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European Radiology

, Volume 15, Issue 5, pp 960–967 | Cite as

Percutaneous radiofrequency ablation of renal cell carcinoma

  • Debra A. GervaisEmail author
  • Ronald S. Arellano
  • Peter R. Mueller
Urogenital

Abstract

Conventional curative therapy for renal cell carcinoma has been open nephrectomy. However, several less invasive and/or nephron-sparing procedures have been developed as alternatives in selected patients. The newest of these therapeutic modalities involves percutaneous image-guided ablation with straight or expandable needle applicators that deposit energy. Radiofrequency ablation is the modality for which there is the largest reported experience with percutaneous application, and involves the use of electrical current to generate frictional heating of tissue. Animal studies confirm the ability of radiofrequency ablation to cause regions of necrosis within normal kidney and in VX2 tumors. Clinically, radiofrequency ablation of small renal cell carcinoma is increasingly being performed in selected patients who are not ideal surgical candidates. Results are excellent for small exophytic tumors, but successful treatment is less likely as tumor size increases or the location becomes more central. Complete treatment of most tumors requires one or more overlapping ablations with the needle electrodes positioned so as to cause necrosis in the entire volume of tumor. The number of overlapping ablations and the position of the needle electrodes vary based on tumor size and geometry. For very large tumors, pre-ablation catheter embolization may enhance the results of ablation by decreasing blood flow and perfusion mediated cooling. Following ablation, imaging with CT or MR is performed to assess the result and to diagnose any residual tumor so that it can be treated. Because the tumor remains in situ, imaging follow-up continues indefinitely. The complication rate of radiofrequency ablation is favorable when compared to surgical techniques. Long-term survival data are not yet available.

Keywords

Kidney neoplasms Radiofrequency ablation, therapy Kidney Interventional procedures 

