Radio Frequency Ablation of Renal Tumors in Patients With Metastatic Renal Cell Carcinoma

Abstract

Purpose The goal of this retrospective study was to evaluate the feasibility, safety, and outcomes of using radiofrequency ablation (RFA) of primary renal tumors as a means of controlling local disease while preserving renal parenchyma in a series of patients with metastatic renal cell carcinoma (RCC) in a single-institutional, multidisciplinary setting. Materials and Methods We evaluated the records of patients with metastatic RCC who had undergone percutaneous RFA of a primary renal tumor. Patients’ demographic and disease characteristics, adjunctive medical and surgical therapies, recurrence, and clinical outcomes were studied. Results Fifteen patients treated between 2002 and 2008 met the inclusion criteria. There was no incomplete ablation or local recurrence. Ten patients had a biopsy-proven RCC in the ablated renal mass. Eight patients had a solitary metastasis, 3 patients had 2-site metastases, and 4 patients had 3 or more metastatic sites. Four patients experienced major complications. Median radiographic and clinical followup of patients at risk for an event was 25.5 and 33.0 months, respectively. Overall survival rates at 1, 3, and 5 years after RFA were 73.3%, 57.1%, and 38.1%, respectively. At last evaluation, 4 were alive and in complete remission, 4 were alive with no evidence of local recurrence but with evidence of distant disease, and 7 had died of their disease. Conclusions RFA is feasible and safe in highly selected patients with metastatic RCC, resulting in durable local control as part of multimodality management, and achieving renal preservation. Further investigation is required to define the role of RFA in this patient population.

Radiofrequency ablation of renal tumours with clinical, radiographical and pathological results

“…Patients with a renal mass who underwent RFA between 2002 and 2008 were included. All patients, including those with familial genetic syndromes, metastatic disease and multiple tumours, were included as part of this intent‐to‐treat analysis. Recorded data included standard demographic variables; imperative vs elective indications for nephron sparing; tumour variables, including size, centrality (exophytic, central), nephrometry score and size of ablation zone; the results of pre‐ and post‐ablation biopsies (tumour histology and grade); post‐ablation time to biopsy, indication for biopsy and the number of cores taken; and clinical and radiographical follow‐up, as well as the survival status, of those with localized RCC.…”

“…Otherwise, a percutaneous approach was performed under CT guidance. Our RFA technique has been previously described in detail . For percutaneous RFA, the patient was placed under general anaesthesia and, using a 200‐W impedance‐based device (Cooltip™; Covidien, Mansfield, MA, USA), one or more electrodes were positioned in the tumour using CT guidance.…”

Update on Thermal Ablation of Renal Cell Carcinoma: Oncologic Control, Technique Comparison, Renal Function Preservation, and New Modalities

“…One recent novel study evaluated the feasibility and safety of utilizing RFA for treatment of the primary RCC in patients with metastatic disease undergoing systemic immunotherapy instead of resection [16]. In this retrospective study, 15 patients were treated with percutaneous RFA.…”

Under‐grading of <4 cm renal masses on renal biopsy

“…It is known that patients who undergo ablation are older and have more medical comorbidities compared with those who undergo surgery [5]. In addition, ablation patients often have other high‐risk features including prior nephrectomy for more advanced tumours, multiple lesions, and hereditary RCC syndromes [6–8]. Conversely, these patients tend to have smaller tumours [5,9].…”