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Minimally invasive ablative approaches in the treatment of renal cell carcinoma

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Abstract

Ablative techniques for the treatment of renal cell carcinoma (RCC) are an extension of nephron-sparing surgery and include cryoablation, radiofrequency ablation (RFA), and high-intensity focused ultrasound (HIFU). Although experimental, these are evolving treatment modalities. The widespread use of computed tomography scans, ultrasound, and magnetic resonance imaging caused an increase in the diagnosis rate of small renal masses amenable to nephron-sparing surgery. The same imaging modalities permit interactive monitoring both during the delivery of ablative measures and at postoperative followup. Cryosurgery is the most studied of the ablative approaches, and clinical studies have demonstrated promising short-term results and a remarkable safety profile. Long-term studies, however, are needed in order to determine the appropriate selection criteria and to confirm a response as durable as that for partial and radical nephrectomy. More data are needed to evaluate the efficacy of RFA. Currently, preclinical results with HIFU do not justify its use for treating RCC in humans.

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References and Recommended Reading

  1. American Cancer Society. Cancer Facts and Figures; 2000.

  2. Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol 1969, 101:297–301.

    PubMed  CAS  Google Scholar 

  3. Novick AC, Streem S, Montie JE, et al.: Conservative surgery in renal cell carcinoma: a single-center experience with 100 patients. J Urol 1989, 141:835–839.

    PubMed  CAS  Google Scholar 

  4. Bosniak MA, Krinsky GA, Waisman J: Management of small incidental renal parenchymal tumors by watchful waiting in selected patients based on observation of tumor growth rates. J Urol 1996, 155:584A.

    Google Scholar 

  5. Arnott J: Practical illustrations of the remedial efficacy of a very low or anaesthestic temperature in cancer. Lancet 1850, 2:257–259.

    Article  Google Scholar 

  6. Cooper IS, Lee A: Cryostatic congelation: a system for producing a limited controlled region of cooling or freezing of biologic tissues. J Nerv Ment Dis 1961, 133:259–263.

    Article  PubMed  CAS  Google Scholar 

  7. Onik GM, Reyes G, Cohen JK, et al.: Ultrasound characteristics of renal cryosurgery. Urology 1993, 42:212–215.

    Article  PubMed  CAS  Google Scholar 

  8. Rossi S, Di Stasi M, Buscarini E, et al.: Percutaneous radiofrequency interstitial thermal ablation in the treatment of small hepatocellular carcinoma. Cancer J Sci Am 1995, 1:73.

    PubMed  CAS  Google Scholar 

  9. de Berg JC, Pattynama PM, Obermann WR, et al.: Percutaneous computed-tomography-guided thermocoagulation for osteoid osteomas. Lancet 1995, 346:350–351.

    Article  PubMed  Google Scholar 

  10. Phipps JH, Lewis BV, Prior MV, Roberts T: Experimental and clinical studies with radiofrequency-induced thermal endometrial ablation for functional menorrhagia. Obstet Gynecol 1990, 76:876–881.

    Article  PubMed  CAS  Google Scholar 

  11. Calkins H, Langberg J, Sousa J, et al.: Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Circulation 1992, 85:1337–1346.

    PubMed  CAS  Google Scholar 

  12. Smith SJ, Bosniak MA, Megibow AJ, et al.: Renal cell carcinoma: earlier discovery and increased detection. Radiology 1989, 170:699–703.

    PubMed  CAS  Google Scholar 

  13. Palmer JM: Role of partial nephrectomy in solitary or bilateral renal tumors. JAMA 1983, 249:2357–2361.

    Article  PubMed  CAS  Google Scholar 

  14. Novick AC: Partial nephrectomy for renal cell carcinoma. Urol Clin North Am 1987, 14:419–433.

    PubMed  CAS  Google Scholar 

  15. Herr HW: Partial nephrectomy for renal cell carcinoma with a normal opposite kidney. Cancer 1994, 73:160–162.

    Article  PubMed  CAS  Google Scholar 

  16. Thrasher JB, Robertson JE, Paulson DF: Expanding indications for conservative renal surgery in renal cell carcinoma. Urology 1994, 43:160–168.

