DOI QR코드

DOI QR Code

CT-Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma in Korea: Mid-Term Outcomes

  • Kim, Hae Jin (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Byung Kwan (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Jung Jae (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Chan Kyo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2016.02.01
  • Accepted : 2016.04.22
  • Published : 2016.09.01

Abstract

Objective: To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. Materials and Methods: Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsy-proven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0-3.9 cm) and 26 months (4-60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. Results: Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were $87.1mL/min/1.73m^2$ ($14.2-142.7mL/min/1.73m^2$) and $72.0mL/min/1.73m^2$ ($7.2-112.6mL/min/1.73m^2$), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. Conclusion: CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes.

Keywords

References

  1. Zagoria RJ, Pettus JA, Rogers M, Werle DM, Childs D, Leyendecker JR. Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology 2011;77:1393-1397 https://doi.org/10.1016/j.urology.2010.12.077
  2. Psutka SP, Feldman AS, McDougal WS, McGovern FJ, Mueller P, Gervais DA. Long-term oncologic outcomes after radiofrequency ablation for T1 renal cell carcinoma. Eur Urol 2013;63:486-492 https://doi.org/10.1016/j.eururo.2012.08.062
  3. Lorber G, Glamore M, Doshi M, Jorda M, Morillo-Burgos G, Leveillee RJ. Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer. Urol Oncol 2014;32:1017-1023 https://doi.org/10.1016/j.urolonc.2014.03.005
  4. Chang X, Liu T, Zhang F, Ji C, Zhao X, Wang W, et al. Radiofrequency ablation versus partial nephrectomy for clinical T1a renal-cell carcinoma: long-term clinical and oncologic outcomes based on a propensity score analysis. J Endourol 2015;29:518-525 https://doi.org/10.1089/end.2014.0864
  5. Park BK, Morrison PR, Tatli S, Govindarajulu U, Tuncali K, Judy P, et al. Estimated effective dose of CT-guided percutaneous cryoablation of liver tumors. Eur J Radiol 2012;81:1702-1706 https://doi.org/10.1016/j.ejrad.2011.04.067
  6. Park BK, Kim CK, Lee HM. Image-guided radiofrequency ablation of Bosniak category III or IV cystic renal tumors: initial clinical experience. Eur Radiol 2008;18:1519-1525 https://doi.org/10.1007/s00330-008-0891-3
  7. Park JJ, Park BK, Park SY, Kim CK. Percutaneous radiofrequency ablation of sporadic Bosniak III or IV lesions: treatment techniques and short-term outcomes. J Vasc Interv Radiol 2015;26:46-54 https://doi.org/10.1016/j.jvir.2014.09.014
  8. Goldberg SN, Grassi CJ, Cardella JF, Charboneau JW, Dodd GD 3rd, Dupuy DE, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2009;20(7 Suppl):S377-S390 https://doi.org/10.1016/j.jvir.2009.04.011
  9. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-470 https://doi.org/10.7326/0003-4819-130-6-199903160-00002
  10. Huda W, Ogden KM, Khorasani MR. Converting dose-length product to effective dose at CT. Radiology 2008;248:995-1003 https://doi.org/10.1148/radiol.2483071964
  11. Cardella JF, Kundu S, Miller DL, Millward SF, Sacks D; Society of Interventional Radiology. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2009;20(7 Suppl):S189-S191 https://doi.org/10.1016/j.jvir.2009.04.035
  12. Chae EJ, Kim JK, Kim SH, Bae SJ, Cho KS. Renal cell carcinoma: analysis of postoperative recurrence patterns. Radiology 2005;234:189-196 https://doi.org/10.1148/radiol.2341031733
  13. Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005;185:64-71 https://doi.org/10.2214/ajr.185.1.01850064
  14. Park BK, Kim CK, Choi HY, Lee HM, Jeon SS, Seo SI, et al. Limitation for performing ultrasound-guided radiofrequency ablation of small renal masses. Eur J Radiol 2010;75:248-252 https://doi.org/10.1016/j.ejrad.2009.03.050
  15. Allaf ME, Varkarakis IM, Bhayani SB, Inagaki T, Kavoussi LR, Solomon SB. Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation--initial observations. Radiology 2005;237:366-370 https://doi.org/10.1148/radiol.2371040829
  16. Sung HH, Park BK, Kim CK, Choi HY, Lee HM. Comparison of percutaneous radiofrequency ablation and open partial nephrectomy for the treatment of size- and location-matched renal masses. Int J Hyperthermia 2012;28:227-234 https://doi.org/10.3109/02656736.2012.666319
  17. Park SY, Park BK, Kim CK. Thermal ablation in renal cell carcinoma: what affects renal function? Int J Hyperthermia 2012;28:729-734 https://doi.org/10.3109/02656736.2012.728017
  18. Park BK, Kim CK. Percutaneous radio frequency ablation of renal tumors in patients with von Hippel-Lindau disease: preliminary results. J Urol 2010;183:1703-1707 https://doi.org/10.1016/j.juro.2010.01.022
  19. Park SY, Park BK, Kim CK, Lee HM, Jeon SS, Seo SI, et al. Percutaneous radiofrequency ablation of renal cell carcinomas in patients with von Hippel Lindau disease previously undergoing a radical nephrectomy or repeated nephron-sparing surgery. Acta Radiol 2011;52:680-685 https://doi.org/10.1258/ar.2011.100435
  20. Park BK, Kim CK, Park SY, Shen SH. Percutaneous radiofrequency ablation of renal cell carcinomas in patients with von Hippel Lindau disease: indications, techniques, complications, and outcomes. Acta Radiol 2013;54:418-427 https://doi.org/10.1177/0284185113475441
  21. Park BK, Kim CK. Complications of image-guided radiofrequency ablation of renal cell carcinoma: causes, imaging features and prevention methods. Eur Radiol 2009;19:2180-2190 https://doi.org/10.1007/s00330-009-1399-1
  22. Meloni MF, Goldberg SN, Moser V, Piazza G, Livraghi T. Colonic perforation and abscess following radiofrequency ablation treatment of hepatoma. Eur J Ultrasound 2002;15:73-76 https://doi.org/10.1016/S0929-8266(01)00171-9
  23. Park BK, Kim CK, Moo HL. Arteriovenous fistula after radiofrequency ablation of a renal tumor located within the renal sinus. J Vasc Interv Radiol 2007;18:1183-1185 https://doi.org/10.1016/j.jvir.2007.06.015
  24. Eisenberg JD, Gervais DA, Singh S, Kalra MK, Sabir SH, Paul AB, et al. Radiation exposure from CT-guided ablation of renal masses: effects on life expectancy. AJR Am J Roentgenol 2015;204:335-342 https://doi.org/10.2214/AJR.14.13010
  25. Tsalafoutas IA, Tsapaki V, Triantopoulou C, Gorantonaki A, Papailiou J. CT-guided interventional procedures without CT fluoroscopy assistance: patient effective dose and absorbed dose considerations. AJR Am J Roentgenol 2007;188:1479-1484 https://doi.org/10.2214/AJR.06.0705

