European Radiology

, 17:725 | Cite as

Image-guided radiofrequency ablation of renal cell carcinoma

  • Andreas Boss
  • Stephan Clasen
  • Markus Kuczyk
  • Fritz Schick
  • Philippe L. Pereira


The incidence of renal cell carcinoma is rising with the increased number of incidental detection of small tumours. During the past few years, percutaneous imaging-guided radiofrequency ablation has evolved as a minimally invasive treatment of small unresectable renal tumours offering reduced patient morbidity and overall health care costs. In radiofrequency ablation, thermal energy is deposited into a targeted tumour by means of a radiofrequency applicator. In recent studies, radiofrequency ablation was shown to be an effective and safe modality for local destruction of renal cell carcinoma. Radiofrequency applicator navigation can be performed via ultrasound, computed tomography or magnetic resonance guidance; however, ultrasound seems less favourable because of the absence of monitoring capabilities during ablation. On-line monitoring of treatment outcome can only be performed with magnetic resonance imaging giving the possibility of eventual applicator repositioning to ablate visible residual tumour tissue. Long-term follow-up is crucial to assess completeness of tumour ablation. New developments in ablation technology and radiological equipment will further increase the indication field for radiofrequency ablation of renal cell carcinoma. Altogether, radiofrequency ablation seems to be a promising new modality for the minimally invasive treatment of renal cell carcinoma, which was demonstrated to exhibit high short-term effectiveness.


