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El Dib R, Nascimento Junior P, Kapoor A. An alternative approach to deal with the absence of clinical trials: a proportional meta-analysis of case series studies. Acta Cir Bras 2013; 28:870-6. [DOI: 10.1590/s0102-86502013001200010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/13/2013] [Indexed: 11/22/2022] Open
Affiliation(s)
- Regina El Dib
- Sao Paulo State University, Brazil; McMaster University, Canada
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Wah TM, Irving HC, Gregory W, Cartledge J, Joyce AD, Selby PJ. Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. BJU Int 2013; 113:416-28. [PMID: 24053769 PMCID: PMC4233988 DOI: 10.1111/bju.12349] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives Patients and Methods Results Conclusions
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Affiliation(s)
- Tze M Wah
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, Leeds Teaching Hospitals Trust, St. James's University Hospital, Leeds, UK
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Thermal Versus Impedance-Based Ablation of Renal Cell Carcinoma: A Meta-analysis. Cardiovasc Intervent Radiol 2013; 37:176-85. [DOI: 10.1007/s00270-013-0743-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
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Chen J, Ding J, Dai Y, Xing W, Sun J, Zhang Z, Xuan Y, Pilli V, Haacke EM, Hu J. Assessment of intratumoral micromorphology for patients with clear cell renal cell carcinoma using susceptibility-weighted imaging. PLoS One 2013; 8:e65866. [PMID: 23755287 PMCID: PMC3675045 DOI: 10.1371/journal.pone.0065866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/29/2013] [Indexed: 12/01/2022] Open
Abstract
Background Multiple treatment options exist for the management of renal cell carcinomas. Preoperative evaluation of clear cell renal cell carcinoma (CRCC) grades is important for deciding upon the appropriate method of therapy. We hypothesize that susceptibility weighted imaging (SWI) is sensitive enough to detect intratumoral microvessles and microbleeding in renal cell carcinoma, which can be used to grade CRCC. Material and Methods Retrospective reviews of 37 patients with pathologically proven CRCCs were evaluated. All patients underwent SWI examinations. The characteristics of intratumoral susceptibility signal intensity (ITSS) includes the likelihood of the presence of ITSS, morphology of ITSS, dominant structure of ITSS and ratio of ITSS area to tumor area, which were all assessed on SWI. The results were compared using the nonparametric Mann-Whitney test. Results ITSS was seen in all patients except 4 patients with low-grade CRCCs. There was no significant difference between low and high-grade CRCCs when looking at the likelihood of the presence of ITSS. There was a significant difference in the mean score of dominant structures between low and high-grade CRCCs. Specifically, more dominant vascular structures and less hemorrhage were seen in low-grade tumors (2.15±1.05) compared to high-grade tumors (1.27±0.47) (P<0.005). The ratio of ITSS area to tumor area was also significantly higher for the high-grade group (1.55±0.52) than that for the low-grade group (0.88±0.43) on SWI (P<0.005). Conclusion SWI is useful for grading CRCCs.
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Affiliation(s)
- Jie Chen
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jiule Ding
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Yongming Dai
- Siemens Healthcare China, MR Collaboration NE Asia, Shanghai, China
| | - Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- * E-mail: (WX); (JH)
| | - Jun Sun
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Zishu Zhang
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yang Xuan
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Vasuki Pilli
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (WX); (JH)
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Chen J, Ding J, Wu C, Xing W, Jiang J, Chen T, Sun J, Hu J. Preoperatively evaluating the correlation between pathological grades and blood oxygenation level-dependent MRI in clear cell renal cell carcinomas. Acad Radiol 2013; 20:224-30. [PMID: 23102582 DOI: 10.1016/j.acra.2012.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/06/2012] [Accepted: 09/07/2012] [Indexed: 10/27/2022]
Abstract
RATIONALE AND OBJECTIVES To assess whether r(2)* values can be used to determine the nuclear grade of clear cell renal cell carcinomas (CRCC). MATERIALS AND METHODS A total of 26 patients with pathologically proven CRCCs underwent blood oxygen level-dependent magnetic resonance imaging. r(2)* values were determined for the solid components of CRCC lesions. Histological nuclear grade was determined for each lesion. All patients were divided into low- and high-grade groups. r(2)* values were compared between different grades and between low- and high- grade groups. Receiver operating characteristic curve was drawn to establish the cutoff point for r(2)* values. The correlation between r(2)* values and pathological groups was assessed. RESULTS Low-grade group (grades I + II) contained 17 cases and high-grade group (grades III + IV) contained nine cases. The intraclass correlation coefficient for r(2)* values was 0.89. Significant difference was seen between different grades (P < .005). r(2)* values of the high-grade group were higher than the low-grade group (P < .005). A sensitivity of 78% and a specificity of 100% were achieved with a cutoff of 31.87 seconds(-1). r(2)* values directly correlated with pathological groups (P < .005). CONCLUSION r(2)* values of CRCCs could be employed as a noninvasive biomarker to help classify the nuclear grade of CRCC.
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Iannuccilli JD, Dupuy DE, Mayo-Smith WW. Solid renal masses: effectiveness and safety of image-guided percutaneous radiofrequency ablation. ACTA ACUST UNITED AC 2013; 37:647-58. [PMID: 21968698 DOI: 10.1007/s00261-011-9807-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With increasing emphasis on minimally invasive nephron-sparing techniques for treatment of renal tumors, image-guided percutaneous radiofrequency ablation (RFA) has emerged as a safe and effective method of tumor eradication that may be performed on an outpatient basis, with relatively low morbidity and mortality. This review addresses the clinical and technical considerations, risks, complications, and currently reported efficacy data pertaining to RFA of renal tumors, as well as the standardized approach to treatment and follow-up currently used in our practice.
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Affiliation(s)
- Jason D Iannuccilli
- Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI 02903, USA.
