Renal cell carcinoma overview
Kidney cancer is the 7th most common cancer in men, representing 5% of all malignancies, and the 10th most common cancer in women (3% malignancies).1
More than 90% of kidney cancer diagnoses are renal cell carcinoma (RCC), with the main histological subtype being clear-cell – the most aggressive form.2, 3
Depending on the stage of severity, kidney tumours are classified into1:
- Stage I: the tumor is limited to the kidney with a maximum diameter of 7 cm, and in particular:
- StageT1a (≤4 cm);
- Stage T1b (4-7 cm);
- Stage III: the tumour is no longer confined to the kidney, but there are no distant metastases;
- Stage IV: cancer has metastasised to other parts of the body.
90%
Mortality incidence of kidney cancer.
7th
RCC is the 7th most common cancer in men.
The incidence rate of RCC is growing (about 2.4% per year), partly due to an increase in the incidental detection of small lesions (<4 cm)4
Due to the increasing incidence of RCC in recent years, particular attention has been directed towards cryoablation as cancer treatment.4
RCC subtypes and use of cryoablation
Renal cell carcinoma has a variety of subtypes, that can be distinguished by how the cancer cells appear microscopically. Clear-cell, papillary, and chromophobe histological types account for 90% of all RCC.3
Treatment options
Renal cell carcinoma can be approached with different therapies, depending on the cancer’s stage (I,II,III,IV), the patient being treated and the physician’s preference. The most common treatments for RCC are: 6, 7
Local treatments
- Surgery (partial nephrectomy)
- Active surveillance
- Radiation therapy
- Radiofrequency (RF) Ablation
- Cryoablation
Systemic treatments
- Targeted drug therapy
- Immunotherapy
- Chemotherapy
Recently, cryoablation has been increasingly recognised by urologists, oncologists, and interventional radiologists as a preferred treatment for RCC.
Indeed, percutaneous cryoablation is now endorsed by the European Association of Urology (EAU) as a highly effective technique in terms of success rates (> 95%)8, particularly in patients with stage 1a or 1b RCC8, 9, 10.
Clinical results – why cryoablation?
The benefits of cryoablation vs surgery for RCC
Cryoablation has been shown to be an effective alternative to surgery for the treatment of stage I RCC.8, 9 It not only provides better overall survival rates than partial nephrectomy (72% vs 49% at 10-year)9, but also offers lower post-operative complications rate (15% vs 31%) 11, 14, 19, superior renal function preservation11 and a shorter hospital stay (1 day vs 4/5 days)12, 13, 14.
>95%
Success rate8
Cryoablation vs surgery:
- Fewer post operative complications11, 14, 19
- Better renal functional preservation11
- Short hospital stay12, 13, 14
The benefits of treating RCC under local anaesthesia conscious sedation (LACS)
A key benefit of cryoablation for the treatment of renal cell carcinoma is that it can be performed under local anaesthesia conscious sedation, providing the same outcomes as when performed under general anaesthesia in terms of safety (low treatment failure rate) and efficacy14, but also reducing the costs16, the procedure time (102 mins) and length of hospital stay (average 1.08 days)17. In many centres, it is performed as a day case)18.
Conscious sedation vs general anaesthesia:
- Lower risk profile14, 15
- Reduced procedure time17
- May be performed as a day case18
Our cryoablation solutions
We offer a broad portfolio of cryoablation systems and needles that provide an efficient treatment against tumours.
With game-changing innovation, we’ve streamlined our technology to meet the practical and efficiency demands of your minimally invasive procedures with no compromise to performance.
