Percutaneous Radiofrequency Ablation of the Renal Tumors. Initial Clinical Experience with Minimally Invasive Therapy
Authors:
P. Hoffmann 1; P. Dvořák 1; P. Morávek 2; H. Šafránek 2
Authors‘ workplace:
Radiologická klinika LF UK a Fakultní nemocnice v Hradci Králové, přednosta: prof. MUDr. P. Eliáš, CSc.
1; Urologická klinika LF UK a Fakultní nemocnice v Hradci Králové, přednosta: doc. MUDr. P. Morávek, CSc.
2
Published in:
Rozhl. Chir., 2007, roč. 86, č. 9, s. 494-499.
Category:
Monothematic special - Original
Overview
Aim of the article:
To evaluate first clinical and interventional radiological features and experience with computed tomography-guided percutaneous radiofrequency ablation of the renal tumors using StarBurst instruments (RITA Medical System, Inc., Mountain View, CA).
Methods:
The group of 8 patients with mean age 77.75 ± 4.38 years underwent during a period of 12 months CT-guided RFA treatments for enhancing renal masses, with a mean size 21.78 ± 9.81 mm, using only conscious sedation and local anaesthesia. All patients had multiple medical comorbidities that limited or completely contraindicated surgical treatment. In two cases tumors involved solitary kidney. Patients were hospitalized in urologic department of University hospital, where possible early complications were monitored. Patients were followed with clinical status and renal function studies. Also enhanced imaging (enhanced computed tomography or magnetic resonance in one case) were performed 1 month, 3, 6 and 12 months after initial procedure. Successful ablation was defined as a lack of enhancement of the renal mass eventually with a scar-like retraction of surrounding renal parenchyma.
Results:
During a 12-months period (from February 2006 to February 2007) 10 percutaneous CT-guided RFA treatments in 8 patients were performed. In 6 patients (75%) were single treatment successful, 1 had an initial failure and underwent reablation successfully and 1 underwent second treatment for coexisting small tumor in the same kidney. All patients stayed in hospital for a 3 days, none from this group died during this period and none need not to be excluded from this study. We did not reveal any early complication. Average length of the following-up was 5.75 months.
Conclusions:
CT-guided percutaneous radiofrequency ablation is a promising therapeutic alternative of surgical methods (nephrectomies or nephron-sparing surgical devices) especially with small renal tumors in patients with multiple medical comorbidities, tumors in solitary kidneys and in rarer indications. The procedure were well tolerated using only conscious sedation and local anaesthesia. None early complication was observed. Other useful informations will be probably captured by following-up this group and by monitoring new patients.
Key words:
percutaneous radiofrequency ablation – renal tumors – minimally invasive therapy.
Sources
1 American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society, 2006.
2. Homma, Y., Kawabe, K., Kitamura, T., et al. Increased incidental detection and reduced mortality in renal cancer: recent retro-spective analysis at eight institutions. Int. J. Urol., 1995; 2: 77–80.
3. Gervais, D. A., MacGovern, F. J., Arellano, R. S., McDougall, W. S., Mueller, P. R. 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, July, 2005; 185: 64–71.
4. Farrell, M. A., Charboneau, W. J., DiMarco, D. S. Imaging-guided radiofrequency ablation of solid renal tumors. AJR, 2003; 180: 1509–1513.
5. Roy-Choudhury, S. H., Cast, J. E. I., Cooksey, G., Puri, S., Breen, D. J. Early experience with percutaneous radiofrequency ablation of small solid renal masses. AJR, 2003; 180: 1055–1061.
6. Mayo-Smith, W. W., Dupuy, D. E., Parikh, P. M., Pezzullo, J. A., Cronan, J. J. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: technique and outcomes of 38 treatment sessions in 32 consecutive patients. AJR, 2003; 180: 1503–1508.
7. Zagoria, R. J., Hawkins, A. D., Clark, P. E., Hall, M. C., et al. Percutaneous CT-guided radiofrequency ablation of Renal neoplasms: Factors influencing Success. AJR, 2004; 183: 201–207.
8. Sewell, P. E., Howard, J. C., Shingleton, W. B., Harrison, R. B. Interventional magnetic resonance image-guided percutaneous cryoablation of renal tumors. South Med. J., 2003; 96:708–710.
9. Shingleton, W. B., Sewell, P. E. Jr. Percutaneous renal tumor cryoablation with magnetic resonance imaging guidance. J. Urol., 2001; 165: 773–776.
10. Permpongkosol, S., Link, R. E., Kavoussi, L. R., Solomon, S. B. Percutaneous computerized tomography guided cryoablation for localized renal cell carcinoma: factors influencing success. J. Urol., 2006 Nov; 176(5): 1907–1908.
11. Aron, M., Gill, I. S.. Minimally Invasive Nephron-Sparing Surgery (MINSS) for Renal Tumours Part II: Probe Ablative Therapy. Eur. Urol., 2007 Feb; 51(2): 348–357.
12. Koehrmann, K. U., Michel, M. S., Fruhauf, J., Volz, J., Back, W., Gaa, J., et al. High-intensity focused ultrasound for non-invasive tissue ablation in the kidney, prostate and uterus. J. Urol., 2000; 163 (4 Suppl.): 156.
13. Diederich, C. J. Thermal ablation and high-temperature thermal therapy: overview of technology and clinical implementation. Int. J. Hyperthermia, 2005 Dec; 21(8): 745–753.
14. Lee, S. J., Choyke, L. T., Locklin, J. K., Wood, B. J. Use of hydrodissection to prevent nerve and muscular damage during radiofrequency ablation of kidney tumors. J. Vasc. Interv. Radiol., 2006 Dec; 17(12): 1967–1969.
15. Farrell, M. A., Charboneau, J. W., Callstrom, M. R., et al. Paranephric water instillation: A technique to prevent bowel injury during percutaneous renal radiofrequency ablation. Am. J. Roentgenol., 181: 1315–1317, 2003.
16. Kariya, S., Tanigawa, N., Kojima, H., Komemushi, A., et al. Radiofrequency Ablation Combined with CO2 Injection for Treatment of Retroperitoneal Tumor: Protecting Surrounding Organs Against Thermal Injury. AJR, 2005; 185: 890–893.
17. Liddell, R. P., Salomon, S. B. Thermal Protection During Radiofrequency Ablation. AJR, 2004; 182: 1459–1461.
18. Hall, W. H., McGahan, J. P., Link, D. P., deVere White, R. W. Combined embolization and percutaneous radiofrequency ablation of a solid renal tumor. AJR, 2000; 174: 1592–1594.
19. Yamakado, K., Nakatsuka, A., Kobayashi, S., Akeboshi, M. et al. Radiofrequency Ablation Combined with Renal Arterial Embolization for the Treatment of Unresectable Renal Cell Carcinoma Larger Than 3.5 cm: Initial Experience. J. Card. Vasc. and Int. Rad., 2006 Jun: 389–394.
20. Ponticelli, C., Mihatsch, M. J., Imbasciati. E. Renal biopsy: performance and interpretation. In: Davison, A. M., Cameron, J. S., Grunfeld, J. P., et al., eds. Oxford textbook of clinical Nephrology. 2nd ed. Oxford, England: Oxford University Press, 1998: 157–171.
21. Maturen, K. E., Nghiem, H. V., Caoili, E. M., Higgins, E. G., et al. Renal Mass Core Biopsy: Accuracy and Impact on Clinical Management. AJR, 2007; 188: 563–570.
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Perspectives in Surgery
2007 Issue 9
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