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Abbas A, Idriz S, Railton NJ, McGill N, Nasruddin AB, Sandeman DD, Breen DJ. Image-guided ablation of Conn's adenomas in the management of primary hyperaldosteronism. Clin Radiol 2012; 68:279-83. [PMID: 23218647 DOI: 10.1016/j.crad.2012.06.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/25/2012] [Accepted: 06/01/2012] [Indexed: 11/18/2022]
Affiliation(s)
- A Abbas
- Department of Radiology, University Hospital Southampton, Southampton, UK
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Turun S, Banghua L, Zheng S, Wei Q. Is tumor size a reliable predictor of histopathological characteristics of renal cell carcinoma? Urol Ann 2012; 4:24-8. [PMID: 22346097 PMCID: PMC3271446 DOI: 10.4103/0974-7796.91617] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 04/09/2011] [Indexed: 02/05/2023] Open
Abstract
Objectives: To determine whether smaller tumor size is associated with less-aggressiveness in renal cell carcinoma (RCC). Materials and Methods: Series records of 505 patients diagnosed with RCC were retrospectively reviewed and the data concerning tumor size and pathological information were extracted and analyzed. Results: Five hundred and eight RCCs were identified. The mean tumor size was 5.02 ± 2.70 cm. No correlation was detected between the size of tumor and the histological subtype. The overall nuclear grade distribution was 57.1% and 42.9% for low-grade and high-grade disease, respectively. Each 1 cm increase in tumor size was associated with a significant increase in the odds ratio of high-grade disease by 1.46. 91.1% were found low-stage lesions and the odds ratio for the association of high-stage disease with each 1 cm increase in tumor size was 1.67. Multinomial models revealed that each 1 cm increase in the tumor size was associated with a 35% increase in renal capsule involvement and 66% renal vascular invasion. The cut-off point of tumor size in renal vascular invasion was 5.6 cm. Conclusion: Tumor size is not an independent predictor for the histological subtype of RCC. However, it is closely correlated to histopathological features, with the indications that the greater the tumor size, the more aggressive potential the RCC is.
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Affiliation(s)
- Song Turun
- Department of Urology, West China Hospital, Sichuan University, Guoxue Xiang, Chengdu, Sichuan, China
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Kim SD, Yoon SG, Sung GT. Radiofrequency ablation of renal tumors: four-year follow-up results in 47 patients. Korean J Radiol 2012; 13:625-33. [PMID: 22977331 PMCID: PMC3435861 DOI: 10.3348/kjr.2012.13.5.625] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/20/2012] [Indexed: 11/25/2022] Open
Abstract
Objective To retrospectively evaluate the intermediate results of radiofrequency ablation (RFA) of small renal masses (SRMs). Materials and Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Soo Dong Kim
- Department of Urology, Dong-A University College of Medicine, Busan 602-714, Korea
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Howenstein MJ, Sato KT. Complications of radiofrequency ablation of hepatic, pulmonary, and renal neoplasms. Semin Intervent Radiol 2012; 27:285-95. [PMID: 22550368 DOI: 10.1055/s-0030-1261787] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Percutaneous thermal ablation has emerged as a viable technique for treatment of numerous solid organ malignancies. As the number of these procedures increases, so do the complications that are seen. Most common complications are generally related to bleeding from the target organ during or after the procedure and from thermal injury to adjacent structures. The nature of these injuries depends on the particular organ being treated, therefore it it best to categorize them this way. We will review the more common complications seen following the ablation of tumors in the liver, kidney, and lung, discuss the clinical presentation associated with each, and suggest precautions to help avoid them in the future. Understanding the potential risks associated with this procedure is critical for treatment planning and fundamental for performing these procedures safely.
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Conzo G, Sciascia V, Palazzo A, Stanzione F, Della Pietra C, Insabato L, Natella V, Radice L, Santini L. Radiofrequency-assisted partial nephrectomy for metanephric adenoma: a case report and literature review. Surg Innov 2012; 20:55-8. [PMID: 22474015 DOI: 10.1177/1553350612442792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Metanephric adenoma (MA) is a rare benign tumor, diagnosis of which is often carried out after surgical treatment. In case of peripheral lesions, a partial nephrectomy (PN)--either open or laparoscopic may be preferred--and, furthermore, a radiofrequency (RF)-assisted procedure may facilitate adequate hemostasis. In November 2010, the authors performed a RF-assisted PN, according to Habib's technique, using a 4-needle bipolar device, on a woman affected by a small exophytic MA of the right kidney. Fibrin glue was applied on the cut surface. Postoperative course was uneventful, and discharge was on postoperative day 4. MA is an extremely rare benign tumor with a favorable prognosis. In case of a preoperative cytological diagnosis, a careful follow-up has to be considered. PN represents the standard of care for small exophytic MA, and RF-assisted procedures allow an excellent hemostasis and a rapid conservative resection, with very low morbidity.
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Affiliation(s)
- Giovanni Conzo
- Department of Anaesthesiologic, Surgical, and Emergency Science, Second University of Naples, Naples, Italy.
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Cornelis F, Balageas P, Le Bras Y, Rigou G, Boutault JR, Bouzgarrou M, Grenier N. Radiologically-guided thermal ablation of renal tumours. Diagn Interv Imaging 2012; 93:246-61. [DOI: 10.1016/j.diii.2012.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Renal ablation (RA) is no longer used exclusively in patients with limited life expectancy. There are few studies reporting a minimum follow-up of 5 years. Biases and discrepancies within the literature are abundant. The outcomes of any series must be interpreted in the context of median follow-up time, reported tumor characteristics, ablation technique and training background of the practitioner, and the definition of tumor recurrence. The long-term oncologic efficacy of radiofrequency ablation (RFA) and cryoablation appear similar, although the percutaneous RFA technique may necessitate reablation in more cases. RA is associated with slightly higher rates of local recurrence compared to surgical excision.
