Percutaneous Radio Frequency Ablation of Small Renal Tumors: Initial Results

Pavlovich, Christian P.; Walther, McClellan M.; Choyke, Peter L.; Pautler, Stephen E.; Chang, Richard; Linehan, W. Marston; Wood, Bradford J.

doi:10.1016/s0022-5347(05)65371-2

Cited by 270 publications

(147 citation statements)

References 22 publications

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“…Previously we reported our initial results on RFA of small hereditary based renal tumors using the RITA Model 500 electrosurgical generator. 2 We reported on 24 ablations performed in 21 patients with renal tumors and at 2-month followup a majority of tumors (19 of 24, 79%) ceased to enhance on contrast CT. 2 Further followup is now available on these patients treated with the old generation RITA device (unpublished data). At a median followup of 24 months 10 of the ablated tumors (40%) demonstrated contrast enhancement (HU change greater than 10) on followup CT (unpublished data), 9 of the tumors have been surgically removed and pathologically confirmed as viable clear cell carcinoma and the remaining case has been retreated with RFA using the higher wattage Radionics system with success based on imaging criteria.…”

Section: Discussionmentioning

confidence: 93%

Radio Frequency Ablation of Small Renal Tumors: Intermediate Results

et al. 2004

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Purpose-With evolving radio frequency technology, the clinical application of radio frequency ablation (RFA) has been actively investigated in the treatment for small renal tumors. We present our intermediate patient outcomes after RFA.Materials and Methods-Since January 2001, 17 patients with a total of 24 hereditary renal tumors ranging from 1.2 to 2.85 cm were treated with RFA using the 200 W Cool-tip RF System (Radionics, Burlington, Massachusetts) under laparoscopic (9) or percutaneous (8) guidance and had a minimum 1-year followup. A percutaneous approach was considered unsuitable if kidney tumors were contiguous to bowel, ureter or large vessels. Treatment eligibility criteria included an average tumor diameter of less than 3.0 cm, tumor growth during 1 year and solid appearance with contrast enhancement (HU change greater than 20) on computerized tomography (CT). Postoperative followup consisted of CT with and without intravenous contrast, and renal function assessment at regular intervals.Results-Median patient age was 38 years (range 20 to 51). At a median followup of 385 days (range 342 to 691), median tumor or thermal lesion diameter decreased from 2.26 to 1.62 cm (p = 0.0013), and only 1 lesion (4%), which was located centrally near the hilum, exhibited contrast enhancement (HU change greater than 10) on CT at 12 months. Of the 15 renal tumors ablated laparoscopically, 13 were in direct contact with the bowel and 2 were abutting the ureter, necessitating mobilization before RFA. Laparoscopic ultrasound was used to guide radio frequency electrode placement and monitor the ablation process in these cases. Operative time and intraoperative blood loss (mean ± standard mean of error) were 243 ± 29 minutes and 67 ± 9 cc, respectively. In 1 patient whose ureter was adherent to the tumor a ureteropelvic junction obstruction developed after laparoscopic RFA, requiring open repair.Conclusions-At the minimum 1-year followup 23 of 24 ablated tumors lacked contrast uptake on CT, meeting our radiographic criteria of successful RFA treatment. RFA treatment of small renal tumors using the Radionics system appears to result in superior treatment outcomes compared to those of earlier series with lower radio frequency power generators. A high wattage generator might attain more consistent energy deposition with subsequent cell death in the targeted tissue due to less convective heat loss.

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Section: Discussionmentioning

confidence: 93%

Radio Frequency Ablation of Small Renal Tumors: Intermediate Results

et al. 2004

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“…Duffey et al [26] investigated the correlation between tumor size and metastasis and found that solid RCCs with diameters < 3 cm did not metastasize. Additionally, these authors demonstrated that none of the 108 investigated patients with tumors !3 cm developed metastatic disease during a median follow-up of 41 months, whereas 20 of the 73 patients with tumors > 3 cm developed metastases during a median follow-up of 59 months.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous CT-guided Radiofrequency Ablation for Renal Cell Carcinoma in von Hippel-Lindau Disease: Midterm Results

Gobara

Hiraki

Iguchi

et al. 2016

Interventional Radiology

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Purpose: To evaluate the safety and midterm results of radiofrequency (RF) ablation for the treatment of renal cell carcinoma (RCC) in patients with von Hippel-Lindau (VHL) disease. Materials and methods: This study included 13 patients with VHL (8 women and 5 men; mean age: 35.5 years) and RCC. Each patient presented with 1-6 RCCs (mean: 2.4 1.7) without extrarenal metastasis. The mean tumor diameter was 18.0 5.0 mm. Transcatheter arterial embolization was performed for 5 (16.7%) of 31 tumors. All RF ablation procedures involved the percutaneous use of internally cooled RF electrodes under computed tomography fluoroscopic guidance. Adverse events were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0, and pre-and post-treatment estimated glomerular filtration rates (eGFRs) were compared using paired t-tests. Local tumor progression, distant metastasis, and survival were also evaluated. Results: Twenty-three RF ablation sessions were technically successful. A grade 3 adverse event (hydronephrosis due to blood clotting, thus requiring ureteral stent placement) occurred in 1 (4%) of 23 sessions. The mean eGFR measured at !1 month after ablation was significantly lower than the mean eGFR before ablation (70.2 21.9 versus 78.8 23.0, p < 0.001). Local tumor progression was seen in 1 (3%) of 31 tumors. No patients died, required dialysis, or developed extra-renal metastases during a median 40-month follow-up. Conclusions: RF ablation for RCC is a safe, highly effective, and promising treatment option for patients with VHL disease.

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“…The criterion of cure is confirmed by the absence of the visualization of contrast (< 10UH) on tomography, with a success rate of 79 to 96% (2,3).…”

Section: Commentsmentioning

confidence: 98%

“…Surgical approach may vary either by means of percutaneous puncture (3) or by laparoscopy (2). The principle of RFA involves heating to high temperatures (< 70 degrees C) thus provoking necrosis of coagulation and cell death (2,3). The criteria of inclusion for RFA are solid lesions < 3 cm, which have been growing over the previous year, creatinine below 2.0 mg/dL and 24-hour creatinine clearance greater than 60 mL/min (2,3).…”

Section: Commentsmentioning

confidence: 99%

“…The position of the tumor (posterior, lateral or medial) has not been considered among the exclusion criteria, although the proximity of the colon, duodenum or of important vessels is a limiting factor for this technique (1-3). The most frequent complications arising from RFA are hematuria (4 to 8%), proteinuria (16%), low back pain (16%) and perirenal hematoma (4%), and these are treated conservatively (2,3).…”

Section: Commentsmentioning

confidence: 99%

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Acute renal insufficiency after radiofrequency of renal tumor

2007

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Recent advances in techniques of imaging and ablation have led to the application of several minimally invasive modalities, such as radiofrequency ablation (RFA) with a success rate varying from 79 to 96% and a serious complication rate of 1 to 4% in the treatment of small renal tumors. The authors report on the case of a 67-year-old patient with a radiofrequency ablation complication, stenosis of the ureteropelvic junction in one kidney, and analyze the results of this modality for the treatment of renal tumors.

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Percutaneous Radio Frequency Ablation of Small Renal Tumors: Initial Results

Cited by 270 publications

References 22 publications

Radio Frequency Ablation of Small Renal Tumors: Intermediate Results

Radio Frequency Ablation of Small Renal Tumors: Intermediate Results

Percutaneous CT-guided Radiofrequency Ablation for Renal Cell Carcinoma in von Hippel-Lindau Disease: Midterm Results

Acute renal insufficiency after radiofrequency of renal tumor

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