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Lourenco P, Bilbey N, Gong B, Bahrabadi A, Halkier B. Percutaneous Ablation Versus Nephrectomy for Small Renal Masses: Clinical Outcomes in a Single-Center Cohort. Cardiovasc Intervent Radiol 2018; 41:1892-1900. [DOI: 10.1007/s00270-018-2050-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/31/2018] [Indexed: 01/20/2023]
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2
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Abstract
BACKGROUND The incidence of small (< 4 cm) solid enhancing renal masses has been rising, and the majority (60% to 80%) of these tumors are renal cell carcinomas (RCCs) when pathologic analysis is performed. Needle ablation for small incidental renal masses is an attractive therapeutic option. Reasons include its decreased morbidity, shorter convalescence, and the ability to avert the higher risk of extirpative surgery in an aging patient population. Radiofrequency ablation (RFA) is a thoroughly studied needle ablative method used for RCC. METHODS The current published literature on renal tumor RFA was reviewed. The in vitro experiments, animal studies and clinical experience with RFA for treatment of small RCCs were analyzed and various controversies in renal RFA are presented for discussion. RESULTS Percutaneous and laparoscopic renal RFA can be safely performed and can eradicate small RCCs with cancer specific survival rates over 90% to 95% in many series. While long-term (5 years or greater) cancer control data are not yet available, these intermediate-term results are similar to those achieved with traditional nephron-sparing surgical options. However, the optimal method to perform RFA for renal masses is still evolving. CONCLUSIONS While long-term cancer control data are not yet available, the current literature suggests that RFA can effectively eradicate small RCCs. Further research is needed to elucidate the influence of various treatment variables, including impedance vs temperature-controlled RFA, sonographic vs computed tomographic guidance, general anesthetic vs conscious sedation, and radiologist vs urologist delivery of renal RFA.
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Affiliation(s)
- Sangtae Park
- Department of Urology, University of Texas, Southwestern Medical Center, Dallas 75390, USA
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3
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Wang X, Zhao X, Lin T, Guo H. Thermo-sensitive hydrogel for preventing bowel injury in percutaneous renal radiofrequency ablation. Int Urol Nephrol 2016; 48:1593-600. [DOI: 10.1007/s11255-016-1349-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/17/2016] [Indexed: 01/20/2023]
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4
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El Dib R, Nascimento Junior P, Kapoor A. An alternative approach to deal with the absence of clinical trials: a proportional meta-analysis of case series studies. Acta Cir Bras 2013; 28:870-6. [PMID: 24316861 DOI: 10.1590/s0102-86502013001200010] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/13/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Systematic reviews are criticized for frequently offering inconsistent evidences and absence of straightforward recommendations. Their value seems to be depreciated when the conclusions are uncertain. To describe an alternative approach of evaluating case series studies in health care when there is absence of clinical trials. METHODS We provide illustrations from recent experiences. Proportional meta-analysis was performed on surgical outcomes: (a) case series studies, (b) use of cryoablation or radiofrequency ablation, and (c) patients with small renal cell carcinoma. The statistically significant difference between both interventions studied was defined if their combined 95% confidential interval (CI) did not overlap. RESULTS As demonstrated by the example, this analysis is an alternative approach to provide some evidence of the intervention's effects under evaluation and plotting all available case series in the absence of clinical trials for the health field. CONCLUSIONS Although we are leading to a low level of evidence to determine efficacy, effectiveness and safety of interventions this alternative approach can help surgeons, physicians and health professionals for a provisionally decision in health care along with their clinical expertise and the patient's wishes and circumstances in the absence of high-quality primary studies. It's not a replacement for the gold standard randomized clinical trial, but an alternative analysis for clinical research.
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5
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Thermal Versus Impedance-Based Ablation of Renal Cell Carcinoma: A Meta-analysis. Cardiovasc Intervent Radiol 2013; 37:176-85. [DOI: 10.1007/s00270-013-0743-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
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6
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El Dib R, Touma NJ, Kapoor A. Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 2012; 110:510-6. [PMID: 22304329 DOI: 10.1111/j.1464-410x.2011.10885.x] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED Study Type - Therapy (systematic review). Level of Evidence 2b What's known on the subject? and What does the study add? The oncological success of partial nephrectomy in the treatment of small renal masses is well established. However, partial nephrectomy has largely supplanted the radical approach. In the last decade, laparoscopy has been adopted as the new surgical approach for the treatment of renal cell carcinoma. Laparoscopy offers the advantage of lower analgesic use, shorter hospital stay, and quicker recovery time. More recently, ablative technologies have been investigated as an alternative to laparoscopic partial nephrectomy. These techniques can often be performed percutaneously in the radiology suite, or laparoscopically without the need for hilar clamping. However, only the cryoablation and radiofrequency ablation modalities have had widespread use with several series reporting short to intermediate results. This review shows that both cryoablation and radiofrequency ablation are promising therapies in patients with small renal tumours (<4 cm), who are considered poor candidates for more involved surgery. OBJECTIVE • To determine the current status of the literature regarding the clinical efficacy and complication rates of cryoablation vs radiofrequency ablation in the treatment of small renal tumours. METHODS • A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: MEDLINE, EMBASE and LILACS. • Inclusion criteria were (i) case series design with more than one case reported, (ii) use of cryoablation or radiofrequency ablation, (iii) patients with renal cell carcinoma and, (iv) outcome reported as clinical efficacy. • When available, we also quantified the complication rates from each included study. • Proportional meta-analysis was performed on both outcomes with a random-effects model. The 95% confidential intervals were also calculated. RESULTS • Thirty-one case series (20 cryoablation, 11 radiofrequency ablation) met all inclusion criteria. • The pooled proportion of clinical efficacy was 89% in cryoablation therapy from a total of 457 cases. There was a statistically significant heterogeneity between these studies showing the inconsistency of clinical and methodological aspects. • The pooled proportion of clinical efficacy was 90% in radiofrequency ablation therapy from a total of 426 cases. There was no statistically significant heterogeneity between these studies. • There was no statistically significant difference regarding complications rate between cryoablation and radiofrequency ablation. CONCLUSIONS • This review shows that both ablation therapies have similar efficacy and complication rates. • There is urgency for performing clinical trials with long-term data to establish which intervention is most suitable for the treatment of small renal masses.
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Affiliation(s)
- Regina El Dib
- Botucatu School of Medicine, UNESP - Univ Estadual Paulista, Botucatu, Brazil.
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7
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Energy Ablative Techniques in Renal Cell Carcinoma. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Krokidis M, Sabharwal T, Adam A. Radiofrequency ablation of multifocal bilateral renal oncocytomas. Interv Med Appl Sci 2011. [DOI: 10.1556/imas.3.2011.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Renal oncocytoma is a usually benign, typically solitary renal tumor, which cannot be reliably distinguished from other renal neoplasms on the basis of its imaging characteristics. Multifocality and/or bilaterality are very rare; to our knowledge only one case of multiple and/or bilateral oncocytomas is reported in the literature and was treated with partial nephrectomy. We report a case of a 72-year-old patient with multifocal and bilateral renal oncocytomas that were treated with radiofrequency ablation.
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Affiliation(s)
- Miltiadis Krokidis
- 1 Department of Radiology, Guy's and St. Thomas' NHS Trust, London, UK
- 2 Guy's and St Thomas' NHS Trust, Department of Radiology, 1st Floor Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, London, UK
| | - Tarun Sabharwal
- 1 Department of Radiology, Guy's and St. Thomas' NHS Trust, London, UK
| | - Andreas Adam
- 1 Department of Radiology, Guy's and St. Thomas' NHS Trust, London, UK
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9
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Ginat DT, Saad WEA. Bowel displacement and protection techniques during percutaneous renal tumor thermal ablation. Tech Vasc Interv Radiol 2010; 13:66-74. [PMID: 20540916 DOI: 10.1053/j.tvir.2010.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although bowel injury is a rare complication of renal radiofrequency ablation, the potential consequences can be devastating. Therefore, it is prudent to perform bowel displacement/protection procedures when feasible. The main bowel displacement techniques include hydrodissection, gas-insufflation, balloon interposition, and electrode torquing. In this article, these techniques are discussed and the steps involved in performing these procedures are enumerated.
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Affiliation(s)
- Daniel T Ginat
- Department of Imaging Sciences and Interventional Radiology, University of Rochester Medical Center, Rochester, NY, USA
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10
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Fennessy FM, Tuncali K, Morrison PR, Tempany CM. MR imaging-guided interventions in the genitourinary tract: an evolving concept. Magn Reson Imaging Clin N Am 2010; 18:11-28. [PMID: 19962090 DOI: 10.1016/j.mric.2009.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
MR imaging-guided interventions are well established in routine patient care in many parts of the world. There are many approaches, depending on magnet design and clinical need, based on MR imaging providing excellent inherent tissue contrast without ionizing radiation risk for patients. MR imaging-guided minimally invasive therapeutic procedures have advantages over conventional surgical procedures. In the genitourinary tract, MR imaging guidance has a role in tumor detection, localization, and staging and can provide accurate image guidance for minimally invasive procedures. The advent of molecular and metabolic imaging and use of higher strength magnets likely will improve diagnostic accuracy and allow targeted therapy to maximize disease control and minimize side effects.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Harvard Medical School/Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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11
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Ginat DT, Saad W, Davies M, Walman D, Erturk E. Bowel displacement for CT-guided tumor radiofrequency ablation: techniques and anatomic considerations. J Endourol 2009; 23:1259-64. [PMID: 19594374 DOI: 10.1089/end.2008.0668] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To describe safety and efficacy of bowel displacement techniques and determine lesion characteristics that are likely to necessitate bowel displacement. PATIENTS AND METHODS A retrospective review of patients who underwent CT-guided renal tumor radiofrequency ablation (RFA) (January 2006-August 2008) was conducted. Techniques included hydrodissection, additional manual torquing of the RFA probe, and additional angioplasty balloon interposition. The goal was to displace bowel from the probe by at least 10 to 20 mm. Air-filled balloon interposition was intended as a thermal barrier. Pre- and postbowel displacement distances were measured by CT. Saline volumes were recorded. Multivariate stepwise regression analysis was used to determine the influence of laterality, renal location, and morphology of renal lesions on their proximity to the colon and use of bowel displacement techniques. RESULTS RFA was performed on 57 consecutive patients. Eleven (19%) patients had bowel displacement attempts. Median pre-RFA lesion edge to colon distance for nondisplaced vs displaced was 43 mm (range 10-100 mm) vs 6 mm (range 0-16 mm), respectively (P < 0.05). Two variables were significant for bowel displacement (F-ratio = 4.681, P = 0.006): Tumor position within the kidney in the craniocaudal plane (P = 0.014) and anterior-posterior plane (P = 0.007). Lower pole and posterior lesions tended to be closer to the colon and more likely to necessitate bowel displacement. Orientation in the medial-lateral plane (P = 0.77) and exophytic nature of the lesion (P = 0.83) were not significant features. Hydrostatic bowel displacement was always the first-line technique and was completely and partly successful in 8 (73%) and 1 (9%) attempts, respectively. Partial success was augmented by probe torquing (distance increased from 1 mm to 16 mm and then to 23 mm with torquing). Mean saline injection: 105 mL (range 55-440 mL). There were two complete failures (18%) in which bowel was displaced only by 0 to 2 mm despite injection of 280 to 440 mL. Balloon interposition was attempted in these two cases. Five minor complications occurred in the nondisplaced cohort. No complications occurred in the bowel displacement cohort. CONCLUSION Lower pole, posterior renal lesions are more likely to necessitate bowel displacement. Bowel displacement techniques are effective and safe in displacing bowel.
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Affiliation(s)
- Daniel T Ginat
- Department of Imaging Sciences, University of Rochester, Rochester, NY 14642, USA.