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El Dib R, Touma NJ, Kapoor A. Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012; 110:510-6. [PMID: 22304329 DOI: 10.1111/j.1464-410x.2011.10885.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Study Type - Therapy (systematic review). Level of Evidence 2b What's known on the subject? and What does the study add? The oncological success of partial nephrectomy in the treatment of small renal masses is well established. However, partial nephrectomy has largely supplanted the radical approach. In the last decade, laparoscopy has been adopted as the new surgical approach for the treatment of renal cell carcinoma. Laparoscopy offers the advantage of lower analgesic use, shorter hospital stay, and quicker recovery time. More recently, ablative technologies have been investigated as an alternative to laparoscopic partial nephrectomy. These techniques can often be performed percutaneously in the radiology suite, or laparoscopically without the need for hilar clamping. However, only the cryoablation and radiofrequency ablation modalities have had widespread use with several series reporting short to intermediate results. This review shows that both cryoablation and radiofrequency ablation are promising therapies in patients with small renal tumours (<4 cm), who are considered poor candidates for more involved surgery. OBJECTIVE • To determine the current status of the literature regarding the clinical efficacy and complication rates of cryoablation vs radiofrequency ablation in the treatment of small renal tumours. METHODS • A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: MEDLINE, EMBASE and LILACS. • Inclusion criteria were (i) case series design with more than one case reported, (ii) use of cryoablation or radiofrequency ablation, (iii) patients with renal cell carcinoma and, (iv) outcome reported as clinical efficacy. • When available, we also quantified the complication rates from each included study. • Proportional meta-analysis was performed on both outcomes with a random-effects model. The 95% confidential intervals were also calculated. RESULTS • Thirty-one case series (20 cryoablation, 11 radiofrequency ablation) met all inclusion criteria. • The pooled proportion of clinical efficacy was 89% in cryoablation therapy from a total of 457 cases. There was a statistically significant heterogeneity between these studies showing the inconsistency of clinical and methodological aspects. • The pooled proportion of clinical efficacy was 90% in radiofrequency ablation therapy from a total of 426 cases. There was no statistically significant heterogeneity between these studies. • There was no statistically significant difference regarding complications rate between cryoablation and radiofrequency ablation. CONCLUSIONS • This review shows that both ablation therapies have similar efficacy and complication rates. • There is urgency for performing clinical trials with long-term data to establish which intervention is most suitable for the treatment of small renal masses.
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Affiliation(s)
- Regina El Dib
- Botucatu School of Medicine, UNESP - Univ Estadual Paulista, Botucatu, Brazil.
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Pretreatment imaging can be used to select imaging guidance, ultrasound alone versus CT plus ultrasound, for percutaneous renal radiofrequency ablation. AJR Am J Roentgenol 2011; 197:1244-50. [PMID: 22021521 DOI: 10.2214/ajr.10.6071] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Although CT is most commonly used for guidance of radiofrequency ablation (RFA) of renal masses, other publications have shown that ultrasound alone may be used. Therefore, we compared the complications and technical effectiveness of renal RFA guided by ultrasound alone versus combined CT and ultrasound guidance. MATERIALS AND METHODS We retrospectively analyzed outcomes and complications of percutaneous renal RFA in two groups of patients for whom RFA was guided by either ultrasound alone (group 1) or combined CT and ultrasound (group 2). The sole factor in determining the method of guidance was preablation imaging. All other technical factors were consistent between the two groups. RESULTS There were 28 masses in 27 patients in group 1 and 32 masses in 29 patients in group 2. There was an overall major complication rate of 3.3% (2/60). Major complications occurred equally in group 2 (3.1% [1/32]) compared with group 1 (3.6% [1/28]). Overall ablative effectiveness was 93% (26/28) in group 1 and 84% (27/32) in group 2. There was no statistical difference between the two groups. CONCLUSION In proper hands, sonography guidance alone is a safe and effective method for performance of renal RFA in preselected cases and can decrease CT utilization. The use of CT is reserved for situations in which pretreatment RFA imaging suggests difficulty in ultrasound mass visualization or when the mass is in close proximity to structures that may be injured by thermal ablation.
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Grasso RF, Luppi G, Faiella E, Giurazza F, Del Vescovo R, Cazzato RL, Beomonte Zobel B. Radiofrequency ablation of renal cell carcinoma in patients with a solitary kidney: a retrospective analysis of our experience. Radiol Med 2011; 117:606-15. [DOI: 10.1007/s11547-011-0758-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/10/2011] [Indexed: 01/29/2023]
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Abstract
Percutaneous ablation in the kidney is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection. Its increasing use has been largely prompted by the rising incidental detection of renal cell carcinomas with cross-sectional imaging and the need to preserve renal function in patients with comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. Clinical studies to date indicate that radiofrequency ablation and cryoablation are effective therapies with acceptable short- to intermediate-term outcomes and with a low risk in the appropriate setting, with attention to pre-, peri-, and postprocedural detail. The results following percutaneous radiofrequency ablation and cryoablation in the treatment of renal cell carcinoma are reviewed in this article, including those of several larger scale studies of ablation of T1a tumors. Clinical and technical considerations unique to ablation in the kidney are presented, and potential complications are discussed.
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Affiliation(s)
- Aradhana M Venkatesan
- Department of Radiology and Imaging Sciences, NIH Clinical Center, 10 Center Dr, Bldg 10, Room 1C369, MSC 1182, Bethesda, MD 20892, USA.
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Dib RE, Touma NJ, Kapoor A. Review of the efficacy and safety of radiofrequency ablation for the treatment of small renal masses. Can Urol Assoc J 2011; 3:143-9. [PMID: 19424470 DOI: 10.5489/cuaj.1048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Small renal masses are increasingly being discovered incidentally on imaging performed for another reason. The standard of care for these masses involves excision by open or laparoscopic techniques. Recently, ablative techniques such as radiofrequency ablation (RFA) and cryoablation have taken a more prominent role in the treatment algorithm for these masses. We sought to evaluate the efficacy and safety of radiofrequency ablation in the treatment of renal tumours. METHODS We conducted a review of the literature. There was no language restriction. We obtained studies from the following sources: the Cochrane Library, PubMed, EMBASE, LILACS and Current Controlled Trials. RESULTS We identified no clinical trials in the literature. Thus we described the results from case series and retrospective studies with a reasonable sample size (number of reported patients in each study > 65). Most patients undergoing RFA had T1a disease with a mean tumour size of about 3 cm. Radiofrequency ablation was usually performed percutaneously with image guidance. Reported follow-up was short and ranged from 1 to 30 months. Most series used radiographic response as a surrogate for cancer control. The rates of local recurrence of the tumour were as high as 13.0% (average 8.5%) and were slightly higher than those associated with cryoablation and partial nephrectomy. Complications included hemorrhage, ureteral strictures and loss of a renal unit. CONCLUSION Our review demonstrates that RFA is a suitable and promising therapy in patients with small renal tumours who are considered to be poor candidates for more involved surgery. However, clinical trials with long-term data are needed to establish the oncological efficacy.
