Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

Abstract

Abstract. Partial nephrectomy is the treatment of choice for small renal cell carcinoma (RCC) from the perspective of cancer management and renal function. However, when patients with RCC are of advanced age, exhibit severe comorbidities, including cardiovascular and pulmonary diseases, or have hereditary RCC, ablative therapies, including radiofrequency ablation (RFA) and cryoablation are useful treatment options. In the present study, the clinical outcomes of percutaneous RFA for treating small RCC were evaluated. Between December 2005 and March 2015, 40 patients (41 renal tumors in total) underwent RFA and a total of 50 sessions of RFA were performed. The average tumor size was 2.5 cm. A total of 18 tumors were exophytic and 23 were parenchymal. Of the 41 tumors, 85.4% were completely ablated by initial RFA and the rate of complete ablation following reablation for residual viable lesions was 95.1%. Local recurrence-free survival following complete ablation was 84.2% at 3 years. A patient with a 4.7 cm RCC tumor rapidly progressed following four RFA treatments until complete ablation was achieved. The metastasis-free survival rate following initial RFA was 95.7% at 3 years. The RCC-specific survival was 100% (mean follow-up, 38 months). Adverse events occurred in five sessions (10%); however, only 1 patient with arteriovenous fistula required intervention (transarterial embolization). The mean hospital stay following RFA was 3.2 days. The mean decrease in estimated glomerular filtration rate following RFA was 2.7%. The results of the present study indicate that percutaneous RFA was an effective treatment for small RCCs with respect to management of cancer, minimal invasiveness and minimal loss of renal function, particularly in patients for whom surgery would be a high risk and those at increased risk of deterioration of renal function.

Outcomes of Microwave Ablation for Small Renal Masses: A Single Center Experience

“…The rate of complications after MWA in our study is similar to the 10%-17% complication rate of RFA reported in the literature, with the majority of complications in this study (3/4) being Clavien grade 1. 3,18 Importantly, the low rate of urine leak in our study (3%), despite treatment of tumors adjacent to the collecting system, is comparable with RFA. 19,20 Our results also contradict those of a recent study by Thompson and colleagues, which described a relatively high (11.5%) rate of postoperative bleeding and urinary complications with MWA, as there were no bleeding complications or clinically significant changes in postprocedural hemoglobin and only a single Clavien grade 3 urinary complication (3%) despite treating multiple tumors in proximity to the collecting system.…”

“…4,14,26 Short-term results for RFA are similar, with 85%-97% initial technical success, 84% RFS, and 100% CSS at 3 years. 16,18 CA also yields similar short-term oncologic outcomes, with initial technical success reported at 93%-96% and 1-year disease-free and OS at 96% and 97%, respectively. 4,[27][28][29] Because of the limited number of complications in our study, we were unable to fully investigate individual risk factors for postoperative complications.…”

Systematic Review of Contemporary Evidence for the Management of T1 Renal Cell Carcinoma: What IRs Need to Know for Kidney Cancer Tumor Boards

“…A total of 1,528 lesions were treated with an average tumor size of 2.5 cm (►Table 1). [37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Although the majority of studies involved percutaneous RFA alone (13), several studies (4) also included the combination of percutaneous and laparoscopic approach. Seventy-eight local recurrences were reported with a tumor recurrence rate of 5.0% (range: 0-15%) for percutaneous approach alone and 5.5% (range: 2.7-8.1%) for studies with a mixture of percutaneous and laparoscopic approaches.…”

Radiofrequency thermoablation (RFA) in kidney cancer patients

“…Расположение опухоли (экзофитно, интрапаренхиматозно или центрально) также влияет на результаты абляции. Даже более крупные экзофитно растущие опухоли почти всегда успешно лечатся, причем ≥70% требуют только одного сеанса РЧА-воздействия, что соответствует и данным литературы [38,39]. Нецентральные, задние и заднелатеральные опухоли легче доступны и лечатся с низкой частотой осложнений, тогда как нижние, передние и медиальные опухоли имеют более высокую вероятность повреждения соседних органов [40].…”