Early Experience with Percutaneous Radiofrequency Ablation of Small Solid  Renal Masses

Roy-Choudhury, Shuvro; Cast, J.E.I.; Cooksey, G.; Puri, Shama; Breen, David J.

doi:10.2214/ajr.180.4.1801055

Cited by 75 publications

(40 citation statements)

References 29 publications

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“…After either one or two sessions, 31 of the 32 tumors (97%) were treated successfully by CT. Six patients (19%) required a second session because of incomplete treatment during the first session. Roy-Choudhury et al (12) examined eight patients with 11 renal tumors (mean size, 3.0 cm; range, 1.5-5.5 cm; 9 tumors were exophytic, and 2 tumors were central). Seven of the eight patients (88%) showed no recurrence at follow-up (mean, 17.1 months; range, 10 -26 months).…”

Section: Clinical Studiesmentioning

confidence: 99%

“…In general, RCC tumors that are Յ3 cm in diameter are ideal for ablation, with near-perfect success rates on postprocedural imaging (7-13). Most tumors smaller than 3 cm can also be treated successfully in a single session (7)(8)(9)(10)(11)(12)(13). Tumors between 3.0 and 3.5 cm in diameter can also be treated successfully with confidence, but multiple ablations and sessions may be required (7)(8)(9)(10)(11)(12)(13).…”

Section: Tumor Factorsmentioning

confidence: 99%

“…Even larger exophytic tumors are almost always treated successfully, with Ն70% requiring only a single RF session (7)(8)(9)(10)(11)(12)(13). Parenchymal tumors may be more difficult to treat, but centrally located tumors represent the largest obstacle for successful ablation.…”

Section: Tumor Factorsmentioning

confidence: 99%

“…Indeed, more than 5,000 RF ablations of focal liver tumors have been performed during the last 5 years, with Food and Drug Administration (FDA) approval being granted for this indication (1)(2)(3)(4)(5)(6). More recently, however, the clinical potential of RF ablation has greatly expanded under the blanket FDA approval for soft tissue including the treatment of kidney (7)(8)(9)(10)(11)(12)(13), breast (14), bone (15)(16)(17), lung (18), retroperitoneum (19), thyroid (20), adrenal gland (21), spleen (22), prostate (23,24), and even pheochromocytoma (25). One site in particular, the kidney, is poised for significant growth as a target for RF ablation.…”

Section: Introductionmentioning

confidence: 99%

“…One site in particular, the kidney, is poised for significant growth as a target for RF ablation. A contributing factor includes the significant increase in the incidence of renal cell carcinoma (RCC), which, when coupled with improved understanding of RF techniques, has recently led many investigators to assess the feasibility and efficacy of RF ablation for renal tumors in select patient populations (7)(8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

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Review of Radiofrequency Ablation for Renal Cell Carcinoma

Hines-Peralta

Goldberg

2004

Clinical Cancer Research

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This review will discuss how minimally invasive, imageguided radiofrequency (RF) tumor ablation [i.e., coagulating tumor using short-duration heating (<15 minutes) by directly applying temperatures >50°C via needle electrodes] is being incorporated as a clinical tool for the treatment of renal cell carcinoma. RF ablation has been used to treat focal liver tumors. Potential benefits of this thermal therapy include reduced morbidity and mortality compared with standard surgical resection and the ability to treat nonsurgical patients. More recently, this technique has been introduced to treat focal renal tumors, particularly incidental lesions smaller than 3 cm in elderly patients and those with comorbid conditions. Other uses have included treatment in patients with von Hippel-Lindau syndrome and other diseases that predispose patients to multiple renal carcinomas, where renal parenchymal preservation is desired. Techniques, complications, and results will be discussed. Additionally, strategies that we are currently studying to improve RF outcomes and enable the potential treatment of larger tumors will be addressed. Most notably, recent data on increased coagulation achieved by combining RF ablation with antivascular/antiangiogenic therapies, such as arsenic trioxide, that reduce blood flow and promote heat retention are provided.

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Section: Clinical Studiesmentioning

confidence: 99%

Section: Tumor Factorsmentioning

confidence: 99%

Section: Tumor Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Review of Radiofrequency Ablation for Renal Cell Carcinoma

Hines-Peralta

Goldberg

2004

Clinical Cancer Research

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Cryoablation or radiofrequency ablation of the small renal mass

Kunkle

Uzzo

2008

Cancer

374

213

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BACKGROUND.The incidence of renal cell carcinoma is rising because of incidental detection of small renal masses (SRMs). Although surgical resection remains the standard of care, cryoablation and radiofrequency ablation (RFA) have emerged as minimally invasive treatment alternatives. The authors of this report performed a comparative meta‐analysis evaluating cryoablation and RFA as primary treatment for SRMs.METHODS.A search of the MEDLINE database was performed reviewing the world literature for clinically localized renal masses treated by cryoablation or RFA.RESULTS.Forty‐seven studies representing 1375 kidney lesions treated by cryoablation or RFA were analyzed. No differences were detected between ablation modalities with regard to mean patient age (P = .17), tumor size (P = .12), or duration of follow‐up (P = .53). Pretreatment biopsy was performed more often for cryoablated lesions (82.3%) than for RFA (62.2%; P < .0001). Unknown pathology occurred at a significantly higher rate for SRMs that underwent RFA (40.4%) versus cryoablation (24.5%; P < .0001). Repeat ablation was performed more often after RFA (8.5% vs 1.3%; P < .0001), and the rates of local tumor progression were significantly higher for RFA (12.9% vs 5.2%; P < .0001) compared with cryoablation. The higher incidence of local tumor progression was found to be correlated significantly with treatment by RFA on univariate analysis (P = .001) and on multivariate regression analysis (P = .003). Metastasis was reported less frequently for cryoablation (1.0%) versus RFA (2.5%; P = .06). Cryoablation usually was performed laparoscopically (65%), whereas 94% of lesions that were treated with RFA were approached percutaneously.CONCLUSIONS.Ablation of SRMs is a viable strategy based on short‐term oncologic outcomes. Although extended oncologic efficacy remains to be established for ablation modalities, the current data suggest that cryoablation results in fewer retreatments and improved local tumor control, and it may be associated with a lower risk of metastatic progression compared with RFA. Cancer 2008. © 2008 American Cancer Society.

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