    Article  PubMed  CAS  Google Scholar 

  17. Licht MR, Novick AC: Nephron-sparing surgery for renal cell carcinoma. J Urol 1993, 149:1–7.

    PubMed  CAS  Google Scholar 

  18. Morgan WR, Zincke H: Progression and survival after renal-conserving surgery for renal cell carcinoma: experience in 104 patients and extended follow-up. J Urol 1990, 144:852–857.

    PubMed  CAS  Google Scholar 

  19. Zisman A, Pantuck A, Belldegrun A, et al.: Laparoscopic radical nephrectomy. Sem Urol Oncol 2001, 19:114–122. This is an excellent review of the clinical utility and oncologic efficacy of laparoscopic radical nephrectomy.

    CAS  Google Scholar 

  20. Uchida M, Imaide Y, Sugimoto K, et al.: Percutaneous cryosurgery for renal tumors. Br J Urol 1995, 75:132–137.

    PubMed  CAS  Google Scholar 

  21. Baust J, Gage AA, Ma H, et al.: Minimally invasive cryosurgerytechnological advances. Cryobiology 1997, 34:373–384.

    Article  PubMed  CAS  Google Scholar 

  22. Campbell SC, Krishnamurthi V, Chow G, et al.: Renal cryosurgery: experimental evaluation of treatment parameters. Urology 1998, 52:29–34.

    Article  PubMed  CAS  Google Scholar 

  23. Gill IS, Novick AC, Meraney AM, et al.: Laparoscopic renal cryoablation in 32 patients. Urology 2000, 56:748–753. This study is the largest series published to date of laparoscopic renal cryoablation and demonstrates promising results.

    Article  PubMed  CAS  Google Scholar 

  24. Stephenson RA, King DK, Rohr LR: Renal cryoablation in a canine model. Urology 1996, 47:772–776.

    Article  PubMed  CAS  Google Scholar 

  25. Nakada SY, Lee FT, Warner T, et al.: Laparoscopic cryosurgery of the kidney in the porcine model: an acute histological study. Urology 1998, 51(suppl 5A):161–166.

    Article  PubMed  CAS  Google Scholar 

  26. Gill IS, Novick AC, Soble JJ, et al.: Laparoscopic renal cryoablation: initial clinical series. Urology 1998, 52:543–551.

    Article  PubMed  CAS  Google Scholar 

  27. Johnson BD, Nakada SY: Laparoscopic cryoablation for renal-cell cancer. J Endourology 2000, 14:873–878.

    Article  CAS  Google Scholar 

  28. Long JP, Faller GT: Percutaneous cryoablation of the kidney in a porcine model. Cryobiology 1999, 38:89–93.

    Article  PubMed  CAS  Google Scholar 

  29. Zlotta AR, Wildschutz T, Raviv G, et al.: Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol 1997, 11:251–258.

    PubMed  CAS  Google Scholar 

  30. Walther MC, Shawker TH, Libutti SK, et al.: A phase 2 study of radio frequency interstitial tissue ablation of localized tumors. J Urol 2000, 163:1424–1427.

    Article  PubMed  CAS  Google Scholar 

  31. Crowley JD, Shelton J, Iverson AJ, et al.: Laparoscopic and computed tomography-guided percutaneous radiofrequency ablation of renal tissue: acute and chronic effects in an animal model. Urology 2001, 57:976–980.

    Article  PubMed  CAS  Google Scholar 

  32. Polascik TJ, Hamper U, Lee BR, et al.: Ablation of renal tumors in a rabbit model with interstitial saline-augmented radiofrequency energy: preliminary report of a new technology. Urology 1999, 53:465–472.

