Article

Durable Oncologic Outcomes After Radiofrequency Ablation Experience From Treating 243 Small Renal Masses Over 7.5 Years

Department of Urology, University of Iowa, Iowa City, Iowa, USA.
Cancer (Impact Factor: 4.9). 07/2010; 116(13):3135-42. DOI: 10.1002/cncr.25002
Source: PubMed

ABSTRACT Long-term oncologic outcomes for renal thermal ablation are limited. The authors of this report present their experience with radiofrequency ablation (RFA) therapy for 243 small renal masses (SRMs) over the past 7.5 years.
The authors' institutional, prospectively maintained RFA database was reviewed to determine intermediate and long-term oncologic outcomes for patients with SRMs (generally < 4 cm) who underwent RFA. Particular attention was placed on patients who had a minimum 3 years of follow-up. Patients were excluded from the analysis if they had received previous treatment for renal cell carcinoma (RCC) on the ipsilateral kidney or if they did not have at least 1 imaging study available for follow-up.
Two hundred eight patients (with 243 SRMs) who had no evidence of previous ipsilateral renal cancer treatment underwent RFA and had follow-up imaging studies available for review. Overall, tumor size averaged 2.4 cm, and follow-up ranged from 1.5 months to 90 months (mean, 27 months). Of the 227 tumors (93%) that underwent preablation biopsy, RCC was confirmed in 79%. The initial treatment success rate was 97%, and the overall 5-year recurrence-free survival rate was 93% (90% for 160 patients who had biopsy-proven RCC). During follow-up, 3 patients developed metastatic disease, and 1 patient died of RCC, yielding 5-year actuarial metastasis-free and cancer-specific survival rates of 95% and 99%, respectively.
RFA provided successful treatment of SRMs and produced a low rate of recurrence as well as prolonged metastasis-free and cancer-specific survival rates at 5 years after treatment. Although longer term follow-up of RFA will be required to determine late recurrence rates, the current results indicated a minimal risk of disease recurrence in patients who are >3 years removed from RFA.

0 Followers
 · 
116 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Image-guided ablation (IGA) techniques have evolved considerably over the past 20 years and are increasingly used to definitively treat small primary cancers of the liver and kidney. IGA is recommended by most guidelines as the best therapeutic choice for patients with early stage hepatocellular carcinoma (HCC)-defined as either a single tumour smaller than 5 cm or up to three nodules smaller than 3 cm-when surgical options are precluded, and has potential as first-line therapy, in lieu of surgery, for patients with very early stage tumours smaller than 2 cm. With regard to renal cell carcinoma, despite the absence of any randomized trial comparing the outcomes of IGA with those of standard partial nephrectomy, a growing amount of data demonstrate robust oncological outcomes for this minimally invasive approach and testify to its potential as a standard-of-care treatment. Herein, we review the various ablation techniques, the supporting evidence, and clinical application of IGA in the treatment of primary liver and kidney cancers.
    Nature Reviews Clinical Oncology 01/2015; DOI:10.1038/nrclinonc.2014.237 · 15.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Stage I renal cell carcinoma is a malignancy with a relatively good prognosis. The incidence of all renal cell carcinomas is approximately 9/100,000 persons. There are nearly 15,000 newly diagnosed patients every year (men twice as often as women). In the last decade, a trend away from radical open resection towards nephron-sparing approaches has been observed. Currently, partial nephrectomy is the surgical gold standard for the treatment of small renal tumors. However, excellent clinical results are obtained using percutaneous radiofrequency ablation (RFA): low complication rates and preservation of the renal function. Primary and secondary technical success rates are 69-100% and 90-100%, respectively. In large series, major complication rates of RFA of 0-14% are reported. A relevant deterioration of renal function after RFA is very rare. The 5-year local recurrence-free survival rates, metastasis-free survival rates, cancer-specific survival rates, and overall survival rates are 88-93, 95-100, 98-100, and 58.3-85%, respectively. In this context, the lack of appropriate long-term data is often cited as a limitation. Different meta-analyses come to the conclusion that in case of adequate tumor and patient selection RFA shows oncologic results comparable with surgical resection. Accepted indications for RFA are T1 renal tumors in patients with advanced age, significant comorbidities, reduced renal function, single kidney, and/or no wish for operation. Predictors for the success include tumor size and location as well as operator experience. To define the real efficacy of RFA in the treatment of renal tumors, randomized controlled clinical long-term studies are indicated.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Renal cell carcinoma (RCC) accounts for 3% of all cancers in adults. The indications for Radiofrequency Ablation (RFA) for renal carcinomas include T1a (tumor 4 cm or less, limited to the kidney), elderly patients, renal impairment, comorbidities, poor surgical candidate, and multiple bilateral renal masses. We retrospectively reviewed medical records, specifically investigating the indications, complications and outcomes of RFA and nephrectomy for treatment of RCC in a tertiary medical center with a predominantly Hispanic patient population. Forty-nine patients with RCC were evaluated. Nine patients had RFA, 9 had partial nephrectomy and 31 had radical nephrectomy. All patients among the 3 groups had stage T1N0M0 RCC at diagnosis. Tumor recurrence was observed in 2 (22%) patients that had RFA, one (11%) patient that had partial nephrectomy and no patients that had radical nephrectomy. One patient had recurrence of the tumor at the opposite kidney pole from the initial RFA site 4 years later. This particular patient did not have any tumor recurrence at the site of the initial RFA. A second RFA was performed on the recurrent tumor with no recurrence upon subsequent follow up visits. The second patient had recurrence of the RCC on 1 year follow that was discovered to be sarcomatoid RCC, which is an aggressive type with a poor prognosis. Our results support the clinical utility of RFA in patients with stage T1 RCC who are poor surgical candidates or those with reduced renal function. The clinical utility of RFA as an equally effective approach when compared to partial nephrectomy in patients with stage T1 RCC that meet strict indications for the procedure. The treatment choice should be individualized and based on the characteristics of the renal tumor such as size, location and histological type of RCC. We conclude that RFA presents a safe treatment choice for patients with RCC if long term follow up is maintained.
    Rare tumors 02/2015; 7(1):5583. DOI:10.4081/rt.2015.5583

Full-text (2 Sources)

Download
14 Downloads
Available from
Oct 7, 2014