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: 4.89). 07/2010; 116(13):3135-42. DOI: 10.1002/cncr.25002
Source: PubMed


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.

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Available from: Clayton Trimmer, Oct 07, 2014
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    • "sparing treatment to the patients who are not appropriate candidates for NSS (Matsumoto et al., 2005; Pasticier et al., 2006; Gill et al., 2007; Tracy et al., 2010; Kim et al., 2012, Laguna et al., 2012; Karam et al., 2013). "
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    ABSTRACT: Background: To evaluate the results of various types of radiofrequency ablation (RFA) treatment of renal tumors in patients with excessive anesthetic and surgical risk. Materials and methods: Data for RFA performed in in high risk patients were retrospectively evaluated. Other RFA applications in patients with no anesthetic and/or surgical risk were excluded. RFA was by ultrasound or CT guided percutaneous (USG/CT-PRFA) and retroperitoneally or transperitoneally laparoscopic (R/T-LRFA) techniques under general or local anethesia. Follow-up data of enhanced CT or MRI after 1, 3 and 6 months were analysed for twelve RFA applications. Results: The RFA applications included 4 (40%) left-sided, 5 (50%) right-sided and 1 (10%) bilaterally RFA (simultaneously 1 right and 2 left). The localizations of tumors were 2 (16.6%) upper, 5 (41.6%) mid and 5 (41.6%) lower pole. The RFA applications included 9 (75%) USG-PRFA, 1 (8.3%) CT-PRFA, 1 (8.3%) T-LRFA and 1 (8.3%) R-LRFA. The mean age was 65.3 ± 8.5 (52-76) years. The mean tumor size was 29.6 ± 6.08 (15-40) mm. No complications related to the RFA were encountered in any of the cases. Failure (residual tumour) was determined in 8.3% (1/12) of USG-RFA application. The success rate was thus 91.7% (11/12). Other 1st, 3rd and 6th months follow-up data revealed no residua and recurrence. Conclusions: RFA application appears to be safe as a less invasive and effective treatment modality in selected cases of small renal tumors in individuals with excessive anesthetic and also surgical risk.
    Full-text · Article · Nov 2013 · Asian Pacific journal of cancer prevention: APJCP
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    • "This patient showed viable cancer cells on biopsy who otherwise demonstrated no evidence of enhancement on a 6 months follow-up CT. However, in a recent study, Tracy et al. (25) raised concerns by emphasizing that the majority of these studies have used traditional hematoxylin and eosin staining in evaluating post-treatment biopsies, which is inadequate for assessing cellular viability, because the heat fixation during RFA results in the preservation of the cellular architecture. To further address this issue, Raman and colleagues recently reported the biopsy data of radiologically negative lesions in 19 patients obtained more than 1 year after RFA. "
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    ABSTRACT: To retrospectively evaluate the intermediate results of radiofrequency ablation (RFA) of small renal masses (SRMs). Percutaneous or laparoscopic RFA was performed on 48 renal tumors in 47 patients. The follow-up studies included a physical examination, chest radiography, creatinine level, and contrast-enhanced CT or MRI. To confirm the pathologic criteria of complete ablation, 35 patients underwent a follow-up biopsy. Recurrence was defined as contrast enhancement on imaging studies after 3 months, lesion growth at subsequent imaging, or viable cancer cells on follow-up biopsy. Technical success was achieved in 43 (89.6%) of 48 renal tumors. The mean tumor size was 2.3 cm and the mean follow-up period was 49.6 months. Repeated RFA was necessary in 5 tumors due to incomplete ablation. The overall complication rate was 35.8%, of which 96.2% were mild complications. Serum creatinine levels at 12 months after RFA did not differ from those before RFA (1.28 vs. 1.36 mg/dL). Four patients were found to have recurrence at various follow-up intervals, and distant metastasis was not found in any cases. RFA appears to be a useful treatment for selected patients with SRMs. Our 4-year follow-up results disclose an excellent therapeutic outcome with RFA, while achieving effective local tumor control.
    Full-text · Article · Sep 2012 · Korean journal of radiology: official journal of the Korean Radiological Society
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    • "In tumours > 5 cm, RFA has a significant failure rate [7]. The RFA provided successful treatment of SRM with a low recurrence rate as well as prolonged metastasis-free and cancer-specific survival rates at 5 years after treatment [5]. "
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    ABSTRACT: Radical endoscopic minimal-invasive treatment methods, such as thermal ablation, are sought as an alternative to standard radical surgical treatment of kidney neoplasms. We analysed patients who could be qualified for radical treatment due to T1a renal tumour. Twenty-three patients out of 129 who underwent radiofrequency thermal ablation of kidney tumours in the years 2003-2010 were analysed. The inclusion criteria were age below 70 years, lack of major comorbidities (ASA score 1, 2), and competent contralateral kidney. In all cases tumour size was below 4 cm. All patients were followed up with computed tomography (CT) and ultrasonography (USG) every 6 months for 3 years. In 20 patients kidney tumour was biopsied before radiofrequency ablation (RFA) and 10 of these biopsies were positive and revealed cancer. Six patients required additional treatment due to recurrence visible in CT - 3 with a positive biopsy result, 1 with negative and 2 without biopsy. Three of them were treated with a second session of RFA, 1 with radical nephrectomy and 2 with partial nephrectomy. No disease dissemination was observed and all patients who received additional treatment remain disease free. The RFA can be safely used in selected patients with T1a tumour as an alternative to partial nephrectomy. Careful follow-up is required after thermal ablation and allows early detection and successful treatment of recurrences.
    Full-text · Article · Dec 2011 · Videosurgery and Other Miniinvasive Techniques / Wideochirurgia i Inne Techniki Malo Inwazyjne
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