RFA Clears Small Renal Cell Tumors
Tumor location does not affect outcome
CT-guided percutaneous radiofrequency ablation (RFA) is safe and effective for treating small biopsy-proven renal tumors, according to researchers.
Investigators at Wake Forest University Baptist Medical Center in Winston-Salem, N.C., reviewed the medical records of 104 patients (69 men, 35 women) with 125 biopsy-proven renal cell carcinoma (RCC) treated with percutaneous RFA at their institution between May 2000 and June 2006.
The patients had a mean age of 70.4 years (range 30-89 years). The tumors ranged in size from 0.6 to 8.8 cm (mean 2.7 cm). Follow-up with CT or MRI scans and clinical assessment ranged from 1-76 months (mean 13.8 months).
A single RFA treatment completely eradicated all of the 95 tumors smaller than 3.7 cm as well as 14 larger tumors, researchers reported in the American Journal of Roentgenology (2007;189:429-436). Seven more of the 16 remaining larger tumors were eradicated after a second treatment, for a total 93% success rate for all 125 tumors. Among these RCCs, 94 (75%) were exophytic, 20 (16%) were parenchymal, 1 (1%) was central and 10 (8%) were mixed. The complication rate was 8%.
“This is the largest treatment group to date of patients with biopsy-proven renal malignancies,” said lead author Ronald Zagoria, MD, professor of radiology and an associate in urologic surgery. “The results—a high cure rate and low complication rate—establish that, at institutions with experience doing this procedure, this is an alternative method for treating small renal malignancies in patients who are not good surgi-cal candidates.”
The study also demonstrated that tumor-free survival was not influenced by gender, side of tumor, or tumor type (exophytic, central, parenchymal, or mixed). “Other people showed that tumors that were exophytic were easier to eradicate than central tumors,” Dr. Zagoria said. “We found the location of the tumor didn't matter if the tumor was small.” Study findings broaden the indications for RFA, he added.
Of the 104 patients, 101 went home the same day, and three were hospitalized after the procedure. One patient had a planned treatment and planned to stay, another patient was hospitalized for treatment of bruising around the puncture site, and a third patient was hospitalized for treatment of exacerbation of a heart condition.
Eight patients experienced complications, including temporary air pockets in the chest cavity, mild to severe pain after the procedure, pneumonia, and ureteral problems. Dr. Zagoria said he was surprised by the low rate of complications, none of which resulted in long-term morbidity.