Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience

Abstract

Purpose: To analyze the outcome of patients undergoing percutaneous CT-guided radiofrequency ablation (RFA) of small renal masses (SRM) at a single center during a ten-year time period.

Materials and Methods: Patient records of renal RFAs (07/2003 – 11/2013) were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity; old age; solitary kidney; impaired renal function; patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Patient and procedural characteristics were recorded. Survival rates were calculated using the Kaplan-Meier’s method and compared with log-rank or cox tests.

Results: 38 patients (16 females, mean age 70.0 years [range 52 – 87]) presenting with a solitary SRM were included in the study. Biopsy showed malignancy in 29 patients; 9 had benign tumors. 26 patients suffered from cardiovascular, respiratory or hepatic comorbidities. Technical success (complete ablation on first follow-up) was achieved in 95 % of cases. Two major complications (bowel perforation; hematothorax) occurred. The 3- and 7-year overall survival (OS) [any cause] rates were 73.4 ± 0.8 % and 50.3 ± 1.0 %, respectively (mean follow-up 54.6 months, range 1 – 127). 4 recurrences and 2 metastases were observed. The presence of comorbidities was the only independent predictor of OS. There was no difference in survival between patients with benign and malignant tumors.

Conclusion: RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control. As RFA is typically performed in multimorbid patients, overall survival seems to depend primarily on comorbidities rather than cancer progression.

Key Points

• RFA of SRM is technically successful in the majority of cases.

• RFA leads to a high degree of local tumor control.

• Post-RFA most patients ultimately die of comorbidities.

• Overall survival post-RFA does not significantly differ between benign and malignant tumors in multimorbid patients.

Citation Format:

• Pieper C. C., Fischer S., Strunk H. et al. Percutaneous CT-Guided Radiofrequency Ablation of Solitary Small Renal Masses: A Single Center Experience. Fortschr Röntgenstr 2015; 187: 577 – 583

Zusammenfassung

Ziel: Analyse der Überlebensraten nach perkutaner CT-gesteuerter Radiofrequenzablation (RFA) von kleinen solitären Nierentumoren in einem Zeitraum von zehn Jahren.

Material und Methoden: Die Patientendaten aller renalen RFAs von 07/2003 bis 11/2013 wurden gesichtet. Die Indikationen zur RFA waren eine bildgebend malignomverdächtige Nierenläsion sowie schwere Komorbiditäten, ein hohes Patientenalter, Vorliegen einer Einzelniere, eine eingeschränkte Nierenfunktion, oder der ausdrückliche Patientenwunsch. Biopsien wurden zum Zeitpunkt der RFA entnommen. Patienten ohne Follow-Up-Untersuchungen wurden von der Auswertung ausgeschlossen. Patienten-bezogene und prozedurale Parameter wurden erfasst. Überlebensraten wurden nach der Kaplan-Meier-Methode berechnet und mittels Log-Rank- bzw. Cox-Test verglichen.

Ergebnisse: Insgesamt wurden 38 Patienten (16 weiblich, mittleres Alter 70,0; 52 – 87 Jahre) mit solitären Nierentumoren in die Studie eingeschlossen (Histologie: 29 maligne, 9 benigne Tumoren). Davon litten 26 Patienten an zusätzlichen kardiovaskulären, pulmonalen oder hepatischen Komorbiditäten. 95 % der RFAs waren technisch erfolgreich (komplette Ablation in der ersten Verlaufsuntersuchung). Es wurden 2 Majorkomplikationen (Darmperforation, Hämatothorax) beobachtet. 3- und 7-Jahres–Gesamtüberlebensraten (jede Todesursache) betrugen jeweils 73,4 ± 0,8 % und 50,3 ± 1,0 % (mittleres Follow-up 54,6 [1 – 127] Monate). Nach RFA wurden 4 Rezidive und 2 neu aufgetretene Metastasen beobachtet. Das Vorliegen von Komorbiditäten war der einzige unabhängige Prädiktor des Gesamtüberlebens. Der Vergleich von Patienten mit benignen und malignen Tumoren ergab keinen signifikanten Unterschied in den Überlebensraten.

Schlussfolgerung: Die RFA von kleinen solitären Nierentumoren ist, bei niedrigen Komplikationsraten, zu einem hohen Prozentsatz technisch erfolgreich und verschafft eine dauerhafte lokale Tumorkontrolle. Das Gesamtüberleben nach RFA hängt bei multimorbiden Patienten primär von Komorbiditäten und weniger vom Tumorprogress ab.

Kernaussagen:

• Die RFA von Nierentumoren hat eine hohe technische Erfolgsrate.

• Durch RFA ist ein hohes Maß an lokaler Tumorkontrolle zu erreichen.

• Nach Therapie versterben die meisten Patienten letztendlich an Komorbiditäten.

• Das Gesamtüberleben nach RFA bei benignen und malignen Tumoren unterscheidet sich bei multimorbiden Patienten nicht.

