Ultrasound Guided Percutaneous Microwave Ablation for Small Renal Cancer: Initial Experience

Liang, Ping; Wang, Yang; Zhang, Dakun; Yu, Xiaoling; Gao, Yongyan; Ni, Xin

doi:10.1016/j.juro.2008.05.012

Cited by 123 publications

(81 citation statements)

References 22 publications

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“…MWA is a minimally invasive technique that has been already used to treat benign and malignant tumors [78][79][80]. Nevertheless, only a few studies considering MWA efficacy in the treatment of benign solid thyroid nodules are available.…”

Section: Clinical Resultsmentioning

confidence: 99%

Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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Benign thyroid nodules are a common disease in the general population. Most often, they are completely asymptomatic and discovered occasionally during routine ultrasound examinations, and do not require any treatment. When thyroid nodules become symptomatic, surgical excision is still considered standard treatment. In the last few years, several experiences in the treatment of benign thyroid nodules through image-guided percutaneous thermal ablation have been reported with encouraging results, so that currently, these treatments are often proposed as first-choice options for patients with symptomatic benign thyroid nodules. In this paper, we discuss the present literature on the topic, focusing on different techniques available for image-guided percutaneous ablation, particularly radiofrequency (RFA), laser (LA), microwave (MWA), and high-intensity-focus ultrasound (HIFU). Little evidence about the efficacy of MWA and HIFU is now available. According to the literature, good results have been obtained with RFA and LA. Regarding RFA, volume reduction after ablative treatment has been found to range from 47 to 84 % at 3-6 months, and from 62 to 93 % at 1 year; LA also seems to be effective in achieving shrinkage of thyroid nodules, with volume reduction from 37 to 81 % at 3-6 months, and from 13 to 82 % at 1-year follow-up. Moreover, applications of advanced image-guidance modality, such as contrast-enhanced ultrasound and virtual navigation with fusion imaging, are discussed.Keywords Laser Á Radiofrequency Á Microwave Á Highintensity focused ultrasound Á Thyroid nodule SOMMARIO I noduli benigni della tiroide sono una evenienza comune nella popolazione generale. Più spesso vengono scoperti occasionalmente durante un esame ecografico fatto per altri motivi, sono asintomatici e non richiedono alcun trattamento. Qualora i noduli diventino sintomatici, l'escissione chirurgica è ancora considerato il trattamento standard. Tuttavia, negli ultimi anni, è cresciuta l'esperienza circa il trattamento di tali noduli tramite ablazione percutanea sotto guida ecografica tanto che, attualmente, questo viene spesso proposto come trattamento di scelta. Lo scopo del nostro lavoro è fare una revisione della letteratura riguardante l'argomento, con un particolare focus sulle differenti tecniche attualmente a disposizione, in particolare radiofrequenza (RFA), laser (LA), microonde (MWA) e high-intensity-focus ultrasound (HIFU). Al momento ci sono ancora poche evidenze sull'efficacia di MWA e HIFU. Secondo quanto riportato in letteratura, buoni risultati sono stati ottenuti con RFA e LA. Riguardo la radiofrequenza, la riduzione volumetrica dopo la procedura ablativa va da 47 a 84 % a 3-6 mesi e da 62 a 93 % a 1 anno; anche il laser sembra essere efficace nel causare la riduzione del nodulo, con percentuali che vanno da 37 a 81 % a 3-6-mesi a da 13 a 82 % a 1 anno di follow-up Abbiamo poi discusso brevemente le

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Section: Clinical Resultsmentioning

confidence: 99%

Image-guided thermal ablation of benign thyroid nodules

et al. 2016

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“…Use of microwave ablation has been studied extensively in the liver, but remains limited for the kidney. Actually, the literature supports the use of MWA for the treatment of small renal tumors with rare objections [7,[29][30][31]. This technology can be applied in selected patients who are not candidates for surgery, as an alternative to other ablative techniques [11,[29][30][31].…”

Section: Resultsmentioning

confidence: 98%

“…Actually, the literature supports the use of MWA for the treatment of small renal tumors with rare objections [7,[29][30][31]. This technology can be applied in selected patients who are not candidates for surgery, as an alternative to other ablative techniques [11,[29][30][31]. Though MWA achieved comparable results to those obtained with RF ablation or cryoablation, MWA needs a relatively short ablation time and may be more suitable for patients with a variety of comorbidities who cannot tolerate long-time anesthesia [31].…”

Section: Resultsmentioning

confidence: 99%

“…Liang et al [29] demonstrated, in 12 patients with small RCC, that MWA ultrasound-guided was a safe and effective technique in selected patients ( Table 2). As in the previous study, Carrafiello et al [30] enrolled 12 patients in a treatment group, in which percutaneous MWA of small RCCs was performed under contrast-enhanced ultrasound guidance.…”

