Korean J Urol.  2011 Aug;52(8):531-537. 10.4111/kju.2011.52.8.531.

Radiofrequency Ablation of Renal Tumors: Our Experience

• Kim JH
• Kim TH
• Kim SD
• Lee KS
• Sung GT

• KMID: 1988957
• DOI: http://doi.org/10.4111/kju.2011.52.8.531

Abstract

PURPOSE
To report our results of nephron-sparing radiofrequency ablation (RFA) of renal tumors.
MATERIALS AND METHODS
Since August 2004, 49 patients with renal tumors were treated with either percutaneous or laparoscopic RFA. All patients underwent preoperative imaging with contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) and were suspected to have renal cell carcinoma. The follow-up for each patient included a physical examination, chest radiography, liver function tests, and a contrast-enhanced CT or MRI. To confirm the pathologic criteria of complete ablation, 30 patients underwent 6-month or 1-year follow-up biopsy. Recurrence was defined as growth of the tumor or any new enhancing portions at 3 months after confirmed nonenhancement of the initial RFA lesion.
RESULTS
Technical success was achieved in 46/49 cases (94%). The mean tumor size was 2.4 cm and the mean follow-up period was 31.7 months (range, 6-68 months). Of 49 patients, repeated RFA was necessary in 7 patients (14%). Three patients were found to have recurrence at various follow-up intervals. Twenty-three patients (47%) experienced complications, and all but one necessitated intervention. No distant metastasis was found in any cases, and all patients are alive and are being serially followed up.
CONCLUSIONS
Percutaneous or laparoscopic RFA is considered to be a useful treatment for selected patients with small renal masses and for nephron-sparing. With a mean follow-up of 31.7 months, our intermediate data suggest excellent therapeutic outcome with RFA with effective local tumor control and preservation of renal function. The ultimate role of this modality will continue to evolve and warrants further studies.

Keyword

Catheter ablation; Kidney neoplasms; Minimally invasive surgical procedures

MeSH Terms

Biopsy
Carcinoma, Renal Cell
Catheter Ablation
Follow-Up Studies
Humans
Kidney Neoplasms
Liver Function Tests
Magnetic Resonance Imaging
Neoplasm Metastasis
Physical Examination
Recurrence
Surgical Procedures, Minimally Invasive
Thorax

Figure

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  FIG. 1 Well ablated, small intraparenchymal renal cell carcinoma in a 62-year-old male who underwent RFA. (A) Contrast-enhanced CT scan before RFA demonstrates a 3.3 cm solid enhancing intraparenchymal renal tumor located at the midpolar region of the right kidney. (B) Three-month follow-up contrast-enhanced CT scan demonstrates no periablation enhancement or residual contrast enhancement within the tumor bed, indicating technical success.

• 

  FIG. 2 A recurrent cystic RCC from the left kidney middle pole in a 63-year-old male. (A) Thirty-month follow-up contrast-enhanced CT scan shows suspicious renal cyst with enhancement, left kidney midpole. (B) One day after 2nd RFA follow-up contrast-enhanced CT scan demonstrates no periablation enhancement or residual contrast enhancement within the tumor bed.

Reference

1. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. 1999. 281:1628–1631.

2. Hock LM, Lynch J, Balaji KC. Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of surveillance, epidemiology and end results program data. J Urol. 2002. 167:57–60.

3. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst. 2006. 98:1331–1334.

4. Bosniak MA, Birnbaum BA, Krinsky GA, Waisman J. Small renal parenchymal neoplasms: further observations on growth. Radiology. 1995. 197:589–597.

5. Lucas SM, Stern JM, Adibi M, Zeltser IS, Cadeddu JA, Raj GV. Renal function outcomes in patients treated for renal masses smaller than 4 cm by ablative and extirpative techniques. J Urol. 2008. 179:75–79.

6. Asano T, Mizuguchi Y, Horiguchi A, Ito K, Sumitomo M, Kimura F, et al. Retroperitoneoscopic partial nephrectomy using radiofrequency coagulation for small renal tumors. Urology. 2007. 70:869–872.

7. Pyo P, Chen A, Grasso M. Retroperitoneal laparoscopic partial nephrectomy:surgical experience and outcomes. J Urol. 2008. 180:1279–1283.

8. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006. 7:735–740.

9. Herr HW. Partial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year followup. J Urol. 1999. 161:33–34.

10. Fergany AF, Hafez KS, Novick AC. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol. 2000. 163:442–445.

11. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007. 178:41–46.

12. Park H, Byun SS, Kim HH, Lee SB, Kwon TG, Jeon SH, et al. Comparison of laparoscopic and open partial nephrectomies in T1a renal cell carcinoma: A Korean Multicenter Experience. Korean J Urol. 2010. 51:467–471.

13. Pasticier G, Timsit MO, Badet L, De La Torre Abril L, Halila M, Fassi Fehri H, et al. Nephron-sparing surgery for renal cell carcinoma: detailed analysis of complications over a 15-year period. Eur Urol. 2006. 49:485–490.

14. Zlotta AR, Wildschutz T, Raviv G, Peny MO, van Gansbeke D, Noel JC, et al. Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol. 1997. 11:251–258.

15. Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol. 2005. 185:64–71.

16. Matsumoto ED, Johnson DB, Ogan K, Trimmer C, Sagalowsky A, Margulis V, et al. Short-term efficacy of temperature-based radiofrequency ablation of small renal tumors. Urology. 2005. 65:877–881.

17. Farrell MA, Charboneau WJ, DiMarco DS, Chow GK, Zincke H, Callstrom MR, et al. Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol. 2003. 180:1509–1513.

18. Park S, Anderson JK, Matsumoto ED, Lotan Y, Josephs S, Cadeddu JA. Radiofrequency ablation of renal tumors: intermediate-term results. J Endourol. 2006. 20:569–573.

19. Mylona S, Kokkinaki A, Pomoni M, Galani P, Ntai S, Thanos L. Percutaneous radiofrequency ablation of renal cell carcinomas in patients with solitary kidney: 6 years experience. Eur J Radiol. 2009. 69:351–356.

20. Watkins TW, Parkinson R. Percutaneous radiofrequency ablation of renal tumors: case series of 11 tumours and review of published work. Australas Radiol. 2007. 51:412–419.

21. Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol. 2000. 174:323–331.

22. Weight CJ, Kaouk JH, Hegarty NJ, Remer EM, O'Malley CM, Lane BR, et al. Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors. J Urol. 2008. 179:1277–1281.

23. Arima K, Yamakado K, Kinbara H, Nakatsuka A, Takeda K, Sugimura Y. Percutaneous radiofrequency ablation with transarterial embolization is useful for treatment of stage 1 renal cell carcinoma with surgical risk: results at 2-year mean follow up. Int J Urol. 2007. 14:585–590.

24. Aron M, Gill IS. Renal tumor ablation. Curr Opin Urol. 2005. 15:298–305.

25. Kwan KG, Matsumoto ED. Radiofrequency ablation and cryoablation of renal tumours. Curr Oncol. 2007. 14:34–38.

26. Zagoria RJ, Traver MA, Werle DM, Perini M, Hayasaka S, Clark PE. Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am J Roentgenol. 2007. 189:429–436.