Key words

abdomen - urinary - ablation procedures - radiofrequency (RF) ablation

• References

• 1 Georgiades C, Rodriguez R. Renal tumor ablation. Tech Vasc Interv Radiol 2013; 16: 230-238
• 2 Volpe A, Panzarella T, Rendon RA et al. The natural history of incidentally detected small renal masses. Cancer 2004; 100: 738-745
• 3 Bosniak MA, Birnbaum BA, Krinsky GA et al. Small renal parenchymal neoplasms: further observations on growth. Radiology 1995; 197: 589-597
• 4 Homma Y, Kawabe K, Kitamura T et al. Increased incidental detection and reduced mortality in renal cancer--recent retrospective analysis at eight institutions. Int J Urol 1995; 2: 77-80
• 5 O'Malley RL, Hayn MH, Hellenthal NJ et al. Safety and outcomes of surgical treatment of renal cell carcinoma in the elderly. Can J Urol 2012; 19: 6111-6117
• 6 Campbell SC, Novick AC, Belldegrun A et al. Practice Guidelines Committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182: 1271-1279
• 7 Stern JM, Svatek R, Park S et al. Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours. BJU Int 2007; 100: 287-290
• 8 Park S, Strup SE, Saboorian H et al. No evidence of disease after radiofrequency ablation in delayed nephrectomy specimens. Urology 2006; 68: 964-967
• 9 National Kidney Foundation. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements 2013; 3: 136-150
• 10 World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191-2194
• 11 Levey AS, Juan P, Bosch JD et al. for the Modification of Diet in Renal Disease Study Group: A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation. Ann Intern Med 1999; 130: 461-470
• 12 Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol 1969; 101: 297-301
• 13 Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol 2010; 183: 473-479
• 14 Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001; 166: 6-18
• 15 Baillargeon-Gagné S, Jeldres C, Lughezzani G et al. A comparative population-based analysis of the rate of partial vs radical nephrectomy for clinically localized renal cell carcinoma. BJU Int 2010; 105: 359-364
• 16 Thompson RH, Kurta JM, Kaag M et al. Tumor size is associated with malignant potential in renal cell carcinoma cases. J Urol 2009; 181: 2033-2036
• 17 Hsu RM, Chan DY, Siegelman SS. Small renal cell carcinomas: correlation of size with tumor stage, nuclear grade, and histologic subtype. Am J Roentgenol Am J Roentgenol 2004; 182: 551-557
• 18 Tracy CR, Raman JD, Donnally C et al. Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years. Cancer 2010 ; 116: 3135-3142
• 19 Tacke J, Mahnken AH, Günther RW. Percutaneous thermal ablation of renal neoplasms. Rofo 2005; 177: 1631-1640
• 20 Psutka SP, Feldman AS, McDougal WS et al. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 2013; 63: 486-492
• 21 Zagoria RJ, Pettus JA, Rogers M et al. Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology 2011; 77: 1393-1397
• 22 Balageas P, Cornelis F, Le Bras Y et al. Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients. Eur Radiol 2013; 23: 1925-1932
• 23 Hiraoka K, Kawauchi A, Nakamura T et al. Radiofrequency ablation for renal tumors: our experience. Int J Urol 2009; 16: 869-873
• 24 Hui GC, Tuncali K, Tatli S et al. Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol 2008; 19: 1311-1320
• 25 Tsoumakidou G, Buy X, Garnon J et al. Percutaneous thermal ablation: how to protect the surrounding organs. Tech Vasc Interv Radiol 2011; 14: 170-176
• 26 Gupta P, Allen BC, Chen MY et al. Renal function outcomes for multifocal renal neoplasms managed by radiofrequency ablation. Cardiovasc Intervent Radiol 2013; 36: 1329-1335
• 27 Pettus JA, Werle DM, Saunders W et al. Percutaneous radiofrequency ablation does not affect glomerular filtration rate. J Endourol 2010; 24: 1687-1691
• 28 Cornelis F, Buy X, Andre M et al. De novo renal tumors arising in kidney transplants: midterm outcome after percutaneous thermal ablation. Radiology 2011; 260: 900-907
• 29 Corcoran AT, Russo P, Lowrance WT et al. A review of contemporary data on surgically resected renal masses--benign or malignant?. Urology 2013; 81: 707-713
• 30 Millet I, Doyon FC, Hoa D et al. Characterization of small solid renal lesions: can benign and malignant tumors be differentiated with CT?. Am J Roentgenol Am J Roentgenol 2011; 197: 887-896
• 31 Remzi M, Katzenbeisser D, Waldert M et al. Renal tumour size measured radiologically before surgery is an unreliable variable for predicting histopathological features: benign tumours are not necessarily small. BJU Int 2007; 99: 1002-1006
• 32 Grimaldi G, Reuter V, Russo P. Bilateral non-familial renal cell carcinoma. Ann Surg Oncol 1998; 5: 548-552
• 33 Maher ER, Yates JR. Familial renal cell carcinoma: clinical and molecular genetic aspects. Br J Cancer 1991; 63: 176-179
• 34 Minardi D, Lucarini G, Mazzucchelli R et al. Prognostic role of Fuhrman grade and vascular endothelial growth factor in pT1a clear cell carcinoma in partial nephrectomy specimens. J Urol 2005; 174: 1208-1212
• 35 Takaki H, Yamakado K, Soga N et al. Midterm results of radiofrequency ablation versus nephrectomy for T1a renal cell carcinoma. Jpn J Radiol 2010; 28: 460-468