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The journal «ONCOSURGERY» 2012, Vol.4, No 4

Percutaneous radiofrequency ablation in kidney tumor treatment

Alekseev BYa, Kalpinskiy AS

PA Herzen Moscow Cancer Research institute, Department of Urology, with course of Oncourology of Advanced Medical Training Faculty in Russian University of Peoples’ Friendship, Moscow, Russia
Contact: Alekseev BYa, e-mail:

The article shows the aspects of percutaneus radiofrequency ablation appliance in treatment for small size kidney tumor (less then 4 cm) in aged patients with severe comorbidity and high surgical risk.

Purpose: evaluate the efficiency and advisability of percutaneus radiofrequency ablation appliance for kidney tumors.

Materials and methods. From April 2006 to March 2012 in P.A. Herzen MCRI, 49 procedures of percutaneus radiofrequency ablation were performed in 44 patients with kidney tumors. The average age was 66.6±9.4 years (46-84). RFA of left kidney tumor was performed in 24 (54.6%) patients, right kidney tumor – in 20 (45.4%) patients. The majority of patients were in the group of high surgical risk. Twenty one patient had primary multifocal cancer, moreover,10 (25%) of them had tumors of other localization in anamnesis, and 11 (25%) had primary multifocal metachronous and synchronous tumors of both kidneys. Eleven patients (25%) had a tumor of single kidney. The majority of patients [39 (88.6%)] underwent one session of RFA, five (11.4%) patients had two sessions. The monopole Cool-tip™ RF ablation system (Tyco-Valleylab) with single-needle electrode and a kit of passive electrodes were used. The electrode was introduced under the ultrasound guide. The average time of RFA was 12.7±2.9 min (6-20). The treatment efficiency was evaluated by means of computer tomography of abdominal cavity and retroperitoneal space with intravenous contrast held every 6 month and ultrasonography with color flow mapping held every 3 month. The main evidence of the treatment effectiveness was the absence of contrast uptake and blood circulation in the tumor.

Results. The average tumor size was 28.5±8.3 mm (12-44 mm). Twenty eight (63.6%) patients underwent preoperative biopsy and in 25 (89.3%) cases renal-cell cancer was confirmed. In 25 (56.8%) patients tumor size was more than 25 mm. Patients with tumor size less than 25 mm underwent RFA from one position, for tumor size more than 25 mm the RFA was held from 2 positions. The average temperature in the tumor tissue after the ablation amounted to 71.9±10.3°C (55-94). Median time of observation was 25 month (1-60). Median postoperative day of hospital stay was 4 days (2-6). Complications of treatment occurred in two cases – subcapsular hematoma and urine fistula that closed after the stent placement. Continued tumor growth took place in 9 (20.4%) patients, 5 of them underwent repeated sessions of RFA, surgical treatment was performed in 3 cases and one patient had distant metastases and had been treated with target therapy. Therefore general 2-year survival rate was 89.3±5.9% and tumor-specific survival rate was 94.7±5.1%. During the observation time 1 (2.3%) patient died from renal-cell cancer progression, and 3 (6.8%) patients died from comorbidities.

Conclusion. The results of our research indicate that RFA performed to aged patients with severe comorbidity show a range of advantages over conventional surgical intervention: a short recovery period and preservation of functioning parenchyma with a low rate of complications.

KEY WORDS: renal cell cancer, patients at high surgical risk, percutaneous radiofrequency ablation.

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