title: Salvage Percutaneous Cryoablation for Locally Recurrent Renal-Cell Carcinoma After Primary Cryoablation.
abstract: The management of locally recurrent renal-cell carcinoma (RCC) following cryoablation remains a clinical dilemma. There is limited data regarding the management of locally recurrent disease in the setting of patients who have failed initial percutaneous cryoablation (PCA). We evaluate and report our experience with salvage PCA for local recurrence following renal cryoablation failure.
  
  
  
  We reviewed our experience with patients who underwent salvage PCA for local biopsy proven RCC recurrence following primary cryoablation procedures. Complications and oncologic outcomes were evaluated. Recurrence-free survival after primary and repeat cryoablation was plotted using the Kaplan-Meier curves.
  
  
  
  A total 250 patients underwent primary cryoablation for RCC and 20 (8%) patients were identified who underwent repeat PCA for 21 locally recurrent tumors. The mean tumor size was 2.4 cm. Biopsy revealed clear cell in 14 patients, three papillary and four chromophobe RCC. All repeat cryoablation procedures were completed successfully, with no treatment failures on postprocedure imaging. There were no complications or deaths. With the median follow-up of 30 months (range 7-63), 3 (15%) patients experienced local recurrence. One patient had an enhancing lesion at 13 months following repeat PCA and underwent a third PCA. Two patients had recurrence at 6 and 35 months respectively and underwent successful laparoscopic partial nephrectomy. Local recurrence-free, metastasis-free and cancer-specific survival rates were 85%, 100%, and 100% respectively. Limitations include retrospective design and small number of patients.
  
  
  
  Repeat PCA after primary cryoablation failure is feasible, has a low complication rate, and acceptable short-term oncologic outcomes. Further studies with durable follow-up are required.
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Joshua
authors.initials: J
authors.lastname: Chamberlin
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Moreira
authors.affiliation: 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York.
authors.forename: Arvin
authors.initials: A
authors.lastname: George
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Kara
authors.initials: K
authors.lastname: Babaian
authors.affiliation: 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York.
authors.forename: Paras
authors.initials: P
authors.lastname: Shah
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Ramy
authors.initials: R
authors.lastname: Youssef
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Kamaljot S
authors.initials: KS
authors.lastname: Kaler
authors.affiliation: 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York.
authors.forename: Igor I
authors.initials: II
authors.lastname: Lobko
authors.affiliation: 2 The Arthur Smith Institute for Urology, North Shore-LIJ Hofstra School of Medicine , New Hyde Park, New York.
authors.forename: Louis
authors.initials: L
authors.lastname: Kavoussi
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D002908:Chronic Disease; D003287:Contrast Media / Q000737:chemistry; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media