title: Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: size matters.
abstract: OBJECTIVE
  Renal tumor size influences the efficacy of radio frequency ablation but identification of confident size cutoffs has been limited by small numbers and short followup. We evaluated tumor size related outcomes after radio frequency ablation for patients with adequate (greater than 3 years) followup.
  
  
  METHODS
  We identified 159 tumors treated with radio frequency ablation as primary treatment. Disease-free survival was defined as the time from definitive treatment to local recurrence, detection of metastasis or the most recent imaging showing no evidence of disease. Patients were evaluated with contrast enhancing imaging preoperatively, and at 6 weeks, 6 months and at least annually thereafter.
  
  
  RESULTS
  Median tumor size was 2.4 cm (range 0.9 to 5.4) with a median followup of 54 months (range 1.5 to 120). Renal cell carcinoma was confirmed in 72% of the 150 tumors that had pre-ablation biopsy (94%). The 3 and 5-year disease-free survival was comparable at 92% and 91% overall, and was dependent on tumor size, being 96% and 95% for tumors smaller than 3.0 cm and 79% and 79%, respectively, for tumors 3 cm or larger (p=0.001). Most failures (14 of 18) were local, either incomplete ablations or local recurrences. This is an intent to treat analysis and, therefore, includes patients ultimately found to have benign tumors, although outcomes were comparable in patients with cancer.
  
  
  CONCLUSIONS
  Radio frequency ablation treatment success of the small renal mass is strongly correlated with tumor size. Radio frequency ablation provides excellent and durable outcomes, particularly in tumors smaller than 3 cm. Of tumors 3 cm or larger, approximately 20% will recur such that alternative treatment techniques should be considered. However, most treatment failures are local and are often successfully treated with another ablation session.
authors.affiliation: Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-6856, USA.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Best
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Park
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Yaacoub
authors.forename: Ephrem O
authors.initials: EO
authors.lastname: Olweny
authors.forename: Yung K
authors.initials: YK
authors.lastname: Tan
authors.forename: Clayton
authors.initials: C
authors.lastname: Trimmer
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cadeddu
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden