1. Percutaneous CT-Guided Cryotherapy of Renal Masses: Long-term Follow-up and Morbidity. Hussein D. Aoun, M.D Wayne State University / Detroit Medical Center Department of Radiology Peter J. Littrup, M.D. Professor of Radiology. Urology & Radiation Oncology: Wayne State University/ Karmanos Cancer Institute

2. Why ICE? Cryotherapy = ‘Freezing’ needles accurately placed and monitored to sculpt treatment zone. Cryo: –Historical established: 7-yr. prostate data – it works with low morbidity! –Painless with minimal sedation. –CT visible ice. –Preservation of collagenous architecture ~ healing potential…

3. Cryotherapy Technology Transition: Laparotomy to Percutaneous

4. Percutaneous Freeze Planning 0 o Visible Margin by CT/US/MRI ~2.5 cm ~4.5 cm Isotherms, tissue types and heat load are important for necrosis -20 o ~ Lethal for ‘watery’ tumors ~ 4 mm inside ice ~ 4 mm inside ice -40 o ~ Lethal for fibrous tumors ~ 8 mm inside ice ~ 8 mm inside ice -150 o ~ Probe surface temp

5. Renal Cryotherapy: 3/2008 Methods & Materials : 100 masses, 90 patients in 98 procedures 23 Saline & 4 balloons – Bowel Protection23 Saline & 4 balloons – Bowel Protection All outpatients – low pain during/afterAll outpatients – low pain during/after Complications - 3% CTCAE grade > 3Complications - 3% CTCAE grade > 3 Mean F/U: 1.3 yrs; 47 >12mo; up to 5 yrs.Mean F/U: 1.3 yrs; 47 >12mo; up to 5 yrs. Recurrences – 4% - all early; probe fail/VHLRecurrences – 4% - all early; probe fail/VHL

6. Average Tumor Size: 3.1cm {1.2-7.6} Average Ice Ball Size: 5.5 cm {3.1-9.7} Con-Arterial

7. Ablation Zone Follow-up: Size CT/MR (-, +, delay) - 1, 3, 6, 12, 18, 24 months CT/MR (-, +, delay) - 1, 3, 6, 12, 18, 24 months

8. Renal Cryotherapy: KCI Results: Local Recurrences 6% (6/100) of masses6% (6/100) of masses 7% (6/90) of patients 7% (6/90) of patients - 4 early experience (1st case undertreat near bowel, 1 probe failure and 2 image only - Bx neg & no progress) - 2 multi-focal tumor recur (VHL, pap Rca)

9. Perc. Renal Cryotherapy Conclusions: Minimal Pain –Outpatient Procedure!Minimal Pain –Outpatient Procedure! Excellent Visualization of ICE under CT!Excellent Visualization of ICE under CT! Balloon / Saline protection - adjacent organs!Balloon / Saline protection - adjacent organs! Any location in the Kidney with good healing!Any location in the Kidney with good healing! CURATIVE MINIMALLY INVASIVE TREATMENT OPTION FOR KIDNEY TUMORS!!!CURATIVE MINIMALLY INVASIVE TREATMENT OPTION FOR KIDNEY TUMORS!!!