Renal Radiofrequency Ablation

ABSTRACT

Radiofrequency ablation (RFA) is a technique that has been available for a considerable period of time. Although initially performed for ablating abnormal conduction pathways in the heart, the concept soon spread to include destruction of tumor tissue. This was first demonstrated with liver tumors, both hepatocellular carcinoma and metastatic disease.[1] [2] [3] [4] [5] Following the favorable early results with liver tumors, the kidney became the next focus of attention for RFA. There are many reasons that a technique such as RFA is useful in treating renal cell carcinoma (RCC) and also why the kidney is a suitable organ for successful RFA.

The incidence of RCC is rising.[6] In addition, the exponential increase in cross-sectional imaging as a first-line investigation for a myriad of indications has resulted in the earlier detection of renal tumors that are asymptomatic and would remain otherwise undetected. The natural history of RCC is extremely variable and, although some tumors are aggressive, many of these tumors grow slowly and are slow to metastasize. This presents a difficult clinical problem. Despite the relative indolence of RCC, predicting the course of any one cancer is impossible, and once detected, the clinician feels obligated to treat the disease. While this may seem entirely appropriate in most settings, it is not so clear, for example, if a nephrectomy for a 2 cm RCC is warranted in an 85-year-old patient with contralateral renal impairment. Given the morbidity and mortality associated with nephrectomy, often for small and indolent tumors, less invasive techniques have been sought for treating these tumors. This has led to the development of nephron-sparing surgery[7] [8] or partial nephrectomy, which at least preserves renal function and is less likely to result in the patient requiring dialysis following the procedure. There is, however, a substantial morbidity and mortality related to partial nephrectomy and a percutaneous technique of tumor treatment, particularly in patients who are high risk for surgical procedures, is desirable. Percutaneous RFA of renal tumors allows for localized tumor destruction and preservation of uninvolved renal parenchyma. It is the ability to treat tumor and maintain renal function that makes renal RFA such an attractive treatment option. Some patients have RCC in a solitary kidney. In both these scenarios, any renal function that is preserved may help keep the patient off dialysis.

KEYWORDS

Radiofrequency (RF) ablation - renal cell carcinoma - percutaneous

REFERENCES

• 1 Solbiati L, Livraghi T, Goldberg S N. et al . Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients.  Radiology . 2001;  221 159-166
• 2 Livraghi T, Goldberg S N, Solbiati L, Meloni F, Ierace T, Gazelle G S. Percutaneous radio-frequency ablation of liver metastases from breast cancer: initial experience in 24 patients.  Radiology . 2001;  220 145-149
• 3 Solbiati L, Goldberg S N, Ierace T. et al . Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes.  Radiology . 1997;  205 367-373
• 4 Rossi S, Buscarini E, Garbagnati F. et al . Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.  AJR Am J Roentgenol . 1998;  170 1015-1022
• 5 Buscarini L, Buscarini E, Di Stasi M, Vallisa D, Quaretti P, Rocca A. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results.  Eur Radiol . 2001;  11 914-921
• 6 Zagoria R J. Imaging of small renal masses: a medical success story.  AJR Am J Roentgenol . 2000;  175 945-955
• 7 Filipas D, Fichtner J, Spix C. et al . Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients.  Urology . 2000;  56 387-392
• 8 Ghavamian R, Cheville J C, Lohse C M, Weaver A L, Zincke H, Blute M L. Renal cell carcinoma in the solitary kidney: an analysis of complications and outcome after nephron sparing surgery.  J Urol . 2002;  168 454-459
• 9 Moreland W S, Zagoria R J, Geisinger K R. Use of fine needle aspiration biopsy in radiofrequency ablation.  Acta Cytol . 2002;  46 819-822
• 10 Arellano R S, Harisinghani M G, Gervais D A, Hahn P F, Mueller P R. Image-guided percutaneous biopsy of the adrenal gland: review of indications, technique, and complications.  Curr Probl Diagn Radiol . 2003;  32 3-10
• 11 Zlotta A R, Wildschutz T, Raviv G. et al . Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience.  J Endourol . 1997;  11 251-258
• 12 Gervais D A, McGovern F J, Wood B J, Goldberg S N, McDougal W S, Mueller P R. Radio-frequency ablation of renal cell carcinoma: early clinical experience.  Radiology . 2000;  217 665-672
• 13 Roy-Choudhury S H, Cast J E, Cooksey G, Puri S, Breen D J. Early experience with percutaneous radiofrequency ablation of small solid renal masses.  AJR Am J Roentgenol . 2003;  180 1055-1061
• 14 Farrell M A, Charboneau W J, DiMarco D S. et al . Imaging-guided radiofrequency ablation of solid renal tumors.  AJR Am J Roentgenol . 2003;  180 1509-1513
• 15 Mayo-Smith W W, Dupuy D E, Parikh P M, Pezzullo J A, Cronan J J. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: techniques and outcomes of 38 treatment sessions in 32 consecutive patients.  AJR Am J Roentgenol . 2003;  180 1503-1508
• 16 Gervais D A, McGovern F J, Arellano R S, McDougal W S, Mueller P R. Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors.  Radiology . 2003;  226 417-424
• 17 Su L M, Jarrett T W, Chan D Y, Kavoussi L R, Solomon S B. Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: preliminary results.  Urology . 2003;  61(4 suppl 1) 26-33
• 18 Ogan K, Jacomides L, Dolmatch B L. et al . Percutaneous radiofrequency ablation of renal tumors: technique, limitations, and morbidity.  Urology . 2002;  60 954-958
• 19 Pavlovich C P, Walther M M, Choyke P L. et al . Percutaneous radio frequency ablation of small renal tumors: initial results.  J Urol . 2002;  167 10-15