To determine safety and efficacy of radiofrequency ablation (RFA) for local treatment of lung metastases of renal cell carcinoma (RCC), sequenced or combined with systemic treatments.
Retrospectively, we studied 53 patients treated by RFA for a maximum of six lung metastases of RCC. The endpoints were local efficacy, overall (OS), disease-free (DFS), pulmonary progression-free (PPFS) and systemic treatment-free (STFS) survivals, complications graded by the CTCAE classification and factors associated with survivals. Potential factors analysed were: clinical and pathological data, tumoral staging of TNM classification, primary tumor histology, Fuhrman's grade, age, number and size of lung metastases and extra-pulmonary metastases pre-RFA.
One hundred metastases were treated by RFA. Median follow-up time was 61 months (interquartile range 90-34). Five-year OS was 62% (95% confidence interval (CI): 44-75). Median DFS was 9.9 months (95% CI: 6-16). PPFS at 1 and 3 years was 58.9% (95%CI: 44.1-70.9) and 35.2% (95%CI: 21.6-49.1), respectively. We observed 3% major complications (grade 3 and 4 of CTCAE classification). Local efficacy was 91%. Median STFS was 28.3 months. Thirteen patients (25%) with lung recurrence could be treated by another RFA. T3/T4 tumors had significantly worse OS, PPFS and STFS. Having two or more lung metastases increased the risk of pulmonary progression more than threefold.
Integrated to systemic treatment strategy, RFA is safe and effective for the treatment strategy of lung metastasis from RCC with good OS and long systemic treatment-free survival. RFA offers the possibility of repeat procedures, with low morbidity.
BMC cancer. 2019 Dec 03*** epublish ***
Alexis Gonnet, Laura Salabert, Guilhem Roubaud, Vittorio Catena, Véronique Brouste, Xavier Buy, Marine Gross Goupil, Alain Ravaud, Jean Palussière
Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France., Department of Medical Oncology, Hospital Saint-Andre, Univ. Bordeaux, 33000, Bordeaux, France., Department of Medical Oncology, Institut Bergonié, 33000, Bordeaux, France., Department of Statistics, Institut Bergonié, 33000, Bordeaux, France., Department of Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France. .