Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours

Abstract

ObjectivesTo evaluate our clinical experience with percutaneous image-guided radiofrequency ablation (RFA) of 200 renal tumours in a large tertiary referral university institution.Patients and MethodsImage-guided RFA (ultrasonography or computed tomography [CT]) of 200 renal tumours in 165 patients from June 2004 to 2012 was prospectively evaluated. Institutional Review Board approval was granted.The treatment response and technical success were defined by absence of contrast enhancement within the tumour on contrast enhanced CT or magnetic resonance imaging. Both major and minor complications, glomerular filtration rate (GFR) before and after RFA, the management and outcomes of the complications, as well as oncological outcome were prospectively documented. Multivariate analysis was used to determine variables associated with major complications and also the percentage GFR change after RFA. The overall (OS), 5-year cancer-specific (CSS), local recurrence-free (LRFS) and metastasis-free survival (MFS) rates are presented using the Kaplan–Meier curves. Results In all, 200 tumours were RF ablated with a mean (range) tumour size of 2.9 (1–5.6) cm and the mean (range) patient age was 67.7 (21–88.6) years with a mean follow-up period of 46.1 months. The primary technical and overall technical success rate was 95.5% and 98.5%, respectively. Two independent predictors of successful RFA in a single sitting were tumour size (<3 cm) and exophytic location in multivariate logistic regression analysis. Major complications included ureteric injury (six patients), calyceal-cutaneous fistula (one), acute tubular necrosis (one) and abscess (two). Two independent predictors of ureteric injury were central location and lower pole position. Within this cohort of patients, only four patients developed significant renal function deterioration i.e. >25% decreased in GFR. In all, 161 (98%) patients of the 165 patients have preservation of renal function. Any change in renal function after RFA was not influenced by tumour factors or solitary kidney status. In our clinical series, this yielded a 5-year OS, CSS, LRFS and MFS rates of 75.8%, 97.9%, 93.5% and 87.7% respectively. ConclusionsImage-guided RFA is a safe, nephron sparing and effective treatment for small renal cell carcinoma (RCC) tumours with a low rate of recurrence and has good 5-year CSS and MFS rates.

Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors – A Systematic Review with Description of Type, Frequency, Risk Factors and Management

“…According to our review, extra-renal metastases after imageguided RFA of renal tumors are very rare but slightly more frequent than de novo renal tumors, and occur up to 4.5 years after initial RFA [3]. In a controlled study, the metastasis-free survival after treatment of T1a renal tumors was significantly better for surgery when compared with RFA (p = 0.005).…”

“…2 defined as no residual unablated tumor and no local tumor progression in the follow-up imaging. 3 for 11 tumors the number of sessions was not indicated. für 11 Tumoren wurde die Anzahl der Behandlungssitzungen nicht angegeben.…”

“…Another major risk factor for treatment failure is a central tumor location [3, 13 -15]. In the study of Wah et al, 77.8 % of the residual unablated tumors were centrally located, whereas all exophytic or parenchymal tumors, regardless of size and location, were completely ablated in one RFA session [3]. According to our analysis, de novo tumors in the kidneys after image-guided RFA are rare but can occur up to 48 months after initial RFA.…”

“…Due to the increasing number of diagnostic procedures, nowadays most renal tumors are detected incidentally at an early stage [1]. The currently available intermediate-and long-term data demonstrate a high rate of oncologic success of image-guided percutaneous RFA with 5-year cancer-specific survival rates of up to 100 % [2,3]. In the latest controlled trials, percutaneous RFA and nephrectomy show comparable survival rates.…”

Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

“…The efficacies of ablative therapies, including radiofrequency (RF) ablation (RFA) and cryoablation, have been reported previously: A number of authors have reported long-term results following RFA for RCC and demonstrated excellent oncological outcomes (14)(15)(16)(17)(18)(19)(20). In our institute, percutaneous RFA for renal cancer was initiated in 2005.…”