Renal artery embolisation in the palliative treatment of renal carcinoma

Abstract

The aim of this study is to review the role and technique of renal artery embolisation (RAE), and assess its effectiveness in the palliative treatment of unresectable or inoperable renal cell carcinoma (RCC) in our institution. The study group consisted of 19 consecutive patients (16 male, 3 female; age range 47-87 years) who underwent palliative RAE for the treatment of renal carcinoma between January 2000 and December 2005. Unresectable disease was present in 11 patients (3 stage IVa, 8 stage IVb). Potentially resectable disease was present in 8 patients (4 stage II, 1 stage IIIa, 1 stage IIIb, 2 stage IIIc); however, these patients were unfit for surgery for other reasons. 13 patients presented with haematuria, which was gross in 7 patients. Nine patients complained of flank pain. RAE was performed using polyvinyl alcohol or embosphere particles, metallic coils and, in some cases, absolute alcohol was necessary. At the time of analysis, 12 patients had died while 7 patients were still alive, with an overall median survival for the study group of 6 months. In the 7 patients with transfusion dependant gross haematuria, there was stabilization of the haemoglobin level post-embolisation. In the 9 patients who presented with flank pain, symptoms improved or resolved in 8 patients. The median length of hospital stay for the 18 patients who were discharged was 5.0 days. RAE is a safe and tolerable management option for patients with inoperable or unresectable renal carcinoma as a means of palliation of local symptoms and improving clinical status, with low morbidity and shorter hospital stay.

The Role Of Transarterial Embolization In The Treatment Of Renal Tumors

“…Embolization effectively reduced the incidence and intensity of haematuria, which resulted in an increase in hemoglobin level in 10 out of 11 patients who had undergone palliative embolization (91%) and there was no further necessity to administer blood derivate products in these patients. In a report by Maxwell et al, an increase in hemoglobin level was noted in all of the patients [12]. In our study, selective embolization of either renal artery was performed in 20 patients (61%), whereas superselective embolization of the branches of the renal artery was performed in 13 patients (39%).…”

“…The lowest rate of PES is reported by Maxwell et al [12]. In their material, lumbar pain was observed in 42% of patients, however only 5% required administration of analgesics; fever occurred in 26% of patients, nausea and vomiting in 10% of patients.…”

“…Also according to other authors, embolization was most commonly performed due to RCC: in 100% [13,14], 90% [12], 88% [16] and 74% [9]. Embolization of the AML was carried out in the case of clinically symptomatic tumors -in patients with its rupture or impending rupture, and at times RAE was performed because of the large size of the tumor [17].…”

“…Embolization is mainly applied as a cytoreductive and palliative procedure in the treatment of the advanced stage RC, which alleviates symptoms like pain and haematuria. The procedure is also applied as a preoperative intervention, prior to elective nephrectomy, which is aimed at a reduction of loss of blood during the resections of large highly-vascularized tumors [7,9,12,13]. Onishi et al demonstrated an improvement in the quality of life and non-significant prolonged survival in patients with inoperable metastatic renal cancer who had undergone embolization [14].…”

Renal Cell Carcinoma Embolization for the Treatment of Budd–Chiari Syndrome

“…Renal artery embolization has been proposed as a palliative treatment for unresectable RCC in patients unfit or unwilling to undergo surgery. 2 Renal artery embolization for RCC was first described in 1969; since then, various techniques and embolic materials have been described.…”