Radiofrequency Ablation in Combination with Embolization in Metachronous Recurrent Renal Cancer in Solitary Kidney after Contralateral Tumor Nephrectomy

Abstract

In single kidneys, percutaneous, minimally invasive techniques are safe and feasible. In large tumors, or where there are adjacent critical structures, we prefer a combination of embolization and thermal ablation (RFA).

Trans-Arterial Embolization of Renal Cell Carcinoma prior to Percutaneous Ablation: Technical Aspects, Institutional Experience, and Brief Review of the Literature

“…This technique has been described in the radiology literature dating back to 2000 with a case report of a single RCC being embolized with 300 µm particles prior to radiofrequency ablation in order to reduce procedural bleeding [23]. Since that time, there are scattered case reports and cohort studies in the literature showing the technique to be both safe and feasible [17,18,19,20,21,22,23]. For example, Yamakado et al [17] theorized that this technique would be of most benefit in RCC larger than 3.5 cm.…”

“…There is no well-defined time point at which ablation should follow TAE [17,18,19,20,21,22,23,24]. It is our preference to perform percutaneous ablation under CT guidance; although, ultrasound could also be used in select patients.…”

“…The choice of embolic material is operator dependent as there is insufficient evidence to say that any one particular embolic approach is superior in RCC [17,18,19,20,21,22,23,24]. Specific types of embolics are discussed to provide the practitioner with the benefits and drawbacks of each.…”

“…Since RCC is a highly vascular tumor, bleeding is one of the major complications seen after percutaneous ablation [16]. Nonetheless, the vascularity of RCC could potentially provide an intriguing target for adjunctive therapy as several reports in the literature describe trans-arterial embolization (TAE) of RCC prior to percutaneous ablation as a means to improve tumor localization, increase tumor ischemia, and decrease post-procedural bleeding [17,18,19,20,21,22,23,24]. Therefore, the purpose of this manuscript is to provide practitioners a guide to the technical aspects of these procedures, discuss our institutional outcomes, and provide a brief review of the literature so that they may best determine which patients could benefit from this treatment approach.…”

Interventional Management of a Renal Cell Carcinoma by Radiofrequency Ablation with Tagging and Cooling

“…Small tumor size (< 3 cm) and a peripheral tumor localization are considered to be predictors for successful ablation (1, 2). For larger tumors, additional embolization has been performed to achieve more homogeneous heating, and thereby an improved outcome (2, 10). For centrally located tumors, collecting system cooling has been proposed as a method to protect these structures from thermal damage.…”