspatients
- 4 early experience (1st case undertreat near bowel, 1 - 4 early experience (1st case undertreat near bowel, 1 probe failure and 2 probe failure and 2 image only - Bx neg & no progress)image only - Bx neg & no progress)- 2 multi-focal tumor recur (VHL, pap Rca)- 2 multi-focal tumor recur (VHL, pap Rca)
Perc. Renal Cryotherapy Conclusions:Perc. Renal Cryotherapy Conclusions:
• Minimal Pain –Outpatient Procedure!Minimal Pain –Outpatient Procedure!
• Excellent Visualization of ICE under CT!Excellent Visualization of ICE under CT!
• Balloon / Saline protection - adjacent organs!Balloon / Saline protection - adjacent organs!
• Any location in the Kidney with good healing!Any location in the Kidney with good healing!
• CURATIVE MINIMALLY INVASIVE CURATIVE MINIMALLY INVASIVE TREATMENT OPTION FOR KIDNEY TREATMENT OPTION FOR KIDNEY TUMORS!!!TUMORS!!!