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15.09.2015 | Interventional

Effectiveness and safety of computed tomography-guided radiofrequency ablation of renal cancer: a 14-year single institution experience in 203 patients

verfasst von: Jason D. Iannuccilli, Damian E. Dupuy, Michael D. Beland, Jason T. Machan, Dragan J. Golijanin, William W. Mayo-Smith

Erschienen in: European Radiology | Ausgabe 6/2016

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Abstract

Objectives

To define effectiveness and safety of CT-guided radiofrequency ablation (RFA) of renal tumours and prognostic indicators for treatment success.

Methods

Patients with a single treatment of a solitary, biopsy-proven renal tumour with intent to cure over a 14-year period were included (n = 203). Probability of residual disease over time, complication rates and all-cause mortality were assessed in relation to multiple variables.

Results

Mean tumour size was 2.5 cm (range 1.0–6.0). Mean follow-up was 34.1 months (range 1–131). There was an increase in likelihood of residual disease for tumours ≥3.5 cm (P < 0.05), clear cell subtype of renal cell carcinoma (P ≤ 0.005) and maximum treatment temperature ≤70 °C (P < 0.05). There was a decrease in likelihood of residual disease for exophytic tumours (P = 0.01) and no difference based on age, gender, tumour location or type of radio freqency (RF) electrode used. Major complications occurred in 3.9 %. Median post-treatment survival was 7 years for patients with tumours <4 cm, and 5-year overall survival was 80 %. Probability of minor complication increased with tumour size (P = 0.03), as did all-cause mortality (P = 0.005).

Conclusions

CT-guided RFA is safe and effective for early-stage renal cancer, particularly for exophytic tumours measuring <3.5 cm. Overall 5-year survival with tumours <4 cm is comparable to partial nephrectomy.

Key points

• Prognostic indicators for success of CT-guided RFA of renal tumours are reported.

• Tumour size ≥3.5 cm confers an increased risk for residual tumour.

• Clear cell renal cell carcinoma subtype confers increased risk for residual tumour.

• Tmax <70 °C within the ablation zone confers increased risk for residual tumour.

• Exophytic tumours have a lower probability of residual disease.

American Cancer Society (2014) Cancer Facts and Figures 2014. American Cancer Society, Atlanta GA. Available via http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/

Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort review. Lancet Oncol 7:735–740CrossRefPubMedPubMedCentral

Licht MR, Novick AC, Goormastic M (1994) Nephron sparing surgery in incidental versus suspected renal cell carcinoma. J Urol 152:39–42PubMed

Wehle MJ, Thiel DD, Petrou SP et al (2004) Conservative management of incidental contrast-enhancing renal masses as safe alternative to invasive therapy. Urology 64:49–52CrossRefPubMed

Fujioka T, Obara W, Committee for Establishment of the Clinical Practice Guideline for the Management of Renal Cell Carcinoma and the Japanese Urological Association (2012) Evidence-based clinical practice guideline for renal cell carcinoma: the Japanese Urological Association 2011 update. Int J Urol 19:496–503CrossRefPubMed

Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279CrossRefPubMed

Joniau S, Tsivian M, Gontero P (2011) Radiofrequency ablation for the treatment of small renal masses: safety and oncologic efficacy. Minerva Urol Nefrol 63:227–236PubMed

Popovic P, Lukic S, Mijailovic M, Salapura V, Garbajs M, Surlan Popovic K (2012) Percutaneous radiofrequency ablation of small renal cell carcinoma: technique, complications, and outcomes. J BUON 17:621–626PubMed

Salas N, Ramanathan R, Dummett S, Leveilee RJ (2010) Results of radiofrequency kidney tumour ablation: renal function preservation and oncologic efficacy. World J Urol 28:583–591CrossRefPubMed

10.

Takaki H, Yamakado K, Soga N et al (2010) Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma. Jpn J Radiol 28:460–468CrossRefPubMed

11.

Varkarakis IM, Allaf ME, Inagaki T et al (2005) Percutaneous radiofrequency ablation of renal masses: results at a 2-year mean followup. J Urol 174:456–460CrossRefPubMed

12.

Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR (2005) Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumours. AJR Am J Roentgenol 185:64–71CrossRefPubMed

13.

Gervais DA, Arellano RS, McGovern FJ, McDougal WS, Mueller PR (2005) Radiofrequency ablation of renal cell carcinoma: part 2, lessons learned with ablation of 100 tumours. AJR Am J Roentgenol 185:72–80CrossRefPubMed

14.

Breen DJ, Rutherford EE, Stedman B et al (2007) Management of renal tumours by image-guided radiofrequency ablation: experience in 105 tumours. Cardiovasc Intervent Radiol 30:936–942CrossRefPubMedPubMedCentral

15.

Zagoria RJ, Traver MA, Werle DM, Perini M, Hayasaka S, Clark PE (2007) Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am J Roentgenol 189:429–436CrossRefPubMed

16.

Levinson AW, Su LM, Agarwal D et al (2008) Long-term oncological and overall outcomes of percutaneous radiofrequency ablation in high risk surgical patients with a solitary small renal mass. J Urol 180:499–504CrossRefPubMed

17.