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Gupta A, Raman JD, Leveillee RJ, Wingo MS, Zeltser IS, Lotan Y, Trimmer C, Stern JM, Cadeddu JA. General Anesthesia and Contrast-Enhanced Computed Tomography to Optimize Renal Percutaneous Radiofrequency Ablation: Multi-Institutional Intermediate-Term Results. J Endourol 2009; 23:1099-105. [DOI: 10.1089/end.2008.0499] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amit Gupta
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jay D. Raman
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Ilia S. Zeltser
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yair Lotan
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Clayton Trimmer
- Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joshua M. Stern
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A. Cadeddu
- Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas
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Long L, Park S. Differences in Patterns of Care: Reablation and Nephrectomy Rates After Needle Ablative Therapy for Renal Masses Stratified by Medical Specialty. J Endourol 2009; 23:421-6. [DOI: 10.1089/end.2008.0234] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Layron Long
- Department of Urology, University of Washington, Seattle, Washington
| | - Sangtae Park
- Pritzker School of Medicine, Department of Surgery, Section of Urology, The University of Chicago, Chicago, Illinois
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14
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Percutaneous radiofrequency ablation of renal cell carcinomas in patients with solitary kidney: 6 years experience. Eur J Radiol 2009; 69:351-6. [DOI: 10.1016/j.ejrad.2007.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/05/2007] [Accepted: 10/08/2007] [Indexed: 11/15/2022]
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Abstract
BACKGROUND The incidence of renal cell carcinoma is rising because of incidental detection of small renal masses (SRMs). Although surgical resection remains the standard of care, cryoablation and radiofrequency ablation (RFA) have emerged as minimally invasive treatment alternatives. The authors of this report performed a comparative meta-analysis evaluating cryoablation and RFA as primary treatment for SRMs. METHODS A search of the MEDLINE database was performed reviewing the world literature for clinically localized renal masses treated by cryoablation or RFA. RESULTS Forty-seven studies representing 1375 kidney lesions treated by cryoablation or RFA were analyzed. No differences were detected between ablation modalities with regard to mean patient age (P = .17), tumor size (P = .12), or duration of follow-up (P = .53). Pretreatment biopsy was performed more often for cryoablated lesions (82.3%) than for RFA (62.2%; P < .0001). Unknown pathology occurred at a significantly higher rate for SRMs that underwent RFA (40.4%) versus cryoablation (24.5%; P < .0001). Repeat ablation was performed more often after RFA (8.5% vs 1.3%; P < .0001), and the rates of local tumor progression were significantly higher for RFA (12.9% vs 5.2%; P < .0001) compared with cryoablation. The higher incidence of local tumor progression was found to be correlated significantly with treatment by RFA on univariate analysis (P = .001) and on multivariate regression analysis (P = .003). Metastasis was reported less frequently for cryoablation (1.0%) versus RFA (2.5%; P = .06). Cryoablation usually was performed laparoscopically (65%), whereas 94% of lesions that were treated with RFA were approached percutaneously. CONCLUSIONS Ablation of SRMs is a viable strategy based on short-term oncologic outcomes. Although extended oncologic efficacy remains to be established for ablation modalities, the current data suggest that cryoablation results in fewer retreatments and improved local tumor control, and it may be associated with a lower risk of metastatic progression compared with RFA.
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Affiliation(s)
- David A Kunkle
- Department of Urologic Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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16
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Hui GC, Tuncali K, Tatli S, Morrison PR, Silverman SG. Comparison of Percutaneous and Surgical Approaches to Renal Tumor Ablation: Metaanalysis of Effectiveness and Complication Rates. J Vasc Interv Radiol 2008; 19:1311-20. [PMID: 18725094 DOI: 10.1016/j.jvir.2008.05.014] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Revised: 05/07/2008] [Accepted: 05/15/2008] [Indexed: 12/25/2022] Open
Affiliation(s)
- Gladwin C Hui
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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17
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Surveillance for the management of small renal masses. Adv Urol 2008:196701. [PMID: 18704192 PMCID: PMC2515364 DOI: 10.1155/2008/196701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 06/08/2008] [Indexed: 01/06/2023] Open
Abstract
Surveillance is a new management option for small renal masses (SRMs) in aged and
infirm patients with
short-life expectancy. The current literature on surveillance of SRM contains mostly small, retrospective studies with limited data. Imaging alone is inadequate for suggesting the aggressive potential of SRM for both diagnosis and followup. Current data suggest that a computed tomography (CT) or magnetic resonance imaging (MRI) every 3 months in the 1st year, every 6 months in the next 2 years, and every year thereafter, is appropriate for observation. The authors rather believe in active surveillance with mandatory initial and followup renal tumor biopsies than classical observation. Since not all SRMs are harmless, selection criteria for active surveillance need to be improved. In addition, there is need for larger studies in order to better outline oncological outcome and followup protocols.
