Skip to main content

Advertisement

SpringerLink
Log in

T1a as the Sole Selection Criterion for RFA of Renal Masses: Randomized Controlled Trials versus Surgery Should Not Be Postponed

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the long-term effects of radiofrequency ablation (RFA) of renal masses (RM) and compare them with surgery.

Methods

A total of 203 RM (193 malignant; mean size 30 mm) in 137 patients (95 male subjects; average age 64 years) underwent RFA. Complications and technique effectiveness were evaluated. Overall survival, cancer-specific survival, and disease-free survival were calculated (mean follow-up time 39 months). Predictors for complications, technique effectiveness, and survival were investigated.

Results

Seventeen (8.4 %) adverse events were recorded (2 % major complications). Exophytic development and smaller size were protective against adverse events. Complete ablation was obtained in 87 % RM (93 % ≤3 cm, 89 % ≤4 cm). T1a threshold was a positive predictor for complete ablation and central location a negative one. Three- and 5-year overall survival were 84 and 75 %; cancer-specific survival 96 and 91 %; and disease-free survival 80 and 75 %. Considering only the 79 patients with newly diagnosed renal cell carcinoma, T1a disease stage resulted a positive predictor for both overall survival (87 and 83 % at 3 and 5 years) and cancer-specific survival (100 % at 5 years).

Conclusion

RFA of noncentral small RM is safe and effective, and it provides favorable long-term oncological outcomes. Selection criteria for RFA can also include T1a renal cell carcinoma in patients without surgical contraindications, even though randomized controlled trials are needed to establish the best treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. McGovern FJ, Wood BJ, Goldberg SN, Mueller PR (1999) Radio frequency ablation of renal cell carcinoma via image guided needle electrodes. J Urol 161:599–600

    Article  CAS  PubMed  Google Scholar 

  2. Clark TW, Millward SF, Gervais DA, Technology Assessment Committee of the Society of Interventional Radiology et al (2009) Reporting standards for percutaneous thermal ablation of renal cell carcinoma. J Vasc Interv Radiol 20(7 suppl):S409–S416

    Article  PubMed  Google Scholar 

  3. Volpe A, Cadeddu JA, Cestari A et al (2011) Contemporary management of small renal masses. Eur Urol 60:501–515

    Article  PubMed  Google Scholar 

  4. Gervais DA, McGovern FJ, Arellano RS et al (2003) Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology 226:417–424

    Article  PubMed  Google Scholar 

  5. Silverman SG, Gan YU, Mortele KJ et al (2006) Renal masses in the adult patient: the role of percutaneous biopsy. Radiology 240:6–22

    Article  PubMed  Google Scholar 

  6. Millet I, Doyon FC, Hoa D (2011) Characterization of small solid renal lesions: can benign and malignant tumors be differentiated with CT? AJR Am J Roentgenol 197:887–896

    Article  PubMed  Google Scholar 

  7. Patel AR, Lee BH, Campbell SC et al (2011) Bilateral synchronous sporadic renal tumors: pathologic concordance and clinical implications. Urology 78:1095–1099

    Article  PubMed  Google Scholar 

  8. Veltri A, Grosso M, Castagneri F et al (2009) Radiofrequency thermal ablation of small tumors in transplanted kidneys: an evolving nephron-sparing option. J Vasc Interv Radiol 20:674–679

    Article  PubMed  Google Scholar 

  9. American Urological Association (AUA) (2009) Guideline for management of the clinical stage 1 renal mass. http://www.auanet.org/common/pdf/education/clinical-guidance/Renal-Mass.pdf

  10. Ljungberg B, Cowanb NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398–406

    Article  PubMed  Google Scholar 

  11. Escudier B, Eisen T, Porta C (2012) Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(suppl 7):vii65–vii71

    Article  PubMed  Google Scholar 

  12. Best SL, Park SK, Yaacoub RF et al (2012) Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters. J Urol 187:1183–1189

    Article  PubMed  Google Scholar 

  13. Zagoria RJ, Pettus JA, Rogers M et al (2011) Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology 77:1393–1399

    Article  PubMed  Google Scholar 

  14. Nadu A, Kleinmann N, Laufer M et al (2009) Laparoscopic partial nephrectomy for central tumors: analysis of perioperative outcomes and complications. J Urol 181:42–47

    Article  PubMed  Google Scholar 

  15. Psutka SP, Feldman AS, McDougal WS et al (2013) Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 63:486–492

    Article  PubMed  Google Scholar 

  16. Olweny EO, Park SK, Tan YK et al (2012) Radiofrequency ablation versus partial nephrectomy in patients with solitary clinical T1a renal cell carcinoma: comparable oncologic outcomes at a minimum of 5 years of follow-up. Eur Urol 61:1156–1161

    Article  PubMed  Google Scholar 

  17. Lian H, Guo H, Zhang G et al (2012) Single-center comparison of complications in laparoscopic and percutaneous radiofrequency ablation with ultrasound guidance for renal tumors. Urology 80:119–125

    Article  PubMed  Google Scholar 

  18. Castle SM, Gorbatiy V, Ekwenna O et al (2011) Laparoscopic and image-guided radiofrequency ablation of renal tumors: patient selection and outcomes. Curr Urol Rep 12:100–106

    Article  PubMed  Google Scholar 

  19. Atwell TD, Schmit GD, Boorjian SA et al (2013) Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol 200:461–466

    Article  PubMed  Google Scholar 

  20. Davis K, Kielar A, Jafari K (2010) 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 63(3 suppl):S23–S32

    PubMed  Google Scholar 

  21. Lowrance WT, Yee DS, Savage C et al (2010) Complications after radical and partial nephrectomy as a function of age. J Urol 183:1725–1730

    Article  PubMed  Google Scholar 

  22. Wehrenberg-Klee E, Clark TW, Malkowicz SB (2012) Impact on renal function of percutaneous thermal ablation of renal masses in patients with preexisting chronic kidney disease. J Vasc Interv Radiol 23:41–45

    Article  PubMed  Google Scholar 

  23. Turna B, Kaouk JH, Frota R et al (2009) Minimally invasive nephron sparing management for renal tumors in solitary kidneys. J Urol 182:2150–2157

    Article  PubMed  Google Scholar 

  24. Raman JD, Raj GV, Lucas SM et al (2010) Renal functional outcomes for tumours in a solitary kidney managed by ablative or extirpative techniques. BJU Int 105:496–500

    Article  PubMed  Google Scholar 

  25. Han JS, Huang WC (2011) Impact of kidney cancer surgery on oncologic and kidney functional outcomes. Am J Kidney Dis 58:846–854

    Article  PubMed  Google Scholar 

  26. Salagierski M, Akdogan B, Brookman-May S (2013) What is the contemporary role of radiofrequency ablation in the management of small renal masses? Are small lesions the radiologist’s tumors? Eur Urol 63:493–495

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy

    Andrea Veltri & Irene Garetto

  2. Department of Surgical Sciences, University of Turin, Via Genova 3, Turin, Italy

    Carlo Gazzera

  3. Institution of Radiology, ASOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, TO, Italy

    Marco Busso & Federica Solitro

  4. Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy

    Giorgina B. Piccoli

  5. Anesthesia and Intensive Care Unit, ASOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, TO, Italy

    Bruno Andreetto

Authors
  1. Andrea Veltri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlo Gazzera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco Busso
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Federica Solitro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giorgina B. Piccoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bruno Andreetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Irene Garetto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrea Veltri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Veltri, A., Gazzera, C., Busso, M. et al. T1a as the Sole Selection Criterion for RFA of Renal Masses: Randomized Controlled Trials versus Surgery Should Not Be Postponed. Cardiovasc Intervent Radiol 37, 1292–1298 (2014). https://doi.org/10.1007/s00270-013-0812-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-013-0812-y

Keywords

Search

Navigation