Hiraoka K, Kawauchi A, Nakamura T, Soh J, Mikami K, Miki T (2009) Radiofrequency ablation for renal tumours: our experience. Int J Urol 16:869–873CrossRefPubMed

18.

Ferakis N, Bouropoulos C, Granitsas T, Mylona S, Poulias I (2010) Long-term results after computed tomography-guided percutaneous radiofrequency ablation for small renal tumours. J Endourol 24:1909–1913CrossRefPubMed

19.

Tracy CR, Raman JD, Donnally C, Trimmer CK, Cadeddu JA (2010) Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer 116:3135–3142CrossRefPubMed

20.

Balageas P, Cornelis F, Le Bras Y et al (2013) Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients. Eur Radiol 23:1925–1932CrossRefPubMed

21.

Forauer AR, Dewey BJ, Seigne JD (2014) Cancer-free survival and local tumour control after impedence-based radiofrequency ablation of biopsy-proven renal cell carcinomas with a minimum of 1-year follow-up. Urol Oncol 32:869–876CrossRefPubMed

22.

Ma Y, Bedir S, Cadeddu JA, Gahan JC (2014) Long-term outcomes in healthy adults after radiofrequency ablation of T1a renal tumours. BJU Int 113:51–55CrossRefPubMed

23.

Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA (2013) Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 63:486–492CrossRefPubMed

24.

Dechet CB, Bostwick DG, Blute ML, Bryant SC, Zincke H (1999) Renal oncocytoma: multifocality, bilateralism, metachronous tumour development and coexistent renal cell carcinoma. J Urol 162:40–42CrossRefPubMed

25.

Kuroda N, Toi M, Hiroi M, Shuin T, Enzan H (2003) Review of renal oncocytoma with focus on clinical and pathobiological aspects. Histol Histopathol 18:935–942PubMed

26.

Shah RB, Bakshi N, Hafez KS, Wood DP Jr, Kunju LP (2005) Image-guided biopsy in the evaluation of renal mass lesions in contemporary urological practice: indications, adequacy, clinical impact, and limitations in pathological diagnosis. Hum Pathol 36:1309–1315PubMed

27.

Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guided tumor ablation: standardization of terminology and reporting criteria. Radiology 235:728–729CrossRefPubMedPubMedCentral

28.

Gazelle GS, Goldberg SN, Solbiati L, Livraghi T (2000) Tumour ablation with radio-frequency energy. Radiology 217:633–646CrossRefPubMed

29.

Burke DR, Lewis CA, Cardella JF et al (2003) Quality improvement guidelines for percutaneous transhepatic cholangiography and biliary drainage. J Vasc Interv Radiol 14:S243–S246CrossRefPubMed

30.

Gooley TA, Leisenring W, Crowley J, Storer BE (1999) Estimation of failure probabilities in the presence of competing risks: new representation of old estimators. Stat Med 18:695–706CrossRefPubMed

31.

Kalbfleish JD, Prentice RL (1980) The statistical analysis of failure time data. John Wiley & Sons, New York

32.

Marubini E, Valsecchi MG (1995) Analyzing survival data from clinical trials and observational studies. John Wiley & Sons, New York

33.

Beland MD, Wolf FJ, Grand DJ, Dupuy DE, Mayo-Smith WW (2011) Incidence of multiple sporadic renal cell carcinomas in patients referred for renal radiofrequency ablation: implications for imaging follow-up. AJR Am J Roentgenol 197:671–675CrossRefPubMed

34.

Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175:425–431CrossRefPubMed

35.

Martin SF, Ahrar K, Cadeddu JA et al (2006) Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study. J Urol 176:1973–1977CrossRef

36.

Arellano RS, Garcia RG, Gervais DA, Mueller PR (2009) Percutaneous CT-guided radiofrequency ablation of renal cell carcinoma: efficacy of organ displacement by injection of 5% dextrose in water into the retroperitoneum. AJR Am J Roentgenol 193:1686–1690CrossRefPubMed

37.

DeBenedectis CM, Beland MD, Dupuy DE, Mayo-Smith WW (2010) Utility of iodinated contrast medium in hydrodissection fluid when performing renal tumour ablation. J Vasc Interv Radiol 21:745–747CrossRefPubMed

38.

MacLennan S, Imamura M, Lapitan MC et al (2012) Systematic review of oncological outcomes following surgical management of localized renal cancer. Eur Urol 61:972–993CrossRefPubMed

39.

Davenport MS, Caoili EM, Cohan RH et al (2009) MRI and CT characteristics of successfully ablated renal masses: imaging surveillance after radiofrequency ablation. AJR Am J Roentgenol 192:1571–1578CrossRefPubMed

40.

Allen BC, Remer EM (2010) Percutaneous cryoablation of renal tumours: patient selection, technique, and postprocedural imaging. Radiographics 30:887–900CrossRefPubMed

Titel: Effectiveness and safety of computed tomography-guided radiofrequency ablation of renal cancer: a 14-year single institution experience in 203 patients
verfasst von: Jason D. Iannuccilli
Damian E. Dupuy
Michael D. Beland
Jason T. Machan
Dragan J. Golijanin
William W. Mayo-Smith
Publikationsdatum: 15.09.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 6/2016
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-4006-7

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Effectiveness and safety of computed tomography-guided radiofrequency ablation of renal cancer: a 14-year single institution experience in 203 patients