References

  1. 1.
    Novick AC (2004) Laparoscopic and partial nephrectomy. Clin Cancer Res 10(18):6322S–6327SGoogle Scholar
  2. 2.
    Poon RT, Ng KK, Lam CM, Ai V, Yuen J, Fan ST (2004) Effectiveness of radiofrequency ablation for hepatocellular carcinomas larger than 3 cm in diameter. Arch Surg 139:281–287Google Scholar
  3. 3.
    Lencioni R, Crocetti L, Cioni D, Della Pina C, Bartolozzi C (2004) Percutaneous radiofrequency ablation of hepatic colorectal metastases: technique, indications, results, and new promises. Invest Radiol 39:689–697PubMedGoogle Scholar
  4. 4.
    Gervais DA, McGovern FJ, Wood BJ, Goldberg SN, McDougal WS, Mueller PR (2000) Radio-frequency ablation of renal cell carcinoma: early clinical experience. Radiology 217(3):665–672PubMedGoogle Scholar
  5. 5.
    Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR (2003) Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology 226(2):417–424PubMedGoogle Scholar
  6. 6.
    Farrell MA, Charboneau WJ, DiMarco DS (2003) Imaging-guided radiofrequency ablation of solid renal tumors. Am J Roentgenol 180(6):1509–1513Google Scholar
  7. 7.
    Su LM, Jarrett TW, Chan DY, Kavoussi LR, Solomon SB (2003) Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results. Urology 61(4 Suppl 1):26–33CrossRefGoogle Scholar
  8. 8.
    Mayo-Smith WW, Dupuy DE, Parikh PM, Pezzullo JA, Cronan JJ (2003) Imaging-guided percutaneous radiofrequency ablation of solid renal masses: technique and outcomes of 38 treatment sessions in 32 consecutive patients. Am J Roentgenol 180(6):1503–1508PubMedGoogle Scholar
  9. 9.
    Pavlovich CP, Walther MM, Choyke PL, Pautler SE, Chang R, Linehan WM et al. (2002) Percutaneous radio frequency ablation of small renal tumors: initial results. J Urol 167(1):10–15CrossRefPubMedGoogle Scholar
  10. 10.
    Ogan K, Jacomides L, Dolmatch BL, Rivera FJ, Dellaria MF, Josephs SC et al. (2002) Percutaneous radiofrequency ablation of renal tumors: technique, limitations, and morbidity. Urology 60(6):954–958CrossRefPubMedGoogle Scholar
  11. 11.
    Roy-Choudhury SH, Cast JEI, Cooksey G, Puri S, Breen DJ (2003) Early experience with percutaneous radiofrequency ablation of small solid renal masses. Am J Roentgenol 180(4):1055–1061Google Scholar
  12. 12.
    Zagoria RJ, Hawkins AD, Clark PE, Hall MC, Matlaga BR, Dyer RB et al. (2004) Percutaneous CT-guided radiofrequency ablation of renal neoplasms: factors influencing success. Am J Roentgenol 183(1):201–207Google Scholar
  13. 13.
    de Baere T, Kuoch V, Smayra T, Dromain C, Cabrera T, Court B et al. (2002) Radiofrequency ablation of renal cell carcinoma: preliminary clinical experience. J Urol 167(5):1961–1964PubMedGoogle Scholar
  14. 14.
    Veltri A, De Fazio G, Malfitana V, Isolato G, Fontana D, Tizzani A et al. (2004) Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients. Eur Radiol 2303–2310Google Scholar
  15. 15.
    Goldberg SN, Gazelle GS, Mueller PR (2000) Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. Am J Roentgenol 174(2):323–331Google Scholar
  16. 16.
    Tacke J, Mahnken A, Roggan A, Gunther RW (2004) Multipolar radiofrequency ablation: first clinical results. Rofo 176:324–329PubMedGoogle Scholar
  17. 17.
    Lee FT Jr, Haemmerich D, Wright AS, Mahvi DM, Sampson LA, Webster JG (2003) Multiple probe radiofrequency ablation: pilot study in an animal model. J Vasc Interv Radiol 14:1437–1442Google Scholar
  18. 20.
    Munver R, Threatt CB, Delvecchio FC, Preminger GM, Polascik TJ (2002) Hypertonic saline-augmented radiofrequency ablation of the VX-2 tumor implanted in the rabbit kidney: a short-term survival pilot study. Urology 60(1):170–175Google Scholar
  19. 21.
    Hsu TH, Fidler ME, Gill IS (2000) Radiofrequency ablation of the kidney: acute and chronic histology in porcine model. Urology 56(5):872–875CrossRefPubMedGoogle Scholar
  20. 22.
    Crowley JD, Shelton J, Iverson AJ, Burton MP, Dalrymple NC, Bishoff JT (2000) Laparoscopic and computed tomography-guided percutaneous radiofrequency ablation of renal tissue: acute and chronic effects in an animal model. Urology 57(5):976–980Google Scholar
  21. 23.
    Polascik TJ, Hamper U, Lee BR, Dai Y, Hilton J, Magee CA et al. (1999) Ablation of renal tumors in a rabbit model with interstitial saline-augmented radiofrequency energy: preliminary report of a new technology. Urology 53(3):465–472Google Scholar
  22. 24.
    Zlotta AR, Wildshutz T, Raviv G, Peny MO, van Gansbeke D, Noel JC 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(4):251–258PubMedGoogle Scholar
  23. 25.
    Walther MM, Shawker TH, Libutti SK, Lubensky I, Choyke PL, Venzon D et al. (2000) A phase 2 study of radio frequency interstitial tissue ablation of localized renal tumors. J Urol 163(5):1424–1427CrossRefPubMedGoogle Scholar
  24. 26.
    Michaels MJ, Harrison KR, Mourtzinos AP, Summerhayes IC, Silverman ML, Libertino JA (2002) Incomplete renal tumor destruction using radio frequency interstitial ablation. J Urol 168(6):2406–2410PubMedGoogle Scholar
  25. 27.
    Rendon RA, Kachura JR, Sweet JM, Gertner MR, Sherar MD, Robinette M et al. (2002) The uncertainty of radiofrequency treatment of renal cell carcinoma: findings at immediate and delayed nephrectomy. J Urol 167(4):1587–1592CrossRefPubMedGoogle Scholar
  26. 28.
    Ogan K, Cadeddu JA (2002) Re: the uncertainty of radiofrequency treatment of renal cell carcinoma: findings at immediate and delayed nephrectomy. J Urol 168(5):2128Google Scholar
  27. 29.
    Rehman J, Landman J, Sundaram CP (2002) Re: the uncertainty of radiofrequency treatment of renal cell carcinoma: findings at immediate and delayed nephrectomy. J Urol 168(5):2128–2129Google Scholar
  28. 30.
    Zagoria RJ, Chen MY, Kavanagh PV, Torti FM (2001) Radio frequency ablation of lung metastases from renal cell carcinoma. J Urol 166(5):1827–1828CrossRefPubMedGoogle Scholar
  29. 31.
    Gervais DA, Arellano RS, Mueller PR (2002) Percutaneous radiofrequency ablation of nodal metastases. Cardiovasc Interv Radiol 25(6):547–549Google Scholar
  30. 32.
    Wood BJ, Grippo J, Pavlovich CP (2001) Percutaneous radio frequency ablation for hematuria. J Urol 166(6):2303–2304CrossRefPubMedGoogle Scholar
  31. 33.
    Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ et al. (2004) Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study. J Clin Oncol 22:300–306Google Scholar
  32. 34.
    Tuncali K, vanSonnenberg E, Shankar S, Mortele KJ, Cibas ES, Silverman SG (2004) Evaluation of patients referred for percutaneous ablation of renal tumors: importance of a preprocedural diagnosis. Am J Roentgenol 183(3):575–582Google Scholar
  33. 35.
    Moreland WS, Zagoria RJ, Geisinger KR (2002) Use of fine needle aspiration biopsy in radiofrequency ablation. Acta Cytol 46(5):819–822Google Scholar
  34. 36.
    Lewin JS, Nour SG, Connell CF, Sulman A, Duerk JL, Resnick ML et al. (2004) Phase II clinical trial of interactive MR imaging-guided interstitial radiofrequency thermal ablation of primary kidney tumors: initial experience. Radiology 232(3):835–845Google Scholar
  35. 37.
    Goldberg SN, Gazelle GS, Compton CC, Mueller PR, Tanabe KK (2000) Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic–pathologic correlation. Cancer 88(11):2452–2463CrossRefPubMedGoogle Scholar
  36. 38.
    McGovern FJ, Wood BJ, Goldberg SN, Mueller PR (1999) Radio frequency ablation of renal cell carcinoma via image guided needle electrodes. J Urol 161(2):599–600CrossRefPubMedGoogle Scholar
  37. 39.
    Mahnken AH, Gunther RW, Tacke J (2004) Radiofrequency ablation of renal tumors. Eur Radiol 14:1449–1455CrossRefGoogle Scholar
  38. 40.
    Johnson DB, Solomon SB, Su LM, Matsumoto ED, Kavoussi LR, Nakada SY, Moon TD, Shingleton WB, Cadeddu JA (2004) Defining the complications of cryoablation and radio frequency ablation of small renal tumors: a multi-institutional review. J Urol 172:874–877Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Debra A. Gervais
    • 1
    Email author
  • Ronald S. Arellano
    • 1
  • Peter R. Mueller
    • 1
  1. 1.Department of Radiology, Division of Abdominal Imaging and InterventionMassachusetts General HospitalBostonUSA

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