Korean J Urol.  2013 Sep;54(9):580-586.

Percutaneous Radiofrequency Ablation of Renal Tumors: A Single-Center Experience

• Seklehner
• Fellner H
• Engelhardt PF
• Schabauer
• Riedl C

Abstract

PURPOSE
To evaluate the oncological outcomes, complications, and changes in renal function in patients treated with computed tomography-guided percutaneous radiofrequency ablation (RFA) for small renal tumors.
MATERIALS AND METHODS
The charts of patients who underwent RFA from 2006 to 2011 at a single institution were reviewed. Oncological and functional outcomes were assessed. Statistical analyses were performed with IBM SPSS ver. 18.0 (IBM Co., Armonk, NY, USA).
RESULTS
A total of 44 RFAs were done in 40 patients. Biopsy prior to RFA was performed in 79.6% of procedures. Of those, 68.6% had renal cell carcinoma (RCC). Mean tumor diameter was 26.2 mm. Grade I complications occurred in 25% of cases (n=11, pain or elevated temperature) and grade II complications in 2.3% (n=1, perirenal bleeding needing two units of blood transfusion). Serum creatinine slightly increased by 0.14 mg/dL at 2 years after RFA (p<0.004). Tumor recurrences were suspected in 8 of 43 cases during follow-up. In five patients, the suspected recurrence was a false-positive as shown by a negative biopsy result or lack of contrast enhancement on subsequent imaging. The verified recurrence rate was 7.7% in all tumors and 2.5% in RCC at a mean follow-up of 2 years. Tumor-free survival was 90% in all patients and 87.5% in those with RCC. Metastasis-free survival was 97.5% and cancer-specific survival was 100%.
CONCLUSIONS
Percutaneous computed tomography-guided RFA shows promising results at intermediate follow-up. Suspected tumor recurrences are frequently false-positives findings. A longer follow-up is required to verify the durability of these results.

Keyword

Ablation techniques; Kidney neoplasms; Minimally invasive surgical procedures; Renal cell carcinoma

MeSH Terms

Ablation Techniques
Biopsy
Carcinoma, Renal Cell
Creatinine
Follow-Up Studies
Hemorrhage
Humans
Kidney Neoplasms
Recurrence
Surgical Procedures, Minimally Invasive
Creatinine

Reference

1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010; 60:277–300.

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. Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer. 2004; 100:738–745.

4. Polascik TJ, Mouraviev V. The rise of ablative technologies for treating the small renal mass. Eur Urol. 2007; 52:636–638.

5. Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, et al. EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol. 2010; 58:398–406.

6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240:205–213.

7. Mason RJ, Abdolell M, Trottier G, Pringle C, Lawen JG, Bell DG, et al. Growth kinetics of renal masses: analysis of a prospective cohort of patients undergoing active surveillance. Eur Urol. 2011; 59:863–867.

8. Klatte T, Patard JJ, de Martino M, Bensalah K, Verhoest G, de la Taille A, et al. Tumor size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol. 2008; 179:1719–1726.

9. Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C, et al. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol. 2006; 176:896–899.

10. Israel GM, Bosniak MA. Pitfalls in renal mass evaluation and how to avoid them. Radiographics. 2008; 28:1325–1338.

11. Leveridge MJ, Finelli A, Kachura JR, Evans A, Chung H, Shiff DA, et al. Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol. 2011; 60:578–584.

12. Altunrende F, Autorino R, Hillyer S, Yang B, Laydner H, White MA, et al. Image guided percutaneous probe ablation for renal tumors in 65 solitary kidneys: functional and oncological outcomes. J Urol. 2011; 186:35–41.

13. Tracy CR, Raman JD, Donnally C, Trimmer CK, Cadeddu JA. Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer. 2010; 116:3135–3142.

14. Varkarakis IM, Allaf ME, Inagaki T, Bhayani SB, Chan DY, Su LM, et al. Percutaneous radio frequency ablation of renal masses: results at a 2-year mean followup. J Urol. 2005; 174:456–460.

15. 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.

16. Levinson AW, Su LM, Agarwal D, Sroka M, Jarrett TW, Kavoussi LR, et al. Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass. J Urol. 2008; 180:499–504.

17. Turna B, Kaouk JH, Frota R, Stein RJ, Kamoi K, Gill IS, et al. Minimally invasive nephron sparing management for renal tumors in solitary kidneys. J Urol. 2009; 182:2150–2157.

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. Kim JH, Kim TH, Kim SD, Lee KS, Sung GT. Radiofrequency ablation of renal tumors: our experience. Korean J Urol. 2011; 52:531–537.

20. McDougal WS, Gervais DA, McGovern FJ, Mueller PR. Long-term followup of patients with renal cell carcinoma treated with radio frequency ablation with curative intent. J Urol. 2005; 174:61–63.

21. 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.

22. Gupta A, Raman JD, Leveillee RJ, Wingo MS, Zeltser IS, Lotan Y, et al. General anesthesia and contrast-enhanced computed tomography to optimize renal percutaneous radiofrequency ablation: multi-institutional intermediate-term results. J Endourol. 2009; 23:1099–1105.

23. Tan HJ, Hafez KS, Ye Z, Wei JT, Miller DC. Postoperative complications and long-term survival among patients treated surgically for renal cell carcinoma. J Urol. 2012; 187:60–66.

24. Lucas SM, Cadeddu JA. The importance of nephron-sparing focal therapy: renal function preservation. J Endourol. 2010; 24:769–774.

25. Salas N, Ramanathan R, Dummett S, Leveillee RJ. Results of radiofrequency kidney tumor ablation: renal function preservation and oncologic efficacy. World J Urol. 2010; 28:583–591.

26. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351:1296–1305.

27. Breda A, Anterasian C, Belldegrun A. Management and outcomes of tumor recurrence after focal ablation renal therapy. J Endourol. 2010; 24:749–752.

28. Nepple KG, Yang L, Grubb RL 3rd, Strope SA. Population based analysis of the increasing incidence of kidney cancer in the United States: evaluation of age specific trends from 1975 to 2006. J Urol. 2012; 187:32–38.