Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center

Abstract

Image-guided thermal ablations are increasingly applied in the treatment of renal cancers, under the guidance of ultrasound (US) or computed tomography (CT). Sometimes, multiple ablations are needed. The aim of the present study was to evaluate the long-term results in patients with renal mass treated with radiofrequency ablation (RFA) with both US and CT, with a focus on the multiple ablations rate. 149 patients (median age 67 years) underwent RFA from January 2008 to June 2015. Median tumor diameter was 25 mm (IQR 17–32 mm). Median follow-up was 54 months (IQR 44–68). 27 (18.1%) patients received multiple successful ablations, due to incomplete ablation (10 patients), local tumor progression (8 patients), distant tumor progression (4 patients) or multiple tumor foci (5 patients), with a primary and secondary technical efficacy of 100%. Complications occurred in 13 (8.7%) patients (6 grade A, 5 grade C, 2 grade D). 24 patients died during follow-up, all for causes unrelated to renal cancer. In conclusion, thermal ablations with the guidance of US and CT are safe and effective in the treatment of renal tumors in the long-term period, with a low rate of patients requiring multiple treatments over the course of their disease.

Image-Guided Thermal Ablation as an Alternative to Surgery for Papillary Thyroid Microcarcinoma: Preliminary Results of an Italian Experience

“…Image-guided thermal ablations have been introduced in the treatment of cancer as an alternative to surgery in patients not suitable for surgical treatment several years ago (21,22). Nowadays, indications have expanded, and image guided thermal ablations are applied in the treatment of a large variety of cancers (23)(24)(25)(26)(27)(28), and in some cases represent the first suggested therapeutic option instead of surgery, as for the treatment of small hepatocellular carcinoma (29). Deriving from experience in other organs, and thanks to technological advancements with the creation of small dedicated ablative devices, image-guided thermal ablations have been applied also to the treatment of thyroid disease (30)(31)(32)(33)(34)(35).…”

Local ablation vs partial nephrectomy in T1N0M0 renal cell carcinoma: An inverse probability of treatment weighting analysis

“…It has been reported that 26.5% of patients need to undergo two or more LA operations to achieve successful treatment, especially for large RCC; for tumors >4.5 cm, approximately 7.4% of patients undergo LA treatment 44 . Mauri et al 45 reported that among 149 patients treated with thermal ablations with a median follow‐up of 54 months, 18.1% received multiple successful ablations due to incomplete ablation, local tumor progression, distant tumor progression, or multiple tumor foci. Simultaneous use of ultrasound and computed tomography in ablation surgery can improve the ability to immediately detect RCC tissue that has not been sufficiently ablated, thereby guiding immediate secondary ablation.…”

“…Simultaneous use of ultrasound and computed tomography in ablation surgery can improve the ability to immediately detect RCC tissue that has not been sufficiently ablated, thereby guiding immediate secondary ablation. One of the disadvantages of image‐guided ablation is that incomplete ablation may occur, especially if the RCC is large or centrally located 45 . It should be noted that these results are mostly from large medical institutions.…”

“…In the era of active surveillance and minimally invasive PN, evidence supporting the effectiveness and safety of ablation techniques continues to be refined 35,42,45 . There are still some difficulties in the promotion of LA; for example, ablation technology and equipment are not widely available in less developed areas.…”

Real-Time US-CT fusion imaging for guidance of thermal ablation in of renal tumors invisible or poorly visible with US: results in 97 cases

“…Image-guided thermal ablations are increasingly used in the treatment of patients with renal cancers, in particular in patients that are unfit for surgery or with previous ipsi-or contralateral renal surgeries [1][2][3]. Several different ablative modalities, including cryoablation, radiofrequency (RF), microwave (MW) and laser ablation have been successfully used in the treatment of small renal tumors, with sustained oncological results and low complications rate [4][5][6][7]. Regardless of the ablative technique applied, precise and reliable imaging is crucial in the guidance of renal thermal ablation, and for a precise early assessment of the result [8][9][10].…”