Thermal Versus Impedance-Based Ablation of Renal Cell Carcinoma: A Meta-analysis

Safety and effectiveness of percutaneous radiofrequency ablation in early stage renal cell carcinoma

The purpose of this study was to analyze the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in early stage renal cell carcinoma. A total of 76 patients suffering from early stage renal cell carcinoma were selected and randomly assigned into the observation group (41 cases) or the control group (35 cases). Percutaneous RFA was used in the observation group, while retroperitoneoscopic radical operation of renal cell carcinoma was used in the control group, and the operative effects were compared. In the observation group, operation time, blood loss during operation, length of stay and incidence rate of complications were lower than those in control group (P<0.05). For both groups, serum C-reactive protein, interleukin-6 and T lymphocyte counts at 1, 2 and 3 days after operation were all increased; however, the control group had significantly greater increase for all the time points (P<0.05). For total effective rates, tumour-free survival times and survival rates, there were no statistically significant differences between the two groups (P>0.05). Percutaneous RFA has a reduced size of operation wound and a quick postoperative recovery time in the treatment of early stage renal cell carcinoma. It results in less inflammation and immunity-based injuries in the body and achieves the same clinical outcomes as retroperitoneoscopic radical operation of renal cell carcinoma.

Thermal ablation in renal cell carcinoma management: a comprehensive review

PURPOSE OF REVIEW

This article provides an overview of recent developments in the field of thermal ablation for renal cell carcinoma and focuses on current standard techniques, new technologies, imaging for ablation guidance and evaluation, and future perspectives.

RECENT FINDINGS

Emerging long-term data on cryoablation and radiofrequency ablation (RFA) show marginally lower oncologic outcomes compared to surgical treatment, balanced by better functional and perioperative outcomes. Reports on residual disease vary widely, influenced by different definitions and strategies in determining ablation failure. Stratifying disease-free survival after RFA according to tumor size suggests 3 cm to be a reasonable cut off for RFA tumor selection. Microwave ablation and high-intensity focal ultrasound are modalities with the potential of creating localized high temperatures. However, difficulties in renal implementation are impairing sufficient ablation results. Irreversible electroporation, although not strictly thermal, is a new technology showing promising results in animal and early human research.

SUMMARY

Although high-level randomized controlled trials comparing thermal ablation techniques are lacking, evidence shows that thermal ablation for small renal masses is a safe procedure for both long-term oncologic and functional outcomes. Thermal ablation continues to be associated with a low risk of residual disease, for which candidates should be properly informed. RFA and cryoablation remain the standard techniques whereas alternative techniques require further studies.

Hybrid paclitaxel and gold nanorod-loaded human serum albumin nanoparticles for simultaneous chemotherapeutic and photothermal therapy on 4T1 breast cancer cells

The use of human serum albumin nanoparticles (HSAPs) as a drug carrier system for cancer treatment has proven successful through current marketable clinical formulations. Despite this success, there is a current lack of multifunctional HSAPs, which offer combinational therapies of more than one proven technique. Gold nanorods (AuNRs) have also shown medicinal promise due to their photothermal therapy capabilities. In this study, a desolvation and cross-linking approach was employed to successfully encapsulate gold nanorods into HSAPs simultaneously with the chemotherapeutic drug paclitaxel (PAC); forming PAC-AuNR-HSAPs with desirable overall particle sizes of 299 ± 6 nm. The loading efficiency of paclitaxel into PAC-AuNR-HSAPs reached up to 3 μg PAC/mg HSA. The PAC-AuNR-HSAPs experienced photothermal heating; with the bulk particle solution reaching up to 46 °C after 15 min of near-IR laser exposure. This heat increase marked the successful attainment of the temperature necessary to cause severe cellular hyperthermia and necrosis. The encasement strategy facilitated a colloidal hybrid treatment system capable of enhanced permeability and retention effects, photothermal ablation of cancer cells, and release of the active paclitaxel of up to 188 ng (from PAC-AuNR-HSAPs created with 30 mg HSA) in a single 15 min irradiation session. When treated with PAC-AuNR-HSAPs containing 20 μg PAC/mL particle solution, 4T1 mouse breast cancer cells experienced ∼82% cell death without irradiation and ∼94% cell death after just one irradiation session. The results for PAC-AuNR-HSAPs were better than that of free PAC, which only killed ∼77% of the cells without irradiation and ∼80% with irradiation. The hybrid particle system also lends itself to future customizable external functionalities via conjugated targeting ligands, such as antibodies. Internal entrapment of patient tailored medication combinations are also possible with this combination treatment platform, which may result in improved quality of life for those undergoing treatment.