Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass.
OBJECTIVE
We present long-term outcomes in patients receiving RFA for solitary small renal masses.


METHODS
We reviewed the overall oncological and survival outcomes of patients with a solitary renal mass treated with radio frequency ablation in whom it had been at least 40 months since treatment. Patients were offered radio frequency ablation due to the high risk of surgical management and surgeon preference. Followup consisted of serum creatinine measurement, physical examination and serial contrast enhanced computerized tomography or magnetic resonance imaging.


RESULTS
The 31 patients received a total of 34 radio frequency ablation treatments to a 1.0 to 4.0 cm solitary renal mass (median 2.0). Mean followup in survivors was 61.6 months (median 62.4, range 41 to 80). There was 1 primary treatment failure, which was successfully retreated. There were 3 recurrences 7, 13 and 31 months after radio frequency ablation, respectively. The overall recurrence-free survival rate was 90.3%. There was a 100% metastasis-free and disease specific survival rate in the cohort. Overall patient survival was 71.0% since 9 died of nonrenal cell carcinoma causes. Of the 31 patients 18 had pathologically confirmed renal cell carcinoma. In these 18 cases the actuarial disease specific, metastasis-free, recurrence-free and overall survival rates were 100%, 100%, 79.9% and 58.3%, respectively, at a mean of 57.4 months of followup. In the entire cohort the difference between the pretreatment and the last known serum creatinine level was 0.15 mg/dl (p = 0.06).


CONCLUSIONS
In patients who have limited life expectancy or are high risk surgical candidates radio frequency ablation provides reasonable long-term oncological control and it may have a role in the management of small renal masses. Meticulous long-term followup is required in patients receiving radio frequency ablation.
The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. doctorlevinson@gmail.com
Adam W
AW
Levinson
Li-Ming
LM
Su
Devesh
D
Agarwal
Myrna
M
Sroka
Thomas W
TW
Jarrett
Louis R
LR
Kavoussi
Stephen B
SB
Solomon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009367:Neoplasm Staging; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome