1. Percutaneous Cryoablation for Renal Cell Cancer Christos Georgiades MD PhD Assistant Professor of Radiology & Surgery Vascular & Interventional Radiology Johns Hopkins Hospital

2. Stamping Out Kidney Cancer Without Surgery 55,000 patients are diagnosed with kidney cancer every year in the US…and increasing 75% of them are discovered by accident and most small enough to be treated by Interventional Radiology (Avoid Surgery)

3. How is Cryoablation done? 1.No incision/No surgery 2.No general anesthesia 3. Ablation needle(s) placed by Interventional Radiologist under Image guidance Skin Tumor Kidney Needle

4. Our Experience –Treated 90 tumors (in 84 patients) 2006-2008 –80 under sedation –4 local anesthesia only –Never general anesthesia –Ages 35-90 –Follow up every 3 months up to a year and then annually

5. Results -Of the 90 tumors (1-10 centimeters) 88 completely treated without any evidence for cancer (98%) 2 had small tumor left (~1cm), one retreated with ablation and now no tumor left (99%) No patients developed new local cancer or metastatic cancer after ablation and none required surgery

6. 1-Year2-Years3-Years Tumor

7. Summary Cryoablation by Interventional Radiology has a near 100% success rate in treating kidney cancers up to 4 and probably up to 7 centimeters in size No incision/no surgery/no anesthesia Most patients go home same day and can resume normal activities quickly Fewer complications, lesser cost In the unlikely case cryoablation fails, patients can still have the surgery they would have in the first place.

8. Conclusions Cryo-ablation should be the first treatment choice for patients whose kidney cancer is 4 centimeters or smaller. and If a patient wishes to avoid or cannot have surgery, even larger lesions can be treated (near 100% success rate cancer up to 7 centimeters in size)