Review of Radiofrequency Ablation for Renal Cell Carcinoma

Abstract

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.

Clinical outcomes of percutaneous radiofrequency ablation for small renal cancer

“…Although various complications have been reported, the majority of those were minor and the complication rates were low (30,31). In the present study, complications were observed in five sessions following RFA (10%).…”

Radiofrequency Ablation of Renal Cell Carcinoma: A Systematic Review

“…Imaging immediately after the procedure can be difficult to interpret because periablation inflammation may mimic the appearance of a residual viable tumor (Hines-Peralta & Goldberg, 2004). A definition of complete coagulation necrosis and thus a completely ablated tumor after RF ablation is the absence of enhancement on CT or MR images.…”

Histopathological findings after radiofrequency (RITA) treatment for prostate cancer

“…The question of whether RITA-induced tissue lesions are truly necrotic in nature also remains to be clarified. Indeed, as Dr S Nahun Goldberg said in the opening comments of a recent article 2 'there is no question that one can achieve (y) mummification of the cells that are in fact dead, but because they don't show signs of coagulative necrosis or the absence of nuclei, many pathologists have originally called these cells live'. The author is referring to liver neoplasms, like much of the available data on RF treatments.…”

“…[1][2][3] Temperatures above 601C have a rapid cytotoxic effect due to protein coagulation. 1 The amount of heat energy produced and the subsequent thermal effect are determined by the amount of tissue contact (the length of the needle) and the wattage.…”