Radiofrequency ablation Renal cell carcinoma Image guidance 


  1. 1.
    Godley P, Kim SW (2002) Renal cell carcinoma. Curr Opin Oncol 14:280–285PubMedCrossRefGoogle Scholar
  2. 2.
    Konnak JW, Grossman HB (1985) Renal cell carcinoma as an incidental finding. J Urol 134:1094–1096PubMedGoogle Scholar
  3. 3.
    Chow WH, Devesa SS, Warren JL et al (1999) Rising incidence of renal cell cancer in the United States. JAMA 281:1628–1631PubMedCrossRefGoogle Scholar
  4. 4.
    Herring JC, Enquist EG, Chernoff A, Linehan WM, Choyke PL, Walther MM (2001) Parenchymal sparing surgery in patients with hereditary renal cell carcinoma: 10–year experience. J Urol 165:777–781PubMedCrossRefGoogle Scholar
  5. 5.
    Novick AC (2002) Nephron-sparing surgery for renal cell carcinoma. Annu Rev Med 53:393–407PubMedCrossRefGoogle Scholar
  6. 6.
    Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR (2005) Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 185:64–71PubMedGoogle Scholar
  7. 7.
    Gervais DA, Arellano RS, Mueller PR (2005) Percutaneous radiofrequency ablation of renal cell carcinoma. Eur Radiol 15(5):960–967PubMedCrossRefGoogle Scholar
  8. 8.
    Mahnken AH, Gunther RW, Tacke J (2004) Radiofrequency ablation of renal tumors. Eur Radiol 14(8):1449–1455PubMedCrossRefGoogle Scholar
  9. 9.
    Mahnken AH, Rohde D, Brkovic D, Gunther RW, Tacke JA (2005) Percutaneous radiofrequency ablation of renal cell carcinoma: preliminary results. Acta Radiol 46(2):208–214PubMedCrossRefGoogle Scholar
  10. 10.
    Farrell MA, Charboneau WJ, DiMarco DS, Chow GK, Zincke H, Callstrom MR, Lewis BD, Lee RA, Reading CC (2003) Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol 18:1509–1513Google Scholar
  11. 11.
    Mayo-Smith WW, Dupuy DE, Parikh PM, Pezzullo JA, Cronan JJ (2003) Imaging-guided percutaneous radiofrequency ablation of solid renal masses: techniques and outcomes of 38 treatment sessions in 32 consecutive patients. AJR Am J Roentgenol 180(6):1503–1508PubMedGoogle Scholar
  12. 12.
    Pavlovich CP, Walther MM, Choyke PL, Pautler SE, Chang R, Linehan WM, Wood BJ (2002) Percutaneous radio frequency ablation of small renal tumors: initial results. J Urol 167:10–15PubMedCrossRefGoogle Scholar
  13. 13.
    Anderson JK, Matsumoto E, Cadeddu JA (2005) Renal radiofrequency ablation: technique and results. Urol Oncol 23:355–360PubMedGoogle Scholar
  14. 14.
    Silverman SG, Tuncali K, vanSonnenberg E, Morrison PR, Shankar S, Ramaiya N, Richie JP (2005) Renal tumors: MR imaging-guided percutaneous cryotherapy—initial experience in 23 patients. Radiology 236(2):716–724PubMedGoogle Scholar
  15. 15.
    HH Pennes (1948) Analysis of tissue and arterial blood temperatures in the resting human forearm. J Appl Physiol 1:93–122PubMedGoogle Scholar
  16. 16.
    Dewey WC (1994) Arrhenius relationships from the molecule and cell to the clinic. Int J Hyperthermia 10(4):457–483PubMedGoogle Scholar
  17. 17.
    Sapareto SA, Dewey WC (1984) Thermal dose determination in cancer therapy. Int J Radiat Oncol Biol Phys 10:787–800PubMedGoogle Scholar
  18. 18.
    Goldberg SN, Gazelle GS (2001) Radiofrequency tissue ablation: physical principles and techniques for increasing coagulation necrosis. Hepatogastroenterology 48:359–367PubMedGoogle Scholar
  19. 19.
    Mulier S, Miao Y, Mulier P, Dupas B, Pereira P, de Baere T, Lencioni R, Leveillee R, Marchal G, Michel L, Ni Y (2005) Electrodes and multiple electrode systems for radiofrequency ablation: a proposal for updated terminology. Eur Radiol 15:798–808PubMedCrossRefGoogle Scholar
  20. 20.
    Pereira PL, Trubenbach J, Schenk M, Subke J, Kroeber S, Schaefer I, Remy CT, Schmidt D, Brieger J, Claussen CD (2004) Radiofrequency ablation: in vivo comparison of four commercially available devices in pig livers. Radiology 232:482–490PubMedGoogle Scholar
  21. 21.
    Frich L, Hol PK, Roy S, Mala T, Edwin B, Clausen OP, Gladhaug IP (2006) Experimental hepatic radiofrequency ablation using wet electrodes: electrode-to-vessel distance is a significant predictor for delayed portal vein thrombosis. Eur Radiol 16:1990–1999. 16 Mar DOI 10.1007/s00330-006-0177-6 Google Scholar
