Wider Use of Radiofrequency Ablation Possible
Radiofrequency ablation (RFA) may be an appropriate treatment for small renal cortical tumors in otherwise healthy patients, a study suggests.
In a review of 63 patients who underwent RFA for these small tumors, Jeffrey Cadeddu, MD, and colleagues at the University of Texas Southwestern Medical Center in Dallas found a renal function preservation rate of 97% and three-, four-, and five-year recurrence-free survival rates of 100%, 100%, and 93%, respectively, according to findings published in the BJU International (2009;104:786-789).
Estimated glomerular filtration rates (eGFRs) were available pre- and post-surgery for 54 patients. Their median eGFRs were 76.3 mL/min/1.73 m2 before RFA and 74.3 after.
Dr. Cadeddu, Professor of Urology and Radiology, noted that the study is novel in that it excluded unhealthy patients who were not candidates for surgery. “We instead extended the procedure to patients who were healthy and good candidates for surgery, too,” Dr. Cadeddu said.
The patients' average age was 58 years and 60% were male. The average lesion diameter was 2.1 cm. Biopsy specimens taken from 56 patients revealed that 38 had renal cell carcinoma (RCC), six had an angiomyolipoma, and six had an oncocytoma. The remaining six biopsies were inconclusive. One patient had a biopsy-confirmed recurrence of RCC at 55 months and underwent a nephrectomy.
The authors concluded that “RFA might a reasonable treatment choice for the healthy patient,” with an appropriate informed consent that weighs the efficacy of local tumor control, renal functional preservation, and technical ease.
Anil Kapoor, MD, Associate Professor of Surgery (Urology) at McMaster University and Chair of the Genitourinary Oncology Program at Juravinski Cancer Centre in Hamilton, Ontario, Canada, recently co-authored a review of the efficacy and safety of RFA for the treatment of small renal masses (Can Urol Assoc J. 2009;3:143-149).
Dr. Kapoor told Renal & Urology News that the gold standard remains surgery with partial nephrectomy because 20-year follow-up data show the risk of cancer recurrence is very low.
“RFA has to be compared to this gold standard, and to date we don't have those long-term data,” Dr. Kapoor added. “Having said that, it looks very promising and we are optimistic that the cancer treatment success rate will be durable.”
Dr. Cadeddu agreed that long-term survival data are required, but only to confirm efficacy in young patients.