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