Section: Percutaneous Mwa Of Renal Tumors: Clinical Seriesmentioning

confidence: 99%

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Microwave ablation of renal tumors: state of the art and development trends

et al. 2014

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In the last decades an increased incidence of new renal tumor cases has been for clinically localized, small tumors \2.0 cm. This trend for small, low-stage tumors is the reflection of earlier diagnosis primarily as a result of the widespread and increasing use of non-invasive abdominal imaging modalities such as ultrasound, computerized tomography, and magnetic resonance imaging. Renal tumors are often diagnosed in elderly patients, with medical comorbidities whom the risk of surgical complications may pose a greater risk of death than that due to the tumor itself. In these patients, unsuitable for surgical approach, thermal ablation represents a valid alternative to traditional surgery. Thermal ablation is a less invasive, less morbid treatment option thanks to reduced blood loss, lower incidence of complications during the procedure and a less long convalescence. At present, the most widely used thermal ablative techniques are cryoablation, radiofrequency ablation and microwave ablation (MWA). MWA offers many benefits of other ablation techniques and offers several other advantages: higher intratumoral temperatures, larger tumor ablation volumes, faster ablation times, the ability to use multiple applicators simultaneously, optimal heating of cystic masses and tumors close to the vessels and less procedural pain. This review aims to provide the reader with an overview about the state of the art of microwave ablation for renal tumors and to cast a glance on the new development trends of this technique.

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“…Clark et al (9) demonstrated the feasibility of MWTA in 10 patients with large kidney tumors before radical nephrectomy and demonstrated complete tumor cell kill inside the ablated lesions. Liang et al (17) confirmed the efficacy of MWTA on renal tumors by treating 12 patients with small lesions (<4 cm in diameter) and no evidence of recurrence after 20 months of follow-up, while Castle et al (18) reported poor oncologic outcomes and significant complication rates in a series of 10 patients with tumor diameter size ranging from 2.0 to 5.5 cm treated by laparoscopic-or CT-guided percutaneous MWTA. Rational explanations for such similar discrepancies could be easily found by evaluating either the absence of a standardized and reproducible method for microwave administration or the adequate selection of patients.…”

Section: Discussionmentioning

confidence: 93%

Microwave-induced thermoablation with Amica-probe is a safe and reproducible method to treat solid renal masses: Results from a phase I study

et al. 2012

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Abstract. Microwave thermal ablation (MWTA) could be considered in the future for treating small solid renal masses. The aim of the present study was to determine both the tolerability of the new Amica-probe applicator-induced MWTA used in vivo on patients with solid renal masses and the effects of heating on renal tumors and normal renal parenchyma. Fourteen patients with renal masses eligible for open radical nephrectomy were enrolled in this phase I study. All patients underwent MWTA of renal masses during the open surgery procedure before clamping of renal vascular pedicle. The effects of MWTA on patients' coagulation and tumor/renal vasculature were investigated. The histological effects of MWTA on the tumor and intralesional vital tumor cell skipping were also evaluated. The MWTA-induced lesion diameters were measured to calculate both the overall ablation volume and the lesion sphericity index (SI). The Clavien-Dindo classification was used. In all patients the RENAL score was 9.4 (8-12) and the Charlson comorbidity index was 4.8 (3-7). MWTA-induced lesion size was 44.14 mm (±22.59). Mean SI was 1.08 (±0.2). No significant differences among coagulation clinical parameters were found. No local bleeding after MWTA treatment was reported. According to the ClavienDindo classification, there were two grade II perioperative complications due to the tumor extent but not related with the MWTA treatment. No residual vital tumor cells inside the MWTA-induced lesions were found. Telephone interview at 27.4 (±4.2) months mean follow-up did not find any long-term adverse events due to previous MWTA treatment. AmicaProbe applicator-induced MWTA is a safe and reproducible method to treat solid renal masses. IntroductionPrevalence of small solid renal masses in adult population recently increased probably due to the large number of people that daily undergo preventive diagnostic investigations such as ultrasonography and computed tomography (CT) scan for unrelated symptoms, resulting in incidental tumor detection (1). Patients' comorbidities, such as cardiovascular or respiratory diseases, could represent limiting factors for planning adequate subsequent surgical approaches although conservative laparoscopy surgery is now considered the gold standard treatment, particularly for tumors <3-4 cm (2). Minimally invasive procedures, such as cryoablation (CryA) and radiofrequency ablation (RFA), have been recently proposed by different authors as alternative methods of treatment to conservative surgery with satisfactory results in terms of perioperative complications such as hemorrhage episodes or metabolic problems related to prolonged period of general anaesthesia (3). Some doubts remain on the efficacy of these methods on tumor complete eradication due to the high prevalence of tumor local recurrences due to persistent vital tumor cells in the context of the ablated tissue (tumor skipping) (4). Both CryA and RFA are based on the application of physical means (cold and heat respectively) at the centre of the lesion to induce...

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Ultrasound Guided Percutaneous Microwave Ablation for Small Renal Cancer: Initial Experience

Abstract: Ultrasound guided percutaneous microwave ablation appears to be a safe and effective technique for small renal cell cancer in select patients.

Cited by 123 publications

References 22 publications

Image-guided thermal ablation of benign thyroid nodules

Image-guided thermal ablation of benign thyroid nodules

Microwave ablation of renal tumors: state of the art and development trends

Microwave-induced thermoablation with Amica-probe is a safe and reproducible method to treat solid renal masses: Results from a phase I study

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