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Percutaneous CT-Guided Cryotherapy of Renal Masses: Long-term Follow-up and Morbidity.

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:

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Percutaneous CT-Guided Cryotherapy of Renal Masses: Long-term Follow-up and Morbidity.

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  1. 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

  2. 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…

  3. Cryotherapy Technology Transition: Laparotomy to Percutaneous

  4. Percutaneous Freeze Planning 0oVisible Margin by CT/US/MRI ~2.5 cm ~4.5 cm Isotherms, tissue types and heat loadare important for necrosis -150o ~ Probe surface temp -20o ~ Lethal for ‘watery’ tumors ~ 4 mm inside ice -40o ~ Lethal for fibrous tumors ~ 8 mm inside ice

  5. Renal Cryotherapy: 3/2008Methods & Materials:100 masses,90 patientsin 98 procedures • 23 Saline & 4 balloons – Bowel Protection • All outpatients – low pain during/after • Complications - 3% CTCAE grade > 3 • Mean F/U: 1.3 yrs; 47 >12mo; up to 5 yrs. • Recurrences – 4% - all early; probe fail/VHL

  6. Con-Arterial Average Tumor Size: 3.1cm {1.2-7.6}Average Ice Ball Size: 5.5 cm {3.1-9.7}

  7. Ablation Zone Follow-up: Size • CT/MR (-, +, delay) - 1, 3, 6, 12, 18, 24 months

  8. Renal Cryotherapy: KCI Results: Local Recurrences • 6% (6/100) of masses • 7% (6/90) of patients - 4 early experience (1st case undertreat near bowel, 1 probe failure and 2 image only - Bx neg & no progress) - 2 multi-focal tumor recur (VHL, pap Rca)

  9. Perc. Renal Cryotherapy Conclusions: • Minimal Pain –Outpatient Procedure! • Excellent Visualization of ICE under CT! • Balloon / Saline protection - adjacent organs! • Any location in the Kidney with good healing! • CURATIVE MINIMALLY INVASIVE TREATMENT OPTION FOR KIDNEY TUMORS!!!

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