Radio-frequency ablation of renal cell carcinoma in patients who were at significant risk.
OBJECTIVE
Although radio-frequency ablation (RFA) has been recently applied as a minimally invasive treatment option for renal cell carcinoma (RCC), indication of this modality remains a critical issue due to the lack of complete tumor destruction as well as the uncertainty of its long-term efficacy. We report the efficacy of RFA for nine carefully selected patients with RCC who had significant reason to avoid invasive surgical treatment under general anesthesia.


METHODS
Radio-frequency ablation was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in nine patients with biopsy proven RCC (mean diameter, 38 mm; range, 20-53 mm), who were at significant operative or anesthetic risk for invasive surgery. Follow-up enhanced CT scans or magnetic resonance images were evaluated every 3-6 months and an evaluation of metastasis was performed every 6 months.


RESULTS
At a mean follow-up of 17 months, seven (78%) of the nine patients with renal tumor showed no tumor enhancement. The renal function of all patients was well preserved. All patients were able to continue undergoing their respective treatments for active diseases in other organs in parallel to the RFA treatment. No distant metastasis, urine leakage were reported and one case of temporary hematuria and one case of peri-renal hemorrhage not requiring blood transfusion were encountered. Intra-operative ultrasonography was useful in the real-time monitoring of the minimally excessive extension of ablation into the normal parenchyma.


CONCLUSIONS
Radio-frequency ablation appears to be an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia.
Ukimura
Osamu
O
Department of Urology, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kyoto 602-8566, Japan. ukimura@koto.kpu-m.ac.jp
Kawauchi
Akihiro
A
Fujito
Akira
A
Mizutani
Yoichi
Y
Okihara
Koji
K
Mikami
Kazuya
K
Soh
Jintetsu
J
Nakamura
Terukazu
T
Nakanishi
Hiroyuki
H
Ushijima
So
S
Miki
Tsuneharu
T
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation; D000075202:Contraindications; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy; D016896:Treatment Outcome