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Affiliation(s)
- Regina El Dib
- Post-doctoral Urology Fellow, St. Joseph's Healthcare, McMaster University, Hamilton, Ont
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Percutaneous cryoablation of renal lesions with radiographic ice ball involvement of the renal sinus: analysis of hemorrhagic and collecting system complications. AJR Am J Roentgenol 2011; 196:935-9. [PMID: 21427348 DOI: 10.2214/ajr.10.5182] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of collecting system and hemorrhagic complications resulting from CT-guided percutaneous cryoablation of renal tumors in which the radiographic ice ball abuts or involves the renal sinus. MATERIALS AND METHODS From November 2005 through July 2009 at our institution, we performed 129 CT-guided percutaneous cryoablation procedures on 107 patients (mean age, 64 years) with renal masses suspicious of being renal cell carcinoma. Radiographic ice balls that abutted or overlapped the renal sinus were classified as central; the other lesions were classified as noncentral. Medical records and follow-up images were retrospectively reviewed for hemorrhage requiring intervention and for evidence of collecting system injury. The mean follow-up period was 9.3 months. RESULTS The radiographic ice ball was classified as central in 67 cases. In these central ablations, the mean sinus involvement was 6.2 mm (range, 0-19 mm), 41 ice balls overlapping the renal sinus by 6 mm or more (mean, 9.4 mm). No cases of collecting system injury were identified for any ablation. Overall, there was only one hemorrhagic complication requiring intervention, and it occurred in a noncentral ablation. CONCLUSION CT-guided percutaneous cryoablation of renal masses with ice ball overlap of the renal sinus resulted in no cases of collecting system injury or serious hemorrhagic complications in our series.
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Wang R, Li AY, Wood DP. The role of percutaneous renal biopsy in the management of small renal masses. Curr Urol Rep 2011; 12:18-23. [PMID: 20949338 DOI: 10.1007/s11934-010-0149-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of percutaneous renal mass biopsy (RMB) has increased in recent years, likely in parallel with the growing incidence of renal cell carcinoma and small renal masses in particular. Biopsy and imaging techniques are improving, and diagnostic sufficiency and accuracy of RMB now are much higher in large-volume, experienced centers. Overall morbidity is low. This has led to a significant expansion of the indications for biopsy beyond documenting renal involvement for patients with metastatic disease or other systemic illnesses. While there still are limitations to its use and clinical judgment is paramount, RMB is proving to be a valuable tool in the clinical diagnosis and management of small renal masses.
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Affiliation(s)
- Rou Wang
- Department of Urology, University of Michigan, Ann Arbor, 48109, USA.
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Barwari K, de la Rosette JJ, Laguna MP. Focal Therapy in Renal Cell Carcinoma: Which Modality Is Best? ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.eursup.2011.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Feng B, Liang P. Local thermal ablation of renal cell carcinoma. Eur J Radiol 2011; 81:437-40. [PMID: 21239130 DOI: 10.1016/j.ejrad.2010.12.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 12/22/2010] [Indexed: 02/08/2023]
Abstract
PURPOSE With evolving local thermal ablation technology, the clinical application of thermal ablation has been actively investigated in the treatment for renal cell carcinoma. We review the evolution and current status of radiofrequency ablation and microwave ablation for renal cell carcinoma. MATERIALS AND METHODS All articles published in English on radiofrequency ablation or microwave ablation as a treatment for renal cell carcinoma were identified with a MEDLINE® and PubMed® search from 1990 to 2010. RESULTS Local thermal ablation has several advantages, including keeping more normal renal units, relatively simple operation, easy tolerance, fewer complications, a shorter hospitalization and convalescence period. Long-term data has determined radiofrequency ablation is responsible for poor surgical candidates with renal cell carcinoma, however, tumor size, location and shape might affect the efficacy of radiofrequency ablation. Microwave ablation can induce large ablation volumes and yield good local tumor control. Associated complications appear to be low. CONCLUSIONS Local ablative approaches seem to represent an attractive alternative to extirpative surgery for the treatment of small renal neoplasms in select patients. Potential developments include concepts to improve the accuracy and effectiveness of thermal ablation by improving the guiding, monitoring capabilities and detection capacity of multi-center lesions to provide at least equivalent cancer control to conventional surgery.
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Affiliation(s)
- Bing Feng
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, PR China
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Laparoscopic and Image-guided Radiofrequency Ablation of Renal Tumors: Patient Selection and Outcomes. Curr Urol Rep 2011; 12:100-6. [DOI: 10.1007/s11934-010-0163-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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75
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Pirasteh A, Snyder L, Boncher N, Passalacqua M, Rosenblum D, Prologo JD. Cryoablation vs. radiofrequency ablation for small renal masses. Acad Radiol 2011; 18:97-100. [PMID: 20880723 DOI: 10.1016/j.acra.2010.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 08/13/2010] [Accepted: 08/13/2010] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES Cancer of the kidney is the third most common cancer of the urinary tract, and renal cell carcinoma is the most lethal of all genitourinary tumors. The incidental discovery of renal cell carcinoma has increased with increased use of cross-sectional imaging. Concomitantly, minimally invasive ablative technologies, including image-guided cryoablation, radiofrequency ablation, and others, have evolved as therapeutic options for small renal masses. MATERIALS AND METHODS Between 2006 and 2009, 111 patients (age range, 31-91 years; mean age, 70 years) underwent percutaneous computed tomography-guided thermal ablation for suspected renal cell carcinoma at two major academic centers. Outcomes data were retrospectively collected and analyzed to compare recurrence rates for patients undergoing radiofrequency ablation (n = 41) versus cryoablation (n = 70). RESULTS There were four cases of suspicious enhancement on follow-up computed tomography or magnetic resonance imaging in each group, with cumulative imaging recurrence rates of 11% and 7% for radiofrequency ablation and cryoablation, respectively. Log rank test analysis revealed no significant difference between rates of imaging recurrence between the two groups (P = .6044). CONCLUSIONS These results suggest that the use of cryoablative technology will result in similar outcomes compared with radiofrequency ablation.
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Affiliation(s)
- Ali Pirasteh
- Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
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76
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Davis K, Kielar A, Jafari K. Effectiveness of ultrasound-guided radiofrequency ablation in the treatment of 36 renal cell carcinoma tumours compared with published results of using computed tomography guidance. Can Assoc Radiol J 2010; 63:S23-32. [PMID: 21145195 DOI: 10.1016/j.carj.2010.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/23/2010] [Accepted: 09/02/2010] [Indexed: 01/29/2023] Open
Abstract
This study aimed to analyse the outcomes of ultrasound (US) guided radiofrequency ablation (RFA) in patients with renal lesions and to compare our outcomes with published results of ablations carried out when using computed tomography (CT) guidance. This retrospective study evaluated RFA of 36 renal tumours in 32 patients (M = 21, F = 11). The mean patient age was 70 years (range, 39-89 years). Ablations were performed by using either multi-tined applicators or cooled and/or cluster applicators under US guidance. Applicator size varied from 2-5 cm, depending on the size of the index tumour. Conscious sedation was administered by an anesthetist. Follow-up imaging by using contrast-enhanced CT was performed 1, 3, 6, and 12 months after RFA, and yearly thereafter. The mean tumour follow-up time was 12 months (range, 1-35 months). The mean tumour size was 2.7 cm (range, 1-5 cm). Primary effectiveness was achieved in 31 cases (86.1%), with patients in 5 cases (11.1%) demonstrating residual disease. Three patients had repeated sessions, which were technically successful. The remaining 2 patients were not re-treated because of patient comorbidities. As a result, secondary effectiveness was achieved in 34 patients (94.4%). In 1 patient, a new lesion developed in the same kidney but remote from the 2 prior areas of treatment. Hydrodissection was performed in 3 patients (8.3%), manipulation or electrode repositioning in 11 patients (30.6%), and ureteric cooling in 1 patient (2.8%). Minor and major complications occurred in 3 (8.3%) and 3 (8.3%) patients, respectively. Correlation coefficients were calculated for distance from skin to tumour and risk of complication as well as compared with primary and secondary effectiveness. This study demonstrates that US-guided RFA is an effective treatment for renal lesions, with rates of effectiveness and complication rates comparable with published CT-guided RFA results.
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Affiliation(s)
- Kellie Davis
- Department of Radiology, University of Ottawa, Calgary, Alberta, Canada.
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77
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Georgiades CS, Rodriguez R, Littrup PJ, Frangakis CE, Leveille R, Ahrar K, Atwell TD, Cadeddu J, Trimmer C, Durack JC, Hammers HJ, Meng MV, Raman S, Solomon SB, Zagoria RJ, McLennan G, LaBerge JM, Gervais DA, Kee ST. Development of a Research Agenda for Percutaneous Renal Tumor Ablation: Proceedings from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2010; 21:1807-16. [DOI: 10.1016/j.jvir.2010.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/28/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022] Open
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Thumar AB, Trabulsi EJ, Lallas CD, Brown DB. Thermal ablation of renal cell carcinoma: triage, treatment, and follow-up. J Vasc Interv Radiol 2010; 21:S233-41. [PMID: 20656233 DOI: 10.1016/j.jvir.2010.01.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 01/06/2010] [Accepted: 01/19/2010] [Indexed: 11/19/2022] Open
Abstract
The incidence of renal cell carcinoma (RCC) is increasing. With the increasing emphasis on minimally invasive nephron-sparing surgery, thermal ablation is playing a larger role in the management of patients with this disease. This review outlines imaging management, intraoperative and percutaneous ablation, and postprocedural follow-up of RCC.
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Affiliation(s)
- Adeep B Thumar
- Department of Urology, Thomas Jefferson University, 132 South 10th St, Suite 766 Main Building, Philadelphia, PA 19107, USA
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79
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Manthe RL, Foy SP, Krishnamurthy N, Sharma B, Labhasetwar V. Tumor ablation and nanotechnology. Mol Pharm 2010; 7:1880-98. [PMID: 20866097 DOI: 10.1021/mp1001944] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Next to surgical resection, tumor ablation is a commonly used intervention in the treatment of solid tumors. Tumor ablation methods include thermal therapies, photodynamic therapy, and reactive oxygen species (ROS) producing agents. Thermal therapies induce tumor cell death via thermal energy and include radiofrequency, microwave, high intensity focused ultrasound, and cryoablation. Photodynamic therapy and ROS producing agents cause increased oxidative stress in tumor cells leading to apoptosis. While these therapies are safe and viable alternatives when resection of malignancies is not feasible, they do have associated limitations that prevent their widespread use in clinical applications. To improve the efficacy of these treatments, nanoparticles are being studied in combination with nonsurgical ablation regimens. In addition to better thermal effect on tumor ablation, nanoparticles can deliver anticancer therapeutics that show a synergistic antitumor effect in the presence of heat and can also be imaged to achieve precision in therapy. Understanding the molecular mechanism of nanoparticle-mediated tumor ablation could further help engineer nanoparticles of appropriate composition and properties to synergize the ablation effect. This review aims to explore the various types of nonsurgical tumor ablation methods currently used in cancer treatment and potential improvements by nanotechnology applications.
