title: Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer.
abstract: OBJECTIVE
  Few studies report long-term follow-up of renal cancer treated by radiofrequency ablation (RFA), thus limiting the comparison of this modality to well-established long-term follow-up series of surgically resected renal masses. Herein, we report long-term oncologic outcomes of renal cancer treated with RFA in a single institution.
  
  
  METHODS
  We retrospectively reviewed patients treated between November 2001 and October 2012 with laparoscopic-guided or computed tomography-guided RFA. All treatments were performed with real-time thermometry ensuring target ablation temperature (>60°C) was adequately reached. Only patients with biopsy-confirmed T1a-category cancer and a follow-up period>48 months were included in our analysis. Follow-up included office visits, laboratory work, and periodic contrast-enhanced imaging. Survival was calculated using the Kaplan-Meier analysis. Overall complications were reported using the Clavien-Dindo scale.
  
  
  RESULTS
  Of 434 RFA cases, 53 treatments in 50 patients met the inclusion criteria. Of these, 29 were treated with computed tomography-guided RFA and 24 with laparoscopic-guided RFA. The mean follow-up interval was 65.6 months (48.5-120.2), and the mean renal mass size was 2.3 cm (0.3-4.0). There were 4 (7.5%) local recurrences and 1 case of distant metastases with no local recurrence. The 5-year overall survival was 98%, cancer-specific survival was 100%, and recurrence-free survival was 92.5%. The complication rate was 26.4%, which included 71% of Clavien-Dindo grade I and 29% of grade II. Mean estimated glomerular filtration rate preoperatively and at the most recent follow-up visit was 77 and 66 ml/min, respectively.
  
  
  CONCLUSIONS
  When performed on selected patients, while monitoring real-time temperatures to ensure adequate treatment end points, RFA offers favorable long-term oncologic outcomes approaching those reported for partial nephrectomy.
authors.affiliation: Department of Urology, University of Miami, Miller School of Medicine, Miami, FL. Electronic address: glorber@med.miami.edu.
authors.forename: Gideon
authors.initials: G
authors.lastname: Lorber
authors.affiliation: Florida International University, College of Medicine, Miami, FL.
authors.forename: Michael
authors.initials: M
authors.lastname: Glamore
authors.affiliation: Department of Vascular and Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Mehul
authors.initials: M
authors.lastname: Doshi
authors.affiliation: Department of Pathology, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Merce
authors.initials: M
authors.lastname: Jorda
authors.affiliation: Department of Radiology, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Gaston
authors.initials: G
authors.lastname: Morillo-Burgos
authors.affiliation: Department of Urology, University of Miami, Miller School of Medicine, Miami, FL.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Leveillee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Image-guided therapy; Laparoscopy; Malignant disease; Percutaneous renal surgery; Renal cancer; Thermal ablation