Effectiveness and safety of computed tomography-guided radiofrequency ablation of renal cancer: a 14-year single institution experience in 203 patients

• Published in: European radiology Vol. 26; no. 6; pp. 1656 - 1664
• Main Authors: Iannuccilli, Jason D., Dupuy, Damian E., Beland, Michael D., Machan, Jason T., Golijanin, Dragan J., Mayo-Smith, William W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2016; Springer Nature B.V
• Subjects: Ablation; Adult; Aged; Aged, 80 and over; Biopsy; Carcinoma, Renal Cell - pathology; Catheter Ablation - methods; Cohort Studies; Diagnostic Radiology; Electrodes; Female; Follow-Up Studies; Hospitals; Humans; Imaging; Internal Medicine; Interventional; Interventional Radiology; Kidney - diagnostic imaging; Kidney - surgery; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - surgery; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neuroradiology; Patients; Radiography, Interventional - methods; Radiology; Retrospective Studies; Success; Surgery; Tomography; Tomography, X-Ray Computed - methods; Treatment Outcome; Tumors; Ultrasound; Rhode Island; United States > US; Radiofrequency ablation; Tumour ablation; Kidney neoplasm; Nephrectomy; Renal cell carcinoma
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-4006-7

Objectives
To define effectiveness and safety of CT-guided radiofrequency ablation (RFA) of renal tumours and prognostic indicators for treatment success.
Methods
Patients with a single treatment of a solitary, biopsy-proven renal tumour with intent to cure over a 14-year period were included (n = 203). Probability of residual disease over time, complication rates and all-cause mortality were assessed in relation to multiple variables.
Results
Mean tumour size was 2.5 cm (range 1.0–6.0). Mean follow-up was 34.1 months (range 1–131). There was an increase in likelihood of residual disease for tumours ≥3.5 cm (P < 0.05), clear cell subtype of renal cell carcinoma (P ≤ 0.005) and maximum treatment temperature ≤70 °C (P < 0.05). There was a decrease in likelihood of residual disease for exophytic tumours (P = 0.01) and no difference based on age, gender, tumour location or type of radio freqency (RF) electrode used. Major complications occurred in 3.9 %. Median post-treatment survival was 7 years for patients with tumours <4 cm, and 5-year overall survival was 80 %. Probability of minor complication increased with tumour size (P = 0.03), as did all-cause mortality (P = 0.005).
Conclusions
CT-guided RFA is safe and effective for early-stage renal cancer, particularly for exophytic tumours measuring <3.5 cm. Overall 5-year survival with tumours <4 cm is comparable to partial nephrectomy.
Key points
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Prognostic indicators for success of CT-guided RFA of renal tumours are reported.
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Tumour size ≥3.5 cm confers an increased risk for residual tumour.
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Clear cell renal cell carcinoma subtype confers increased risk for residual tumour.
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Tmax <70 °C within the ablation zone confers increased risk for residual tumour.
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Exophytic tumours have a lower probability of residual disease.