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Boss A, Rempp H, Martirosian P, Clasen S, Schraml C, Stenzl A, Claussen CD, Schick F, Pereira PL. Wide-bore 1.5 Tesla MR imagers for guidance and monitoring of radiofrequency ablation of renal cell carcinoma: initial experience on feasibility. Eur Radiol 2008; 18:1449-55. [PMID: 18351355 DOI: 10.1007/s00330-008-0894-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 01/29/2008] [Accepted: 02/04/2008] [Indexed: 01/18/2023]
Abstract
This study was conducted to test and demonstrate the feasibility of magnetic resonance (MR)-guided radiofrequency (RF) ablation of renal cell carcinoma (RCC) using a 1.5 T whole-body scanner equipped with a wide-bore superconductive magnet. Two patients with contrast-enhancing renal masses were treated with multipolar RF ablation (Celon ProSurge). Applicator navigation and near real-time ablation monitoring were performed in a wide-bore 1.5 T scanner using adapted fluoroscopic and diagnostic sequences. In addition to T2-weighted imaging for ablation monitoring, perfusion-weighted images acquired with an arterial spin-labeling technique (FAIR-TrueFISP) were applied. Results were compared to a previous study on 12 patients performed at 0.2 T. Navigation and monitoring of RF ablation using the wide-bore system operating at 1.5 T were clearly improved compared to former experiences on a 0.2 T MR unit. Fluoroscopic and diagnostic images for MR guidance could be acquired with distinctly higher image quality and shorter acquisition time resulting in higher accuracy of applicator placement and shorter treatment time. Spin-labeling perfusion imaging exhibited good image quality, potentially providing additional clinically important information. MR-guided RF ablation of RCC can safely be performed in a 1.5 T wide-bore scanner offering higher image quality, shorter acquisition time, and new monitoring modalities not feasible at 0.2 T.
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Affiliation(s)
- Andreas Boss
- Section of Experimental Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Radiofrequency Ablation of Renal Tumors with an Expandable Multitined Electrode: Results, Complications, and Pilot Evaluation of Cooled Pyeloperfusion for Collecting System Protection. Cardiovasc Intervent Radiol 2008; 31:595-603. [DOI: 10.1007/s00270-007-9291-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 12/22/2007] [Accepted: 12/28/2007] [Indexed: 11/27/2022]
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Abstract
Development of cross-sectional imaging has led to a significant increase in diagnosis of small renal tumors. Nephron-sparing surgery has proven to be effective in the management of these small tumors. Could radiofrequency ablation be as effective in the management of these patients, after showing promising results in a selected group of patients? In this article we discuss the principles of radiofrequency ablation and present results in a selected group of patients. We also outline future perspectives of this noninvasive technique.
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Affiliation(s)
- Adel Abdellaoui
- The Peninsula Medical School, Royal Devon & Exeter NHS Foundation Trust, Radiology Department, Barrack Road, Exeter, EX2 5DW, UK
| | - Anthony F Watkinson
- The Peninsula Medical School, Royal Devon & Exeter NHS Foundation Trust, Radiology Department, Barrack Road, Exeter, EX2 5DW, UK
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22
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Carrafiello G, Laganà D, Ianniello A, Mangini M, Fontana F, Cotta E, Concollato L, Marconi A, Recaldini C, Dionigi G, Rovera F, Boni L, Cuffari S, Fugazzola C. Percutaneous radiofrequency thermal ablation of renal cell carcinoma: Is it possible a day-hospital treatment? Int J Surg 2008; 6 Suppl 1:S31-5. [DOI: 10.1016/j.ijsu.2008.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Fennessy FM, Tuncali K, Morrison PR, Tempany CM. MR imaging-guided interventions in the genitourinary tract: an evolving concept. Radiol Clin North Am 2008; 46:149-66, vii. [PMID: 18328885 PMCID: PMC3403748 DOI: 10.1016/j.rcl.2008.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
MR imaging-guided interventions are well established in routine patient care in many parts of the world. There are many approaches, depending on magnet design and clinical need, based on MR imaging providing excellent inherent tissue contrast without ionizing radiation risk for patients. MR imaging-guided minimally invasive therapeutic procedures have advantages over conventional surgical procedures. In the genitourinary tract, MR imaging guidance has a role in tumor detection, localization, and staging and can provide accurate image guidance for minimally invasive procedures. The advent of molecular and metabolic imaging and use of higher strength magnets likely will improve diagnostic accuracy and allow targeted therapy to maximize disease control and minimize side effects.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Harvard Medical School/Brigham and Women's Hospital, Boston, MA 02115, USA.
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24
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25
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Abstract
Needle ablative therapies for small incidental renal masses are emerging as alternatives to traditional extirpative surgery. Reasons include their associated decreased morbidity, shorter convalescence, and the ability to avert the higher risk of extirpative surgery in an aging patient population. Cryoablation (CA) and radiofrequency ablation are the two most thoroughly studied needle ablative methods used for renal cancer. High-intensity focused ultrasound has also been studied but with limited published human experience at this time. For both radiofrequency ablation and CA, in vitro experiments, animal studies, and (increasingly) human experience have been published, allowing us to define appropriate candidates for such therapies, their oncologic outcomes, and the potential pitfalls. While long-term data is being collected, the current literature suggests that CA and radiofrequency ablation can be safely performed and can effectively eradicate small renal cancers with cancer-specific survival rates similar to those of traditional surgical options.
