Radiofrequency ablation (RFA) of renal cell carcinoma (RCC): experience in 200 tumours. (22nd October 2013)

• Record Type: Journal Article
• Authors: Wah, Tze M.; Irving, Henry C.; Gregory, Walter; Cartledge, Jon; Joyce, Adrian D.; Selby, Peter J.
• Is Part Of: BJU international. Volume 113:Number 3(2014:Mar.)
• Page Start: 416
• Page End: 428
• Publication Date: 2013-10-22
• Subjects: Genitourinary organs -- Diseases -- Periodicals; Genitourinary organs -- Surgery -- Periodicals; Urology -- Periodicals; 616.6
• DOI: 10.1111/bju.12349
• Languages: English
• ISSNs: 1464-4096

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bju12349-sec-0001" sec-type="section"> <title>Objectives</title> <p> <list id="bju12349-list-0001" list-type="bullet"> <list-item> <p>To evaluate our clinical experience with percutaneous image‐guided radiofrequency ablation (RFA) of 200 renal tumours in a large tertiary referral university institution.</p> </list-item> </list> </p> </sec> <sec id="bju12349-sec-0002" sec-type="section"> <title>Patients and Methods</title> <p> <list id="bju12349-list-0002" list-type="bullet"> <list-item> <p>Image‐guided RFA (ultrasonography or computed tomography [CT]) of 200 renal tumours in 165 patients from June 2004 to 2012 was prospectively evaluated. Institutional Review Board approval was granted.</p> </list-item> <list-item> <p>The treatment response and technical success were defined by absence of contrast enhancement within the tumour on contrast enhanced CT or magnetic resonance imaging.</p> </list-item> <list-item> <p>Both major and minor complications, glomerular filtration rate (GFR) before and after RFA, the management and outcomes of the complications, as well as oncological outcome were prospectively documented.</p> </list-item> <list-item> <p>Multivariate analysis was used to determine variables associated with major complications and also the percentage GFR change after RFA.</p> </list-item> <list-item> <p>The overall (OS), 5‐year cancer‐specific (CSS), local recurrence‐free (LRFS) and metastasis‐free survival (MFS) rates are presented using the Kaplan–Meier curves.</p> </list-item> </list> </p> </sec> <sec id="bju12349-sec-0003" sec-type="section"> <title>Results</title> <p> <list id="bju12349-list-0003" list-type="bullet"> <list-item> <p>In all, 200 tumours were RF ablated with a mean (range) tumour size of 2.9 (1–5.6) cm and the mean (range) patient age was 67.7 (21–88.6) years with a mean follow‐up period of 46.1 months.</p> </list-item> <list-item> <p>The primary technical and overall technical success rate was 95.5% and 98.5%, respectively. Two independent predictors of successful RFA in a single sitting were tumour size (<3 cm) and exophytic location in multivariate logistic regression analysis.</p> </list-item> <list-item> <p>Major complications included ureteric injury (six patients), calyceal‐cutaneous fistula (one), acute tubular necrosis (one) and abscess (two). Two independent predictors of ureteric injury were central location and lower pole position.</p> </list-item> <list-item> <p>Within this cohort of patients, only four patients developed significant renal function deterioration i.e. >25% decreased in GFR. In all, 161 (98%) patients of the 165 patients have preservation of renal function. Any change in renal function after RFA was not influenced by tumour factors or solitary kidney status.</p> </list-item> <list-item> <p>In our clinical series, this yielded a 5‐year OS, CSS, LRFS and MFS rates of 75.8%, 97.9%, 93.5% and 87.7% respectively.</p> </list-item> </list> </p> </sec> <sec id="bju12349-sec-0004" sec-type="section"> <title>Conclusions</title> <p> <list id="bju12349-list-0004" list-type="bullet"> <list-item> <p>Image‐guided RFA is a safe, nephron sparing and effective treatment for small renal cell carcinoma (RCC) tumours with a low rate of recurrence and has good 5‐year CSS and MFS rates.</p> </list-item> </list> </p> </sec> </abstract>