    Article  PubMed  CAS  Google Scholar 

  33. Chapelon JY, Margonari J, Theillere Y, et al.: Effects of highenergy focused ultrasound on kidney tissue in the rat and the dog. Eur Urol 1992, 22:147–152.

    PubMed  CAS  Google Scholar 

  34. Adams JB, Moore RG, Anderson JH, et al.: High-intensity focused ultrasound ablation of rabbit kidney tumors. J Endourol 1996, 10:71–75.

    PubMed  CAS  Google Scholar 

  35. Susani M, Madersbacher S, Kratzik C, et al.: Morphology of tissue destruction induced by focused ultrasound. Eur Urol 1993, 23(suppl 1):34–38.

    PubMed  Google Scholar 

  36. Watkin NA, Morris SB, Rivens IH, et al.: High-intensity focused ultrasound ablation of the kidney in a large animal model. J Endourol 1997, 11:191–196.

    PubMed  CAS  Google Scholar 

  37. Hill CR, ter Haar GR: Review article: high intensity focused ultrasound-potential for cancer treatment. Br J Radiol 1995, 68:1296–1303.

    Article  PubMed  CAS  Google Scholar 

  38. Gervais DA, McGovern FJ, Wood BJ, et al.: Radio-frequency ablation of renal cell carcinoma: early clinical experience. Radiology 2000, 217:665–672. This study is the largest clinical study to date of RFA for RCC and outlines some of the technical difficulties encountered.

    PubMed  CAS  Google Scholar 

  39. Cozzi PJ, Lynch WJ, Collins S, et al.: Renal cryotherapy in a sheep model: a feasibility study. J Urol 1997, 157:710–712.

    Article  PubMed  CAS  Google Scholar 

  40. Delworth MG, Pisters LL, Fornage BD, et al.: Cryotherapy for renal cell carcinoma and angiomyolipoma. J Urol 1996, 55:252–254.

    Google Scholar 

  41. Zegel HG, Holland GA, Jennings SB, et al.: Intraoperative ultrasonographically guided cryoablation of renal masses: initial experience. J Ultrasound Med 1998, 17:571–576.

    PubMed  CAS  Google Scholar 

  42. Bishoff JT, Chan DY, Chen RB, et al.: Laparoscopic renal cryoablation: acute and long-term clinical and pathological effects in animal and human studies [abstract]. J Endourol 1998, 12:S88.

    Google Scholar 

  43. Rodriguez R, Chan DY, Bishoff JT, et al.: Renal ablative cryosurgery in selected patients with peripheral renal masses. Urology 2000, 55:25–30.

    Article  PubMed  CAS  Google Scholar 

  44. Rukstalis DB, Khorsandi M, Garcia FU, et al.: Clinical experience with open renal cryoablation. Urology 2001, 57:34–39. This is the largest series to date of open renal cryoablation. It demonstrates the safety and efficacy of the technique.

    Article  PubMed  CAS  Google Scholar 

  45. Levin HS, Meraney AM, Novick AC, et al.: Needle biopsy histology of renal tumors 3–6 months after laparoscopic renal cryoablation. J Urol 2000, 163(S):153a.

    Google Scholar 

  46. Zincke H, Dechet CB, Blute ML, et al.: Needle biopsy of solid renal masses. J Urol 1998, 159:A169.

    Article  Google Scholar 

  47. Chan DY, Rodriquez R, Kavouss L: Laparoscopic renal ablation [letter]. Urology 2001, 58:132–134.

    Article  PubMed  CAS  Google Scholar 

  48. Gettman MT, Bishoff JT, Su LM, et al.: Hemostatic laparoscopic partial nephrectomy: initial experience with the radiofrequency coagulation-assisted technique. Urology 2001, 58:8–11.

    Article  PubMed  CAS  Google Scholar 

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Janzen, N., Zisman, A., Pantuck, A.J. et al. Minimally invasive ablative approaches in the treatment of renal cell carcinoma. Curr Urol Rep 3, 13–20 (2002). https://doi.org/10.1007/s11934-002-0005-8

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