Cited by

  1. Renal Cell Carcinoma: Alternative Nephron-Sparing Treatment Options for Small Renal Masses, a Systematic Review vol.31, pp.10, 2017, https://doi.org/10.1089/end.2017.0382
  2. RFA versus robotic partial nephrectomy for T1a renal cell carcinoma: a propensity score-matched comparison of mid-term outcome vol.28, pp.7, 2016, https://doi.org/10.1007/s00330-018-5305-6
  3. Low-dose CT protocols for guiding radiofrequency ablation for the treatment of small renal cell carcinomas vol.34, pp.6, 2016, https://doi.org/10.1080/02656736.2017.1373408
  4. Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: risk factors analysis of 171 tumors vol.35, pp.1, 2018, https://doi.org/10.1080/02656736.2018.1475684
  5. Comparison of General Anesthesia and Conscious Sedation During Computed Tomography–Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma vol.69, pp.1, 2016, https://doi.org/10.1016/j.carj.2017.07.003
  6. Radiofrequency ablation for the treatment of knee osteoarthritis: present status and future perspectives vol.34, pp.8, 2016, https://doi.org/10.1080/02656736.2017.1413716
  7. Adjunctive Thermoprotection During Percutaneous Thermal Ablation Procedures: Review of Current Techniques vol.42, pp.3, 2016, https://doi.org/10.1007/s00270-018-2089-7
  8. Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center vol.12, pp.5, 2020, https://doi.org/10.3390/cancers12051183
  9. Performance of a New Blunt-Tip Needle for the Displacement of Critical Structure in Thermal Ablation vol.43, pp.6, 2016, https://doi.org/10.1007/s00270-020-02472-y
  10. Real-Time US-CT fusion imaging for guidance of thermal ablation in of renal tumors invisible or poorly visible with US: results in 97 cases vol.38, pp.1, 2021, https://doi.org/10.1080/02656736.2021.1923837
  11. Percutaneous Microwave Ablation of Category T1a Renal Cell Carcinoma: Intermediate Results on Safety, Technical Feasibility, and Clinical Outcomes of 119 Tumors vol.216, pp.1, 2016, https://doi.org/10.2214/ajr.20.22818
  12. Outcomes of Percutaneous Thermal Ablation for Biopsy-Proven T1a Renal Cell Carcinoma in Patients With Other Primary Malignancies vol.217, pp.1, 2016, https://doi.org/10.2214/ajr.19.22520