Radio Frequency Ablation of Renal Cell Carcinoma: Preliminary Clinical Experience

Baère, Thierry De; Kuoch, Viseth; Smayra, Tarek; Dromain, Clarisse; Cabrera, Tatiana; Court, B; Roche, Alain

doi:10.1016/s0022-5347(05)65062-8

Cited by 71 publications

(25 citation statements)

References 21 publications

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“…In our series, feasibility of percutaneous renal RFA is similar to that reported in the studies of the above-mentioned authors [2,4,5,27] and in a few others [28]. However, we always performed our treatments under US guidance, never using CT guidance.…”

Section: Discussionsupporting

confidence: 86%

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Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

et al. 2004

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Minimally invasive treatment for small renal cell carcinoma (RCC) can be necessary in selected patients and, anyway, is desirable. In situ ablation techniques, including RFA, have been developed. The aim of this study is to evaluate the feasibility, safety and short-term local effectiveness of percutaneous US-guided RFA in a small series, as well as mid-term patient outcome. Thirteen patients with a total of 18 tumors (17 small lesions, 35 mm in size or less, and a larger one, 75 mm in size) underwent 19 RFA sessions. Seven patients had a solitary kidney, and three suffered from VHL disease, too. We treated four lesions in a patient with a bilateral tumor. In another patient, three lesions were ablated. Seventeen tumors were RCC; one was a metastasis from lung cancer. Eight lesions were parenchymal, six exophytic, two parenchymal/exophytic, one parenchymal/central and one central. A monopolar RF system with multitined expandable electrode needles was used. The 35-mm lesion underwent two sessions; the 75-mm lesion was treated with transcatheter arterial embolization before RFA. Tumors with complete loss of contrast enhancement at short-term CT (or MR) were considered successfully treated. Percutaneous US-guided RFA was always feasible without major complications. The success rate after a single treatment in tumors less than 35 mm in size was 88.2% (15/17) and rose to 94.1% (16/17) after the second treatment of the largest lesion. After a mean 14-month follow-up, no successfully treated lesions recurred locally. Only the patient with metastasis from lung cancer died from disease progression in a further location, while all other patients are alive, with renal function still sufficient to avoid dialysis. US guidance allows an easy and safe percutaneous approach for RFA of small non-parahilar RCC. The treatment is locally effective and can be proposed as a minimally invasive therapy for patients with contraindications to surgery or to those expressing an informed consent. Based on the results of this study and of the literature, mid-term results on the clinical usefulness are very encouraging.

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Section: Discussionsupporting

confidence: 86%

“…Treatment can be effective in these patients in order to avoid or delay nephrectomy or dialysis. A wide standardization and larger follow-up are necessary to permit RFA to develop past its "infancy" [28,33].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

et al. 2004

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“…However, the collecting system occupies 53.36% of the sinus space, ranging from 34.78 to 71.91%. RFA [de Baere et al, 2002;Gervais et al, 2003] and CA [Desai et al, 2005] can be successful in man with peripheral tumors up to 4 cm. Tumors larger than 5 cm or with a component in the renal sinus are more difficult to treat and present more complications [Gervais et al, 2000[Gervais et al, , 2003.…”

Section: Discussionmentioning

confidence: 99%

“…Radiofrequency ablation (RFA) and cryoablation (CA) are the most studied probe ablative treatments [Gervais et al, 2000;de Baere et al, 2002;Gervais et al, 2003;Hwang et al, 2004;Johnson et al, 2004;Desai et al, 2005]. Some complications have been associated with these technologies, such as hemorrhage [de Baere et al, 2002;Gervais et al, 2003;Johnson et al, 2004;Desai et al, 2005], ureteropelvic junction obstruction [Gervais et al, 2003;Hwang et al, 2004;Johnson et al, 2004], urinary leakage [Johnson et al, 2004] and renal loss [Johnson et al, 2003].…”

Section: Introductionmentioning

confidence: 99%

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Proportional Analysis of the Pig Renal Parenchyma and Sinus Structures

Pereira‐Sampaio

Henry

Favorito

et al. 2008

Cells Tissues Organs

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Aims: This study was performed to determine the proportion of the parenchyma and sinus structures of pig kidneys and the distance between the collecting system and the kidney surface. Methods: Forty-one pig kidneys were analyzed. Cavalieri’s principle was used to obtain the volume of the cortex, medulla and sinus, as well the proportions of the arteries, veins and collecting system in the sinus. Results: The volume of the renal parenchyma varied from 129 to 488.4 cm³. The renal cortex was 83.79% and the medulla 16.21%. The collecting system occupied the greatest part of the sinus, ranging from 34.78 to 71.91% of the renal sinus. The collecting system was closer to the dorsal than to the ventral surface in the cranial pole (p < 0.001) and the hilar zone (p < 0.01). The distance from the collecting system to the medial border was shorter than that to the lateral border in the caudal pole (p < 0.001). Conclusion: With this new information about the variation in thickness of the pig renal parenchyma, continued studies using the pig model are needed to support the use of radiofrequency ablation and cryoablation in deep and large renal tumors with a component in the renal sinus.

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Cryoablation or radiofrequency ablation of the small renal mass

Kunkle

Uzzo

2008

Cancer

379

213

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BACKGROUND.The incidence of renal cell carcinoma is rising because of incidental detection of small renal masses (SRMs). Although surgical resection remains the standard of care, cryoablation and radiofrequency ablation (RFA) have emerged as minimally invasive treatment alternatives. The authors of this report performed a comparative meta‐analysis evaluating cryoablation and RFA as primary treatment for SRMs.METHODS.A search of the MEDLINE database was performed reviewing the world literature for clinically localized renal masses treated by cryoablation or RFA.RESULTS.Forty‐seven studies representing 1375 kidney lesions treated by cryoablation or RFA were analyzed. No differences were detected between ablation modalities with regard to mean patient age (P = .17), tumor size (P = .12), or duration of follow‐up (P = .53). Pretreatment biopsy was performed more often for cryoablated lesions (82.3%) than for RFA (62.2%; P < .0001). Unknown pathology occurred at a significantly higher rate for SRMs that underwent RFA (40.4%) versus cryoablation (24.5%; P < .0001). Repeat ablation was performed more often after RFA (8.5% vs 1.3%; P < .0001), and the rates of local tumor progression were significantly higher for RFA (12.9% vs 5.2%; P < .0001) compared with cryoablation. The higher incidence of local tumor progression was found to be correlated significantly with treatment by RFA on univariate analysis (P = .001) and on multivariate regression analysis (P = .003). Metastasis was reported less frequently for cryoablation (1.0%) versus RFA (2.5%; P = .06). Cryoablation usually was performed laparoscopically (65%), whereas 94% of lesions that were treated with RFA were approached percutaneously.CONCLUSIONS.Ablation of SRMs is a viable strategy based on short‐term oncologic outcomes. Although extended oncologic efficacy remains to be established for ablation modalities, the current data suggest that cryoablation results in fewer retreatments and improved local tumor control, and it may be associated with a lower risk of metastatic progression compared with RFA. Cancer 2008. © 2008 American Cancer Society.

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Radio Frequency Ablation of Renal Cell Carcinoma: Preliminary Clinical Experience

Cited by 71 publications

References 21 publications

Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients

Proportional Analysis of the Pig Renal Parenchyma and Sinus Structures

Cryoablation or radiofrequency ablation of the small renal mass

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