Elsevier

Urology

Volume 77, Issue 6, June 2011, Pages 1393-1397
Urology

Oncology
Long-term Outcomes After Percutaneous Radiofrequency Ablation for Renal Cell Carcinoma

https://doi.org/10.1016/j.urology.2010.12.077Get rights and content

Objectives

To assess the long-term oncological efficacy of radiofrequency ablation (RFA) for treatment of renal cell carcinoma (RCC).

Methods

In this institutional review board–approved, retrospective study, the records and imaging studies for all RCC patients treated with percutaneous RFA before 2005 were reviewed and analyzed.

Results

A total of 48 RCCs in 41 patients were treated with RFA. Median size of RCC treated was 2.6 cm (range: 0.7-8.2 cm). Of the 48 treated RCCs, 5 (12%) had recurrent tumor after a single ablation session. The median size of the index lesion in the cases with recurrence was 5.2 cm (interquartile range [IQR]: 4-5.3) compared with 2.2 cm (IQR: 1.7-3.1, P = .0014) without local recurrence. There were no recurrences when RCCs less than 4 cm were treated. Seventeen (41%) patients with 18 treated RCCs died during the follow-up period at a median time of 34 (IQR: 10-47) months. One patient (2%) died of metastatic RCC, whereas 16 died of unrelated causes. Twenty-four patients with 30 RCCs treated with RFA survived. For the remaining 30 RCCs, median follow up was 61 months (IQR: 54-68). No patients in this group of survivors had metastatic RCC, 1 had recurrence diagnosed at 68 months. The long-term recurrence-free survival rate was 88% after RFA.

Conclusions

RFA can result in durable oncological control for RCCs less than 4 cm. RFA is an effective treatment option for patients with RCCs less than 4 cm who are poor surgical candidates. For patients with larger RCCs alternative treatments should be considered.

Section snippets

Material and Methods

This retrospective study was approved by the institutional review board at our institution. We conducted a review of patients who underwent percutaneous RFA at our institution before 2005 and identified 41 patients treated for 48 index lesions. All of these patients had pretreatment abdominal CT or MRI and chest evaluation with chest radiography or chest CT. Patients in this cohort were initially evaluated by a urologist who assessed surgical risk. All of these patients had serious

Results

A total of 48 RCCs in 41 patients were treated with CT-guided percutaneous RFA. Four patients were treated for multiple RCCS: 2 patients had 2 tumors, 1 had 3 tumors, and 1 had 4. Of the 41 patients, there were 31 (76%) males and 10 (24%) females. The median age of patients was 72 (interquartile range [IQR]: 61-78) at the time of treatment. The median size of RCC treated was 2.6 cm (IQR: 1.7-3.6). The largest tumor was 8.2 cm. There were 4 (8%) complications, 2 small asymptomatic

Comment

Standard therapy for RCC has been surgical extirpation. Surgical options include both radical and partial nephrectomy,10, 11, 12, 13, 14, 15, 16 with the requirement of using general anesthesia. It is not rare to encounter patients with small RCCs who are unable, because of co-morbidities, to safely undergo surgical resection, or patients in whom renal sparing surgery is not possible even though adequate renal function after resection will likely be compromised. Active surveillance of these

Conclusions

The results of this study indicate that percutaneous RFA at a high-volume center is safe, and can result in durable oncological control for RCCs less than 4 cm. For these tumors, no local recurrences occurred with median follow up of 61 months for patients alive at the end of this study. For larger RCCs the risk of incomplete ablation is substantially higher and surgery is advisable for these patients. These data support the use of CT-guided percutaneous radiofrequency ablation for the

References (26)

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