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Affiliation(s)
- Sangtae Park
- Department of Urology, LSU Health Sciences Center, 1501 Kings Hwy., Shreveport, LA 71103-4228, USA
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26
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de Senneville BD, Mougenot C, Quesson B, Dragonu I, Grenier N, Moonen CTW. MR thermometry for monitoring tumor ablation. Eur Radiol 2007; 17:2401-10. [PMID: 17701184 DOI: 10.1007/s00330-007-0646-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 03/27/2007] [Indexed: 01/10/2023]
Abstract
Local thermal therapies are increasingly used in the clinic for tissue ablation. During energy deposition, the actual tissue temperature is difficult to estimate since physiological processes may modify local heat conduction and energy absorption. Blood flow may increase during temperature increase and thus change heat conduction. In order to improve the therapeutic efficiency and the safety of the intervention, mapping of temperature and thermal dose appear to offer the best strategy to optimize such interventions and to provide therapy endpoints. MRI can be used to monitor local temperature changes during thermal therapies. On-line availability of dynamic temperature mapping allows prediction of tissue death during the intervention based on semi-empirical thermal dose calculations. Much progress has been made recently in MR thermometry research, and some applications are appearing in the clinic. In this paper, the principles of MRI temperature mapping are described with special emphasis on methods employing the temperature dependency of the water proton resonance frequency. Then, the prospects and requirements for widespread applications of MR thermometry in the clinic are evaluated.
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Affiliation(s)
- Baudouin Denis de Senneville
- Laboratory for Molecular and Functional Imaging: From Physiology to Therapy, CNRS/Université Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux, France
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Chen SH, Mouraviev V, Raj GV, Marguet CG, Polascik TJ. Ureteropelvic Junction Obliteration Resulting in Nephrectomy After Radiofrequency Ablation of Small Renal Cell Carcinoma. Urology 2007; 69:982.e3-5. [PMID: 17482951 DOI: 10.1016/j.urology.2007.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 01/11/2007] [Accepted: 02/16/2007] [Indexed: 01/29/2023]
Abstract
Percutaneous radiofrequency ablation is a minimally invasive treatment that is currently used to treat renal tumors. Despite its minimally invasive nature, potential serious complications can occur. We report the second case of ureteropelvic junction obstruction after radiofrequency ablation that resulted in nephrectomy. The use of radiofrequency ablation should be considered with caution, particularly when tumors are centrally located or abut the renal pelvis. Additional data are needed to better define the indications and contraindications to minimally invasive ablative technologies when used in the clinical setting.
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Affiliation(s)
- Stephanie H Chen
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Abstract
Solid renal tumours with a diameter <4 cm may be effectively cured by partial nephrectomy but this is associated with a complication rate of 15-20%. In addition, these tumours are more frequently diagnosed in the elderly (<70 years) and 26% are aggressive G3 and potentially hazardous tumours. Since these tumours are frequently unifocal, spherical, peripherally located and easily accessible for minimally invasive approaches, energy ablative techniques are attractive less invasive therapeutic options. These tumours may be treated by freezing (cryoablation) or by heat (radiofrequency ablation, high intensified focused ultrasound). Cryoablation seems to be the most reliable technique with a 1.6% recurrence rate over 3 years follow-up but only 1.8% complications. Conversely skipping renders RFA unreliable in highly vascularised tumours >3 cm with 23% vital tumours to be found at histological work-up. Laparoscopic HIFU is still experimental. Percutaneous techniques are less effective as compared with laparoscopy with recurrence rates ranging between 13-21% (cryoablation) and 14-18% (RFA). In addition, oncological follow-up relies solely on radiological measurements, frequently without histological verification thus making percutaneous techniques unpredictable.
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Affiliation(s)
- H C Klingler
- Universitätsklinik für Urologie, Medizinische Universität, Währinger Gürtel 18-20 Wien.
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Keane T, Gillatt D, Evans CP, Tubaro A. Current and Future Trends in the Treatment of Renal Cancer. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.eursup.2006.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Patard JJ, Lechevallier E, Congregado Ruiz B, Montorsi F. New Research on Kidney Cancer: Highlights from Urologic and Oncologic Congresses in 2006. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.eursup.2006.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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