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Affiliation(s)
- Rachel L Manthe
- Department of Biomedical Engineering, Lerner Research Institute, and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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80
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Breen DJ, Railton NJ. Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management. Cardiovasc Intervent Radiol 2010; 33:896-908. [PMID: 20544228 DOI: 10.1007/s00270-010-9892-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 04/01/2010] [Indexed: 01/22/2023]
Abstract
Renal cell carcinoma is a common malignancy causing significant mortality. In recent years abdominal imaging, often for alternate symptomatology, has led the trend toward the detection and confirmation of smaller renal tumors. This has permitted the greater use of localized and nephron-sparing techniques including partial nephrectomy and image-guided ablation. This article aims to review the current role of image-guided biopsy and ablation in the management of small renal tumors. The natural history of renal cell carcinoma, the role of renal biopsy, the principles and procedural considerations of thermal energy ablation, and the oncological outcomes of these minimally invasive treatments are discussed and illustrated with cases from the authors' institution. Image-guided ablation, in particular, has changed the treatment paradigm and, by virtue of its increasingly evident efficacy and low morbidity, now favors the treatment of smaller tumors in patients previously unfit for surgery.
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Affiliation(s)
- David J Breen
- Mailpoint 053, Clinical Radiology Department, Southampton General Hospital, Southampton, UK.
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81
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Renal Artery Embolization Combined With Radiofrequency Ablation in a Porcine Kidney Model: Effect of Small and Narrowly Calibrated Microparticles as Embolization Material on Coagulation Diameter, Volume, and Shape. Cardiovasc Intervent Radiol 2010; 34:156-65. [DOI: 10.1007/s00270-010-9908-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 05/20/2010] [Indexed: 12/18/2022]
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82
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Gontero P, Joniau S, Zitella A, Tailly T, Tizzani A, Van Poppel H, Kirkali Z. Ablative therapies in the treatment of small renal tumors: How far from standard of care? Urol Oncol 2010; 28:251-9. [DOI: 10.1016/j.urolonc.2009.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 06/08/2009] [Accepted: 06/11/2009] [Indexed: 11/28/2022]
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83
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Joniau S, Tailly T, Goeman L, Blyweert W, Gontero P, Joyce A. Kidney Radiofrequency Ablation for Small Renal Tumors: Oncologic Efficacy. J Endourol 2010; 24:721-8. [DOI: 10.1089/end.2009.0677] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Tailly
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Lieven Goeman
- Department of Urology, Hospital St Jan, Brussels, Belgium
| | - Wim Blyweert
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Paolo Gontero
- Department of Urology, University of Turin, Turin, Italy
| | - Adrian Joyce
- Department of Urology, St James' University Hospital, Leeds, United Kingdom
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84
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Ablación por radiofrecuencia de tumores renales. Aspectos prácticos y resultados. RADIOLOGIA 2010; 52:228-33. [DOI: 10.1016/j.rx.2010.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Revised: 01/16/2010] [Accepted: 01/18/2010] [Indexed: 11/20/2022]
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85
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Leveillee RJ, Ramanathan R. Optimization of Image-Guided Targeting in Renal Focal Therapy. J Endourol 2010; 24:729-44. [DOI: 10.1089/end.2009.0622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Raymond J. Leveillee
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Rajan Ramanathan
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida
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86
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Javadi S, Ahrar JU, Ninan E, Gupta S, Matin SF, Ahrar K. Characterization of contrast enhancement in the ablation zone immediately after radiofrequency ablation of renal tumors. J Vasc Interv Radiol 2010; 21:690-5. [PMID: 20227295 DOI: 10.1016/j.jvir.2009.12.400] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 11/19/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To characterize the degree of contrast enhancement within the ablation zone immediately after radiofrequency (RF) ablation of renal tumors. MATERIALS AND METHODS Patients with renal tumors treated with percutaneous RF ablation at one institution between January 2004 and October 2007 were retrospectively reviewed. For each tumor, computed tomography (CT) density measurements were made at four phases (noncontrast, arterial phase, parenchymal phase, and excretory phase) in each of four CT examinations (before ablation, day 0, 1 month, and 6 months). RESULTS A total of 36 renal tumors in 34 patients were treated with CT-guided RF ablation in 35 sessions. Before RF ablation, all tumors exhibited enhancement after intravenous administration of contrast material. The peak density was reached during the parenchymal phase, with a partial washout of contrast agent in the excretory phase. On CT images acquired immediately after RF ablation (day 0), 28 of the 36 ablated tumors (78%) exhibited clinically significant homogeneous enhancement (ie, density change >10 HU) within the ablation zone. However, contrast-enhanced CT studies performed at 1 and 6 months revealed no clinically significant enhancements in any of the 36 treated tumors (mean density changes of 4 HU at 1 month and 3 HU at 6 months). CONCLUSIONS Contrast-enhanced CT studies revealed a mild, temporary homogenous contrast enhancement of the ablation zone immediately after RF ablation of renal tumors, which should not be mistaken for a residual, unablated tumor. This enhancement in the ablation zone eventually disappears in follow-up contrast-enhanced CT studies.
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Affiliation(s)
- Sanaz Javadi
- Department of Radiology, Section of Interventional Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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87
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Hoffmann RT, Jakobs TF, Kubisch CH, Trumm C, Weber C, Siebels M, Helmberger TK, Reiser MF. Renal cell carcinoma in patients with a solitary kidney after nephrectomy treated with radiofrequency ablation: Mid term results. Eur J Radiol 2010; 73:652-6. [PMID: 19181470 DOI: 10.1016/j.ejrad.2008.12.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/12/2008] [Accepted: 12/23/2008] [Indexed: 01/29/2023]
Affiliation(s)
- Ralf-Thorsten Hoffmann
- Institute of Clinical Radiology, Ludwig Maximilians-University, Marchioninistrasse, Munich, Germany.
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88
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Affiliation(s)
- Inderbir S Gill
- Center for Robotic Surgery and Advanced Laparoscopy, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA.
