Prospective Trial Evaluates Two Methods of Treating Renal Cell Carcinoma

Researchers compared two methods of treating renal cell carcinoma (RCC) and found that transarterial chemoembolization using drug-eluting embolic agent (DEE) saturated with doxorubicin appears safe and effective, compared with treatment with transarterial embolization (TAE).

RCC is often treated with percutaneous thermal ablation, but ablation can be technically difficult to achieve due to factors such as the location of the tumors and proximity to renal blood vessels and organs. As a result, researchers have been investigating minimally invasive procedures that can be used in circumstances when ablation is not feasible.

The current study was a prospective, controlled trial, and its results were published in the Journal of Vascular and Interventional Radiology.

The study took place between 2012 and 2015, and it included 12 patients with biopsy-verified RCC eligible for nephron-sparing surgery or radical nephrectomy. Patients had a mean tumor size of 3.2 cm ± 0.62 and were randomized to receive either DEE transarterial chemoembolization or TAE before undergoing planned surgery.

Particles were injected selectively via a microcatheter into arteries feeding the tumors, and computed tomograph (CT) and microscopy of excised tumors was used to assess patients’ response. There were no major complications in either study arm, the researchers noted.

The 6 patients treated with DEE transarterial chemoembolization had a significantly higher degree of necrosis (88.3% average) than those treated with TAE, who had an average of 29.4%. Those outcomes resulted from CT assessment, but histopathologic evaluation yielded similar findings, with an average necrosis of 87.5% for DEE transarterial chemoembolization compared with 26% for TAE.

“The significant correlation between the histopathologic findings and CT findings shown by this study suggests that CT can be used to evaluate the cytoreductive effects in RCC after DEE transarterial chemoembolization,” the study’s authors wrote. “However, larger studies with a greater range in tumor size and with longer follow-up are required to evaluate this and to find out whether palliative use of DEE transarterial chemoembolization improves overall survival in RCC.”

Additionally, 4 tumors in each arm were analyzed with both CT and microscopy, and there was a significant correlation between radiologic findings and the percentage of necrosis seen on microscopy, though some viable tumor cells were still found with microscopy.

“In conclusion, DEE transarterial chemoembolization had a significantly more potent cytoreductive effect on treated RCCs compared with TAE as observed on CT and microscopy.

However, viable tumor cells were detected on microscopy even when CT showed total tumor necrosis. Because of this finding, DEE transarterial chemoembolization is limited to palliation.”

Reference

Karalli A, Ghaffarpour R, Axelsson R, et al. Transarterial Chemoembolization of Renal Cell Carcinoma: A Prospective Controlled Trial. J Vasc Interv Radiol. 2017 Sep 22. pii: S1051-0443(17)30748-0.