title: Percutaneous cryoablation of metastatic renal cell carcinoma for local tumor control: feasibility, outcomes, and estimated cost-effectiveness for palliation.
abstract: OBJECTIVE
  To assess complications, local tumor recurrences, overall survival (OS), and estimates of cost-effectiveness for multisite cryoablation (MCA) of oligometastatic renal cell carcinoma (RCC).
  
  
  METHODS
  A total of 60 computed tomography- and/or ultrasound-guided percutaneous MCA procedures were performed on 72 tumors in 27 patients (three women and 24 men). Average patient age was 63 years. Tumor location was grouped according to common metastatic sites. Established surgical selection criteria graded patient status. Median OS was determined by Kaplan-Meier method and defined life-years gained (LYGs). Estimates of MCA costs per LYG were compared with established values for systemic therapies.
  
  
  RESULTS
  Total number of tumors and cryoablation procedures for each anatomic site are as follows: nephrectomy bed, 11 and 11; adrenal gland, nine and eight; paraaortic, seven and six; lung, 14 and 13; bone, 13 and 13; superficial, 12 and nine; intraperitoneal, five and three; and liver, one and one. A mean of 2.2 procedures per patient were performed, with a median clinical follow-up of 16 months. Major complication and local recurrence rates were 2% (one of 60) and 3% (two of 72), respectively. No patients were graded as having good surgical risk, but median OS was 2.69 years, with an estimated 5-year survival rate of 27%. Cryoablation remained cost-effective with or without the presence of systemic therapies according to historical cost comparisons, with an adjunctive cost-effectiveness ratio of $28,312-$59,554 per LYG.
  
  
  CONCLUSIONS
  MCA was associated with very low morbidity and local tumor recurrence rates for all anatomic sites, with apparent increased OS. Even as an adjunct to systemic therapies, MCA appeared cost-effective for palliation of oligometastatic RCC.
authors.affiliation: Department of Radiology, Wayne State University, Detroit, MI 48201, USA.
authors.forename: Hyun J
authors.initials: HJ
authors.lastname: Bang
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Littrup
authors.forename: Dylan J
authors.initials: DJ
authors.lastname: Goodrich
authors.forename: Brandt P
authors.initials: BP
authors.lastname: Currier
authors.forename: Hussein D
authors.initials: HD
authors.lastname: Aoun
authors.forename: Lance K
authors.initials: LK
authors.lastname: Heilbrun
authors.forename: Ulka
authors.initials: U
authors.lastname: Vaishampayan
authors.forename: Barbara
authors.initials: B
authors.lastname: Adam
authors.forename: Allen C
authors.initials: AC
authors.lastname: Goodman
mesh_terms: D002292:Carcinoma, Renal Cell / Q000191:economics* / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D008824:Michigan; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015641:Radiography, Interventional / Q000191:economics / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000191:economics; D055815:Young Adult