  22. 22.
    Burdio F, Navarro A, Sousa R, Burdio JM, Guemes A, Gonzalez A, Cruz I, Castiella T, Lozano R, Berjano E, Figueras J, de Gregorio MA (2006) Evolving technology in bipolar perfused radiofrequency ablation: assessment of efficacy, predictability and safety in a pig liver model. Eur Radiol 16:1826–1824. 16 Mar DOI 10.1007/s00330-005-0131-z Google Scholar
  23. 23.
    Clasen S, Schmidt D, Boss A, Dietz K, Krober SM, Claussen CD, Pereira PL (2006) Multipolar radiofrequency ablation with internally cooled electrodes: experimental study in ex vivo bovine liver with mathematic modeling. Radiology 238(3):881–890PubMedGoogle Scholar
  24. 24.
    Miao Y, Ni Y, Bosmans H et al (2001) Radiofrequency ablation for eradication of renal tumor in a rabbit model by using a cooled-tip electrode technique. Ann Surg Oncol 8:651–657PubMedCrossRefGoogle Scholar
  25. 25.
    Hsu TH, Fidler ME, Gill IS (2000) Radiofrequency ablation of the kidney: acute and chronic histology in porcine model. Urology 56:872–875PubMedCrossRefGoogle Scholar
  26. 26.
    Crowley JD, Shelton J, Iverson AJ, Burton MP, Dalrymple NC, Bishoff JT (2001) Laparoscopic and computed tomography-guided percutaneous radiofrequency ablation of renal tissue: acute and chronic effects in an animal model. Urology 57:976–980PubMedCrossRefGoogle Scholar
  27. 27.
    Lee JM, Kim SW, Chung GH, Lee SY, Han YM, Kim CS (2003) Open radio-frequency thermal ablation of renal VX2 tumors in a rabbit model using a cooled-tip electrode: feasibility, safety, and effectiveness. Eur Radiol 13:1324–1332PubMedCrossRefGoogle Scholar
  28. 28.
    Aschoff AJ, Sulman A, Martinez M, Duerk JL, Resnick MI, MacLennan GT, Lewin JS (2001) Perfusion-modulated MR imaging-guided radiofrequency ablation of the kidney in a porcine model. AJR Am J Roentgenol 177:151–158PubMedGoogle Scholar
  29. 29.
    Eichel L, Kim IY, Uribe C, Khonsari S, Basillote J, Steward E, Coad J, Bischof J, Rudie E, Kluge S, McDougall EM, Clayman RV (2005) Third Prize: Comparison of radical nephrectomy, laparoscopic microwave thermotherapy, cryotherapy, and radiofrequency ablation for destruction of experimental VX-2 renal tumors in rabbits. J Endourol 19:1082–1087PubMedCrossRefGoogle Scholar
  30. 30.
    Novick AC (2002) Nephron-sparing surgery for renal cell carcinoma. Annu Rev Med 53:393–407PubMedCrossRefGoogle Scholar
  31. 31.
    Uzzo RG, Novick AC (2001) Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 166:6–18PubMedCrossRefGoogle Scholar
  32. 32.
    Sowery RD, Siemens DR (2004) Growth characteristics of renal cortical tumors in patients managed by watchful waiting. Can J Urol 11:2407–2410PubMedGoogle Scholar
  33. 33.
    Wehle MJ, Thiel DD, Petrou SP, Young PR, Frank I, Karsteadt N (2004) Conservative management of incidental contrast-enhancing renal masses as safe alternative to invasive therapy. Urology 64:49–52PubMedCrossRefGoogle Scholar
  34. 34.
    Zagoria RJ, Hawkins AD, Clark PE, Hall MC, Matlaga BR, Dyer RB, Chen MY (2004) Percutaneous CT-guided radiofrequency ablation of renal neoplasms: factors influencing success. AJR Am J Roentgenol 183:201–207PubMedGoogle Scholar
  35. 35.
    Ryo E, Takeshita S, Shiba M, Ayabe T (2006) Radiofrequency ablation for cystic adenomyosis: a case report. J Reprod Med 51:427–430PubMedGoogle Scholar
  36. 36.
    Sahin M, Kartal A, Haykir R, Cakir M (2006) RF-assisted cystectomy and pericystectomy: a new technique in the treatment of liver hydatid disease. Eur Surg Res 38:90–93PubMedCrossRefGoogle Scholar
  37. 37.
    Mickisch GH, Mattes RH (2005) Combination of surgery and immunotherapy in metastatic renal cell carcinoma. World J Urol 23:191–195PubMedCrossRefGoogle Scholar
  38. 38.
    Lewin JS, Nour SG, Connell CF, Sulman A, Duerk JL, Resnick MI, Haaga JR (2004) Phase II clinical trial of interactive MR imaging-guided interstitial radiofrequency thermal ablation of primary kidney tumors: initial experience. Radiology 232:835–845PubMedGoogle Scholar