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89
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Zurera L, López D, Canis M, García-Revillo J, Campos P, Robles R, Molina G. Radiofrequency ablation of renal tumors: Practical aspects and results. RADIOLOGIA 2010. [DOI: 10.1016/s2173-5107(10)70015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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90
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del Cura JL, Zabala R, Iriarte JI, Unda M. Treatment of renal tumors by percutaneous ultrasound-guided radiofrequency ablation using a multitined electrode: effectiveness and complications. Eur Urol 2009; 57:459-65. [PMID: 19926208 DOI: 10.1016/j.eururo.2009.11.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/03/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is a minimally aggressive, therapeutic alternative for renal tumors. It can be an alternative to nephrectomy in patients with previous nephrectomy, bilateral tumors, von Hippel-Lindau disease, or small renal carcinomas and in those with contraindications for surgery. OBJECTIVE To assess the effectiveness of the treatment of renal tumors by RFA in the short and medium term and to identify the possible complications and the factors that determine therapeutic success. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of patients with renal tumors treated with RFA between May 2005 and December 2008 was performed in a tertiary academic hospital. Patients were selected among those with previous nephrectomy, bilateral neoplasms, von Hippel-Lindau disease, surgical risk, comorbidity, advanced age, or patient's refusal to surgery. Tumors with evidence of extrarenal extension were excluded. Patients were followed up for 10-50 mo using computed tomography and magnetic resonance imaging. INTERVENTION Ultrasound-guided RFA was performed on 65 tumors (range: 1.2-5.3 cm) of 58 patients using multitined electrodes. MEASUREMENTS Incomplete ablation rate, therapeutic success rate, and complications rate. RESULTS AND LIMITATIONS Therapeutic success was achieved in 59 of 65 tumors (91%): 53 in a single session, 5 in two sessions, and 1 in three sessions. A significant relationship was observed between size and growth pattern of the tumor and both therapeutic success and incomplete ablation rates. Therapeutic success in tumors >5 cm was 60%. Complications were detected in 10 patients (13%); 5% were considered major complications. Limitations include the lack of pathologic studies to confirm a complete ablation and the lack of a control group to compare with the results of those who underwent nephrectomy. CONCLUSIONS RFA is safe and effective in renal tumors. Corticomedullary lesions and tumors >3 cm have greater possibility of incomplete ablation. In tumors >5 cm, RFA has a significant failure rate.
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Affiliation(s)
- Jose L del Cura
- Radiology Department, Basurto University Hospital, Bilbao, Spain.
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91
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Long JA, Neuzillet Y, Poissonnier L, Lang H, Paparel P, Escudier B, Rioux-Leclercq N, Correas JM, Mejean A, Baumert H, Soulié M, Patard JJ. Les traitements ablatifs modifient-ils la prise en charge des tumeurs du rein chez la personne âgée ? Prog Urol 2009; 19 Suppl 3:S116-23. [DOI: 10.1016/s1166-7087(09)73356-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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92
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Hiraoka K, Kawauchi A, Nakamura T, Soh J, Mikami K, Miki T. Radiofrequency ablation for renal tumors: our experience. Int J Urol 2009; 16:869-73. [PMID: 19735313 DOI: 10.1111/j.1442-2042.2009.02378.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report our results of percutaneous radiofrequency ablation (RFA) for renal tumors and to assess predictors of therapeutic efficacy. METHODS Forty patients (median age 73 years) with renal tumors were treated with RFA under local or epidural anesthesia. All of them had high surgical risk or refused radical surgery. Tumors were punctured percutaneously using the Radionics Cool-tip RF System under computed tomography or ultrasonographic guidance. Median tumor diameter was 24 mm. After RFA, contrast-enhanced computed tomography or magnetic resonance imaging was performed within 1 month. Complete response (CR) was defined as no enhancement inside the tumor. Factors related to the outcome and to renal function were assessed. RESULTS Median follow up was 16 months. CR was observed in 34 cases (85.0%). A significant difference in CR rate was observed between tumors < or =30 mm and those >30 mm. Outcomes tended to be better for tumors in the mid to lower kidney, and those away from the renal hilum. Recurrence was observed in one case (2.9%), but a CR was obtained again by additional RFA. Out of a total of 77 RFA procedures, complications occurred in only three cases (3.9%), and conservative treatment was possible in all cases. Serum creatinine levels 3 months after RFA did not differ from those before RFA. CONCLUSIONS Percutaneous RFA is a safe and effective treatment for small renal tumors in patients with high surgical risk or who refuse radical surgery.
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Affiliation(s)
- Kenji Hiraoka
- Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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93
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Gupta A, Raman JD, Leveillee RJ, Wingo MS, Zeltser IS, Lotan Y, Trimmer C, Stern JM, Cadeddu JA. General Anesthesia and Contrast-Enhanced Computed Tomography to Optimize Renal Percutaneous Radiofrequency Ablation: Multi-Institutional Intermediate-Term Results. J Endourol 2009; 23:1099-105. [DOI: 10.1089/end.2008.0499] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amit Gupta
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jay D. Raman
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Ilia S. Zeltser
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Clayton Trimmer
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joshua M. Stern
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A. Cadeddu
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
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Imaging-Guided Percutaneous Ablation of Renal Cell Carcinoma: A Primer of How We Do It. AJR Am J Roentgenol 2009; 192:1558-70. [DOI: 10.2214/ajr.09.2582] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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95
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Bird VG, Carey RI, Ayyathurai R, Bird VY. Management of renal masses with laparoscopic-guided radiofrequency ablation versus laparoscopic partial nephrectomy. J Endourol 2009; 23:81-8. [PMID: 19118475 DOI: 10.1089/end.2008.0087] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Laparoscopic-guided radiofrequency ablation (LRFA) has been introduced as a minimally invasive nephron-sparing management option for renal tumors. Many patients who desire treatment present with multiple comorbidities, which poses a therapeutic challenge. Our purpose is to determine if multipass LRFA is comparable, in terms of surgical risk and immediate postoperative outcomes, to laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS A retrospective study identified 36 and 33 patients who underwent LRFA and LPN, respectively. Perioperative demographic data, tumor characteristics, and follow-up data were evaluated. Statistical analysis was performed using the Student t test and chi-square analysis. RESULTS Age, American Society of Anesthesiology score, and Charlson Comorbidity Index were significantly higher in the LRFA group than the LPN group (P < 0.001). Average tumor size was 2.8 cm and 3.1 cm for the LRFA and LPN groups, respectively. There were no significant differences in change between the preoperative and postoperative creatinine/glomerular filtration rate values or perioperative complication rates for the groups. Estimated blood loss and length of stay were significantly lower for the LRFA group than the LPN group (P < 0.05). Follow-up ranged 6 to 23 months and 6 to 58 months for the LRFA and the LPN groups, respectively. There has been no evidence of tumor recurrence in the follow-up period. CONCLUSIONS We present our initial report comparing patients undergoing LRFA v LPN for the management of renal tumors. Our preliminary results with our experience with multipass laparoscopic-guided RFA demonstrate that this technique can be safely used in an elderly, higher risk population. Long-term follow-up is needed to determine oncologic efficacy.
