PTU - Polskie Towarzystwo Urologiczne
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Radiofrequency ablation: An option and a dilemma in kidney tumours management
Article published in Urologia Polska 2008/61/4.

authors

Marek Salagierski2, Maciej Salagierski1, Waldemar Różański2, Anna Salagierska-Barwińska3
1I Klinika Urologii Uniwersytetu Medycznego w Łodzi
2II Klinika Urologii Uniwersytetu Medycznego w Łodzi
3Zakład Radiologii i Diagnostyki Obrazowej Uniwersytetu Medycznego w Łodzi

keywords

kidney percutaneous radiofrequency ablation treatment tumour

summary

The aim of the study.
The aim of this study was to describe our experience with percutaneous ultrasound guided radiofrequency
ablation of kidney tumours.

Material and method.
From July 2002 to August 2008, 103 radiofrequency ablations (RFA) in patients with kidney tumours were
performed. The average tumour size was 35 mm (range, 17-59 mm) with the mean age of 67 years (range, 18-84 years). Most of
the RFA candidates had contraindications to surgery. Needle biopsy was not done on a regular basis and RFA was performed based
on radiographic findings. The average ablation time was between 10 and 15 minutes. The procedure was performed under conscious
sedation with local anaesthesia. Treatment efficacy was assessed by computed tomography. The absence of contrast enhancement
was considered to be a successful treatment.

Results.
The average follow up was 30 months (range, 6-72 months). In 98 tumours (94%) total absence of contrast enhancement
was obtained after the initial RFA and in 5 tumours (6%) after the second ablation session. There were no complications following
99 procedures (96%). In four procedures minor complications were observed. In one patient during the follow up a metastasis to a
homolateral adrenal gland was discovered and one patient died of a pancreatic cancer.

Conclusions.
RFA is a minimally invasive and safe treatment option in kidney tumours management. Despite the promising results
the long-term follow-up is necessary to establish the oncological durability of RFA.