References:
1.Escudier B, Porta C, Schmidiger M, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 30: 706–720, 2019. doi: 10.1093/annonc/mdz056
2.Sung WW, Ko PY, Chen WJ, et al. Trends in the kidney cancer mortality‑to‑incidence ratios according to health care expenditures of 56 countries. Sci Rep 11, 1479 (2021). 10.1038/s41598-020-79367-y
3.Padala SA, Barsouk A, Thandra KC, et al. Epidemiology of Renal Cell Carcinoma. World J Oncol. 2020 Jun; 11(3): 79–87. doi: 10.14740/wjon1279
4.Cernic S, Marrocchio C, Ciabattoni R, et al. Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center. Medicina (Kaunas). 2021 Mar 20;57(3):291. doi: 10.3390/medicina57030291
5.Kidney Cancer. The Global Cancer Observatory. December, 2020. https://gco.iarc.fr/today/data/factsheets/cancers/29-Kidney-fact-sheet.pdf
6.Kidney Cancer Treatment. Cancer.org. https://www.cancer.org/cancer/kidney-cancer/treating.html
7.Gray RE, Harrys GT. Renal Cell Carcinoma: Diagnosis and Management. Am Fam Physician. 2019 Feb 1;99(3):179-184. https://www.aafp.org/afp/2019/0201/p179.html#afp20190201p179-b23
8.Ljungberg B, Albiges L, Bedke J, et al. (2021). European Association of Urology Guidelines on Renal Cell Carcinoma 2021. https://www.researchgate.net/publication/350621384_European_Association_of_Urology_Guidelines_on_Renal_Cell_Carcinoma_2021
9.Morkos J, Porosnicu Rodriguez KA, Zhou A, et al. Percutaneous Cryoablation for Stage 1 Renal Cell Carcinoma: Outcomes from a 10-year Prospective Study and Comparison with Matched Cohorts from the National Cancer Database. Radiology 2020; 296:452–459. doi: 10.1148/radiol.2020192325
10.Maria T, Georgiades C. Percutaneous Cryoablation for Renal Cell Carcinoma. J Kidney Cancer VHL. 2015;2(3):105-113. doi: 10.15586%2Fjkcvhl.2015.34
11.Deng W, Chen L, Wang Y, et al. Cryoablation versus Partial Nephrectomy for Clinical Stage T1 Renal Masses: A Systematic Review and Meta-Analysis. J Cancer 2019; 10(5):1226-36. doi: 10.7150/jca.28881
12.Chehab C, Friedlander JA et al. Percutaneous Cryoablation vs Partial Nephrectomy: Cost Comparison of T1a Tumors. J Endourol 2016; 30(2):710-6. 10.1089/end.2015.0183
13.Breen D, King A et al. Image-guided Cryoablation for Sporadic Renal Cell Carcinoma: Three –and 5-year Outcomes in 220 Patients with Biopsy-Proven Renal Cell Carcinoma. Radiology 2018; 289(2):554-61. 10.1148/radiol.2018180249
14.Stacul F, Sachs C, Giudici F, et al. Cryoablation of renal tumors: long-term follow-up from a multicenter experience. Abdom Radiol 46, 4476–4488 (2021). doi: 10.1007/s00261-021-03082-z
15.Patel SR, Francois S, Bhamber T, et al. Safety and effectiveness of percutaneous renal cryoablation with conscious sedation. Arab J Urol. 2020 Mar 23;18(3):163-168. doi: 10.1080/2090598X.2020.1739382
16.Saunders R, Davis JA et al. Clinical and economic burden of procedural sedation-related adverse events and their outcomes: analysis from five countries. Ther Clin Risk Manag. 2018; 14:393-401. doi: 10.2147/tcrm.s154720
17.khunov Z, Juncal S et al. Comparison of outcomes in patients undergoing percutaneous renal cryoablation with sedation vs general anesthesia. Urology 2015; 85(1):130-4. doi: 10.1016/j.urology.2014.09.013
18.Georgiades CS & Rodriquez R. Efficacy and safety of percutaneous cryoablation for stage 1A/B renal cell carcinoma: Results of a prospective, single-arm, 5-year study. Cardiovasc Intervent Radiol 2014; 37(6):1494-9. doi: 10.1007/s00270-013-0831-8
19.Bhindi B, Mason RJ, Haddad MM, et al. Outcomes After Cryoablation Versus Partial Nephrectomy for Sporadic Renal Tumors in a Solitary Kidney: A Propensity Score Analysis. Eur Urol 2018; 73(2):254-9. doi: 10.1016/j.eururo.2017.09.009
A.Padala SA et al. 2020. See resource n. 3
B.Feng X, Zhang L, Tu W, Cang S. Frequency, incidence and survival outcomes of clear cell renal cell carcinoma in the United States from 1973 to 2014. Medicine (Baltimore). 2019 Aug; 98(31): e16684. doi: 10.1097%2FMD.0000000000016684
C.Muglia VF, Prando A. Renal cell carcinoma: histological classification and correlation with imaging findings. Radiol Bras. 2015 May-Jun; 48(3): 166–174. doi: 10.1590/0100-3984.2013.1927
D.What is Kidney Cancer?, cancer.org. Last Revised: May 5, 2020. https://www.cancer.org/cancer/kidney-cancer/about/what-is-kidney-cancer.html
E.Haddad MM, Schmit G, Kurup AN, et al. Percutaneous Cryoablation of Solitary, Sporadic Renal Cell Carcinoma: Outcome Analysis Based on Clear-Cell versus Papillary Subtypes. J Vasc Interv Radiol. 2018 Aug;29(8):1122-1126. doi: 10.1016/j.jvir.2018.02.029
F.Okhunov Z, Chamberlin J, Moreira DM, et al. Salvage Percutaneous Cryoablation for Locally Recurrent Renal-Cell Carcinoma After Primary Cryoablation. J Endourol. 2016 Jun;30(6):632-7. doi: 10.1089/end.2016.0088
G.Stacul F, et al. 2021. See resource n. 14
H.Cernic S, Marrocchio C, Ciabattoni R, et al. Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center. Outcomes in a Single Center. Medicina 2021, 57, 291. doi: 10.3390/medicina57030291
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