The role of transarterial embolization in the treatment of renal cell carcinoma

Abstract

OBJECTIVE To review the role of transarterial renal embolization in our unit, assessing the indications, tolerability and efficacy of this technique for treating renal cell carcinoma (RCC). PATIENTS AND METHODS Thirty patients undergoing transarterial embolization between 1991 and 1999 were identified and 25 case notes analysed retrospectively. RESULTS Most patients (14 of 25) presented with less advanced (stage I–III) RCC who were unable or unwilling to undergo radical surgery; the remainder (11) presented with advanced (stage IV) disease. The embolizing agent was ethanol, usually combined with stainless steel coils (85% of cases). Procedural pain and fever was controlled successfully. The median hospital stay associated with the procedure was 4 days. At the time of analysis six of 11 stage IV and 11 of 14 stage I–III patients were alive (median follow‐up 27 and 39 months, respectively). Symptoms from the primary tumour were well controlled. Overall, 17 of 25 (68%) of patients reported no problems while three (12%) required brief hospital admission for treatment of persistent haematuria. Fourteen patients were subsequently re‐staged; the primary tumour in two had increased, in seven remained unchanged and in five it decreased. No patients without metastases developed them and metastases in two patients regressed. CONCLUSION Transarterial embolization is associated with minimal morbidity and complications, and subsequent symptom control is good. The effect of palliative embolization on RCC progression is unknown and requires prospective investigation. Presently, there is no role for cytoreductive embolization; it should be included as a treatment option in clinical trials evaluating such options in patients with metastatic RCC.

The Role Of Transarterial Embolization In The Treatment Of Renal Tumors

“…[8] Schwartz et al reported a similar percentage (66%) of cytoreductive embolizations [9]. According to most other authors, the interventions were performed exclusively as a palliative procedure [10,11]. 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.…”

“…Onishi et al applied only ethanol in a group of patients with RCC [14]. Munro et al most often used ethanol combined with other agents (alcohol with coils in 85%, alcohol and gelatin sponge in 8%, in 7% only alcohol) [10]. May et al applied only coils in 95% of 227 presurgical renal transarterial embolizations [7].…”

Pilot study of transcatheter arterial ethanol embolization under closed renal circuit for large renal cell carcinomas

“…The major difference between nephrectomy and standard TAE in patients with large RCCs is that nephrectomy results in complete remission of the tumor in the kidney, whereas standard TAE usually does not. Although a variety of embolic materials for TAE, many researchers have recently used absolute ethanol because of its reported ability to induce capillary embolization and improve survival [10][11][31][32]. To achieve results that approach the effectiveness of nephrectomy, we recommend that a sufficient dose of absolute ethanol is used to ablate parasitic collaterals as extensively as possible.…”

The role of interventional oncology in the palliative care of cancer patients

“…These studies demonstrated relative safety and efficacy of the procedure though QOL metrics were not reported. Several studies have evaluated the role of transarterial renal embolization in the setting of palliation for hematuria [83][84][85]. Mukund et al demonstrated gross hematuria control in 6/7 patients [84].…”