  39. 39.
    Boss A, Clasen S, Kuczyk M, Anastasiadis A, Schmidt D, Claussen CD, Schick F, Pereira PL (2005) Radiofrequency ablation of renal cell carcinomas using MR imaging: initial results. Rofo 177:1139–1145PubMedGoogle Scholar
  40. 40.
    Boss A, Clasen S, Kuczyk M, Anastasiadis A, Schmidt D, Graf H, Schick F, Claussen CD, Pereira PL (2005) Magnetic resonance-guided percutaneous radiofrequency ablation of renal cell carcinomas: a pilot clinical study. Invest Radiol 40(9):583–590PubMedCrossRefGoogle Scholar
  41. 41.
    Beisland C, Medby PC, Sander S, Beisland HO (2000) Nephrectomy—indications, complications and postoperative mortality in 646 consecutive patients. Eur Urol 37:58–64PubMedCrossRefGoogle Scholar
  42. 42.
    Butler BP, Novick AC, Miller DP, Campbell SA, Licht MR (1995) Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery. Urology 45:34–40PubMedCrossRefGoogle Scholar
  43. 43.
    Kam AW, Littrup PJ, Walther MM, Hvizda J, Wood BJ (2004) Thermal protection during percutaneous thermal ablation of renal cell carcinoma. J Vasc Interv Radiol 15:753–758PubMedGoogle Scholar
  44. 44.
    Farrell MA, Charboneau JW, Callstrom MR, Reading CC, Engen DE, Blute ML (2003) Paranephric water instillation: a technique to prevent bowel injury during percutaneous renal radiofrequency ablation. AJR Am J Roentgenol 181:1315–1317PubMedGoogle Scholar
  45. 45.
    Boss A, Clasen S, Kuczyk M, Anastasiadis A, Schmidt D, Claussen CD, Schick F, Pereira PL (2005) Thermal damage of the genitofemoral nerve due to radiofrequency ablation of renal cell carcinoma: a potentially avoidable complication. AJR Am J Roentgenol 185:1627–1631PubMedCrossRefGoogle Scholar
  46. 46.
    Morcos SK, Thomsen HS, Webb JA (1999) Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR). Eur Radiol 9:1602–1613PubMedCrossRefGoogle Scholar
  47. 47.
    Merkle EM, Nour SG, Lewin JS (2005) MR imaging follow-up after percutaneous radiofrequency ablation of renal cell carcinoma: findings in 18 patients during first 6 months. Radiology 235:1065–1071PubMedGoogle Scholar
  48. 48.
    Boss A, Martirosian P, Schraml C, Clasen S, Fenchel M, Anastasiadis A, Claussen CD, Pereira PL, Schick F (2006) Morphological, contrast-enhanced and spin labeling perfusion imaging for monitoring of relapse after RF ablation of renal cell carcinomas. Eur Radiol 16:1-11. DOI 10.1007/s00330-005-0098-9 Google Scholar
  49. 49.
    Thomsen HS (2004) Gadolinium-based contrast media may be nephrotoxic even at approved doses. Eur Radiol 14:1654–1656PubMedGoogle Scholar
  50. 50.
    Zlotta AR, Wildschutz T, Wood BJ et al (1997) Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol 11:251–258PubMedCrossRefGoogle Scholar
  51. 51.
    McGovern FJ, Wood BJ, Goldberg SN et al (1999) Radiofrequency ablation of renal cell carcinoma via image guided needle electrodes. J Urol 161:599–600PubMedCrossRefGoogle Scholar
  52. 52.
    Hall WH, McGahan JP, Link DP, deVere White RW (2000) Combined embolization and percutaneous radiofrequency ablation of a solid renal tumor. AJR Am J Roentgenol 174:1592–1594PubMedGoogle Scholar
  53. 53.
    Ogan K, Jacomides L, Dolmatch BL et al (2002) Percutaneous radiofrequency ablation of renal tumors: technique, limitations, and morbidity. Urology 60:954–958PubMedCrossRefGoogle Scholar
  54. 54.
    Sabharwal R, Vladica P (2006) Renal tumors: technical success and early clinical experience with radiofrequency ablation of 18 tumors. Cardiovasc Intervent Radiol 29:202–209PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Andreas Boss
    • 1
  • Stephan Clasen
    • 1
  • Markus Kuczyk
    • 3
  • Fritz Schick
    • 2
  • Philippe L. Pereira
    • 1
  1. 1.Department of Diagnostic RadiologyEberhard Karls UniversityTübingenGermany
  2. 2.Section of Experimental RadiologyEberhard Karls University of TübingenTübingenGermany
  3. 3.Department of UrologyEberhard Karls UniversityTübingenGermany

Personalised recommendations