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Affiliation(s)
- Vincent G Bird
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida 33136, USA
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96
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Delayed Development of Pneumothorax After Pulmonary Radiofrequency Ablation. Cardiovasc Intervent Radiol 2009; 32:484-90. [DOI: 10.1007/s00270-008-9489-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 10/31/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
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97
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Mahnken AH, Bruners P, Günther RW. Techniques of interventional tumor therapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:646-53. [PMID: 19471636 DOI: 10.3238/arztebl.2008.0646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 05/26/2008] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The last few years have seen the rapid development of new image-guided interventions for the local treatment of malignant tumors. The goal of this article is to provide an overview of the techniques that are most commonly used today in interventional oncology. METHODS Selective literature review on the current state of image-guided interventional techniques for local tumor therapy. RESULTS While surgery, radiation oncology, and systemic chemotherapy are still the three main pillars of tumor therapy, a broad range of minimally invasive, image-guided techniques for local tumor treatment is now available. These may be categorized as percutaneous injection of a toxic substance, transarterial embolization, thermal ablation, and internal radiotherapy. The choice of treatment depends on the type, location, and size of tumor. The greatest amount of clinical experience to date has been gathered in the treatment of primary and secondary hepatic malignancy, but there are interventional treatment options for virtually all regions of the body. At present, the utility of this form of treatment is limited for very large or multiple tumors; novel therapeutic options for these situations are now being studied. DISCUSSION The outcome of treatment depends on a judicious determination of the indication for it. The indication should be established by interdisciplinary consensus after all treatment options have been considered.
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Affiliation(s)
- Andreas H Mahnken
- Klinik für radiologische Diagnostik, Universitätsklinikum der RWTH Aachen.
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98
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Percutaneous RF Thermal Ablation of Renal Tumors: Is US Guidance Really Less Favorable Than Other Imaging Guidance Techniques? Cardiovasc Intervent Radiol 2008; 32:76-85. [DOI: 10.1007/s00270-008-9414-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 07/11/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
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99
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Pandharipande PV, Gervais DA, Mueller PR, Hur C, Gazelle GS. Radiofrequency ablation versus nephron-sparing surgery for small unilateral renal cell carcinoma: cost-effectiveness analysis. Radiology 2008; 248:169-78. [PMID: 18458248 DOI: 10.1148/radiol.2481071448] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the relative cost-effectiveness of percutaneous radiofrequency (RF) ablation versus nephron-sparing surgery (NSS) in patients with small (<or=4-cm) renal cell carcinoma (RCC), given a commonly accepted level of societal willingness to pay. MATERIALS AND METHODS A decision-analytic Markov model was developed to estimate life expectancy and lifetime costs for 65-year-old patients with a small RCC treated with RF ablation or NSS. The model incorporated RCC presence, treatment effectiveness and costs, and short- and long-term outcomes. An incremental cost-effectiveness analysis was performed to identify treatment preference under an assumed $75,000 per quality-adjusted life-year (QALY) societal willingness-to-pay threshold level, within proposed ranges for guiding implementation of new health care interventions. The effect of changes in key parameters on strategy preference was addressed in sensitivity analysis. RESULTS By using base-case assumptions, NSS yielded a minimally greater average quality-adjusted life expectancy than did RF ablation (2.5 days) but was more expensive. NSS had an incremental cost-effectiveness ratio of $1,152,529 per QALY relative to RF ablation, greatly exceeding $75,000 per QALY. Therefore, RF ablation was considered preferred and remained so if the annual probability of post-RF ablation local recurrence was up to 48% higher relative to that post-NSS. NSS preference required an estimated NSS cost reduction of $7500 or RF ablation cost increase of $6229. Results were robust to changes in most model parameters, but treatment preference was dependent on the relative probabilities of local recurrence after RF ablation and NSS, the short-term costs of both, and quality of life after NSS. CONCLUSION RF ablation was preferred over NSS for small RCC treatment at a societal willingness-to-pay threshold level of $75,000 per QALY. This result was robust to changes in most model parameters, but somewhat dependent on the relative probabilities of post-RF ablation and post-NSS local recurrence, NSS and RF ablation short-term costs, and post-NSS quality of life, factors which merit further primary investigation.
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Affiliation(s)
- Pari V Pandharipande
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, Boston, MA 02114, USA.
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Imaging-guided percutaneous radiofrequency ablation of adrenal metastases: preliminary results at a single institution with a single device. Cardiovasc Intervent Radiol 2008; 31:762-7. [PMID: 18421499 DOI: 10.1007/s00270-008-9337-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 02/28/2008] [Accepted: 03/03/2008] [Indexed: 10/22/2022]
Abstract
The aim of this study was to show the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of adrenal metastases (AM). Seven imaging-guided percutaneous RFA treatments were performed in six patients (two men and four women; mean age, 67.2 years; range, 55-74 years) with six AM who were referred to our institution from 2003 to 2006. One patient was treated twice for recurrence after first treatment. The average diameter of the treated AM was 29 mm (range, 15-40 mm). In all patients, the diagnosis was obtained with CT current protocols in use at our institution and confirmed by pathology with an image-guided biopsy. No major complications occurred. In one patient shortly after initiation of the procedure, severe hypertension was noted; another patient developed post-RFA syndrome. In five of six lesions, there was no residual enhancement of the treated tumor. In one patient CT examination showed areas of residual enhancement of the tumor after treatment. Our preliminary results suggest that imaging-guided percutaneous RFA is effective for local control of AM, without major complications and with a low morbidity rate related to the procedure. Long-term follow-up will need to be performed and appropriate patient selection criteria will need to be determined in future randomized trials.
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