references

  1. Van PH, Dilen K, Baert L: Incidental renal cell carcinoma and nephron sparing surgery. Curr Opin Urol 2001,11 (3), 281-286.
  2. Berger A, Crouzet S, Canes D, Haber GP, Gill IS: Minimally invasive nephron-sparing surgery. Curr Opin Urol 2008, 18 (5), 462-466.
  3. Goldberg SN, Gazelle GS, Mueller PR: Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques,
  4. and diagnostic imaging guidance. AJR Am J Roentgenol 2000, 174 (2), 323-331.
  5. Zlotta AR, Wildschutz T, Raviv G et al: Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol 1997, 11 (4), 251-258.
  6. Krejci KG, Blute ML, Cheville JC et al: Nephron-sparing surgery for renal cell carcinoma: clinicopathologic features predictive of patient outcome. Urology 2003, 62 (4), 641-646.
  7. Krejci KG, Leibovich BC: Should there be a size limit for elective nephronsparing surgery? Curr Urol Rep 2003 4 (1), l21-129.
  8. Remzi M, Katzenbeisser D, Waldert M et al: Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small. BJU Int 2007, 99 (5),1002-1006.
  9. Fergany AF, Hafez KS, Novick AC: Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol 2000, 63 (2), 442-445.
  10. Pandharipande PV, Gervais DA, Mueller PR et al: Radiofrequency ablation versus nephron-sparing surgery for small unilateral renal cell carcinoma: cost-effectiveness analysis. Radiology 2008, 248 (1), 169-178.
  11. Bandi G, Hedican S, Moon T et al: Comparison of postoperative pain, convalescence, and patient satisfaction after laparoscopic and percutaneous
  12. ablation of small renal masses. J Endourol 2008, 22 (5), 963-967.
  13. Gervais DA, McGovern FJ, Arellano RS at al: Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient
  14. management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005, 185 (1), 64-71.
  15. Zagoria RJ, Traver MA, Werle DM et al: Oncologic efficacy of CT-guide percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am J Roentgenol 2007, 189 (2), 429-436.
  16. Veltri A, Calvo A, Tosetti I et al: Experiences in US-guided percutaneous radiofrequency ablation of 44 renal tumors in 31 patients: analysis of
  17. predictors for complications and technical success. Cardiovasc Intervent Radiol 2006, 29 (5), 811-818.
  18. Johnson DB, Saboorian MH, Duchene DA et al: Nephrectomy after radiofrequency ablation-induced ureteropelvic junction obstruction: potential
  19. complication and long-term assessment of ablation adequacy. Urology 2003, 62 (2), 351-352.
  20. Park BK, Kim CK, Lim HK: Renal Infarction Resulting From Segmental Arterial Injury During Radiofrequency Ablation of Renal Tumor in Patient
  21. with a Single Kidney. Urology 2008, 1.
  22. Carrafiello G, Lagana D, Ianniello A et al: Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours:
  23. one centre experience and review of published works. Australas Radiol 2007, 51 (6), 550-554.
  24. Rouviere O, Badet L, Murat FJ et al: Radiofrequency ablation of renal tumors with an expandable multitined electrode: results, complications,
  25. and pilot evaluation of cooled pyeloperfusion for collecting system protection. Cardiovasc Intervent Radiol 2008, 31 (3), 595-603.
  26. Prevoo W, van den Bosch MA, Horenblas S: Radiofrequency ablation for treatment of sporadic angiomyolipoma. Urology 2008, 72 (1), 188-191.
  27. Matevossian E, Novotny A, Vogelsang B et al: Noninvasive therapy of incidental de novo renal cell carcinoma in a kidney allograft 12 years after
  28. transplantation: report of a case and review of literature. Transplant Proc 2008, 40 (4), 915-917.
  29. Harabayashi T, Shinohara N, Katano H et al: Management of renal angiomyolipomas associated with tuberous sclerosis complex. J Urol 2004, 171 (1), 102-105.
  30. Ukimura O, Mitterberger M, Okihara K et al: Real-time virtual ultrasonographic radiofrequency ablation of renal cell carcinoma. BJU Int 2008, 101 (6), 707-711.
  31. Johnson DB, Duchene DA, Taylor GD et al: Contrast-enhanced ultrasound evaluation of radiofrequency ablation of the kidney: reliable imaging of the thermolesion. J Endourol 2005, 19 (2), 248-252.
  32. Carey RI, Leveillee RJ: First prize: direct real-time temperature monitoring for laparoscopic and CT-guided radiofrequency ablation of renal tumors
  33. between 3 and 5 cm. J Endourol 2007, 21 (8), 807-813.
  34. Salagierski M, Salagierski M, Salagierska-Barwińska A, Sosnowski M: Percutaneous ultrasound-guided radiofrequency ablation for kidney
  35. tumors in patients with surgical risk. Int J Urol 2006, 13 (11), 1375-1379.
  36. Kunkle DA, Uzzo RG: Cryoablation or radiofrequency ablation of the small renal mass: a meta-analysis. Cancer 2008, 113 (10), 2671-2680.
  37. Michaels MJ, Rhee HK, Mourtzinos AP et al: Incomplete renal tumor destruction using radio frequency interstitial ablation. J Urol 2002,168
  38. (6), 2406-2409.
  39. Stern JM, Anderson JK, Lotan Y et al: Nicotinamide adenine dinucleotide staining immediately following radio frequency ablation of renal tumorsis
  40. a positive stain synonymous with ablative failure? J Urol 2006, 176 (5), 1969-1972.
  41. Dechet CB, Zincke H, Sebo TJ et al: Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine
  42. the nature of solid renal masses in adults. J Urol 2003, 169 (1), 71-74.
  43. Salagierski M, Salagierski M: Haemostatic radiofrequency ablation assisted partial nephrectomy: is radiofrequency energy a viable solution?
  44. Urol Int 2008, 81 (1), 77-81. Kołodziejczyk E, Matuszewski M, Krajka K: Porównanie rodzajów znieczulenia zastosowanego podczas zabiegów termoablacji guzów nerek u chorych z dużym ryzykiem operacyjnym. Urol Pol 2006, 59, 3.

correspondence

Marek Salagierski
II Klinika Urologii UM
ul. Pabianicka 62
93-513 Łódź
tel. (042) 689 52 11
msalagierski@yahoo.com