Ablative therapies in the treatment of small renal tumors: how far from standard of care?
Authors:
P. Gontero
Authors place of work:
Urologia 1 Molinette Hospital
; University of Torino
Published in the journal:
Urol List 2010; 8(2): 24-32
Summary
Ablative therapies in the treatment of small renal tumors:
how far from standard of care?
Objectives:
To determine the current clinical value of minimally invasive thermoablative techniques (MI thermoablative T) to ablate small renal tumors through a literature review.
Methods:
A literature search was conducted on the most commonly used MI thermoablative T for small renal tumors, namely cryoablation (CA) and radiofrequency ablation (RFA). Primary objective was to carry out a comparative assessment of the complication rate, recurrence rate and cancer specific survival rates across techniques. Secondary objective was to critically review technical aspects of the procedures.
Results:
Five year follow up data were available only for laparoscopic CA, with a recurrence rate varying from 0 to 15 %. Follow up of percutaneous CA and RFA did not go beyond 2 years and excellent recurrence free rates were obtained at the price of a significant retreatment rate. The need for retreatment was perceived as lower with percutaneous CA than with RFA. Overall complication rate did not exceed 5 % in all techniques albeit laparoscopic CA carried a significant degree of invasiveness as compared with other percutaneous techniques.
Conclusions:
MI thermoablative T for small renal tumors should still be confined to carefully selected patients. PCA seems to hold the premises for the best compromise between low invasiveness and high efficacy, while RFA appears highly advantageous in terms of procedural costs.
Key words:
cryoablation, radiofrequency ablation, laparoscopic, percutaneous, renal tumors
Zdroje
1. Perrotti M, Badger WJ, McLeod D et al. Does laparoscopy beget underuse of partial nephrectomy for T(1) renal masses? Competing treatment decision pathways may influence utilization. J Endourol 2007; 21(10): 1223–1128.
2. Phillips B, Ball C, Sackett D et al. Levels of evidence and grades of recommendation. Oxford Centre for Evidence based Medicine. Downloaded at http://www. cebm.net/levels_of_evidence.asp.
3. Acker JP, Larese A, Yang H et al. Intracellular ice formation is affected by cell interactions. Cryobiology 1999; 38(4): 363–371.
4. Hoffmann NE, Bischof JC. The cryobiology of cryosurgical injury. Urology 2002; 60 (2 Suppl 1): 40–49.
5. Baust JG, Gage AA. The molecular basis of cryosurgery. BJU Int 2005; 95(9): 1187–1191.
6. Mouraviev V, Joniau S, Van Poppel H et al. Current status of minimally invasive ablative techniques in the treatment of small renal tumors. Eur Urol 2007; 51(2): 328–336.
7. Woolley ML, Schulsinger DA, Durand DB et al. Effect of freezing parameters (freeze cycle and thaw process) on tissue destruction following renal cryoablation. J Endourol 2002; 16(7): 519–522.
8. Cestari A, Guazzoni G, Buffi NM et al. Laparoscopic Cryoablation of Small Renal Masses: Technique and Results after 6-Year Experience. Eur Urol Suppl 2007; 6: 646–652.
9. Gill IS, Remer EM, Hasan WA et al. Renal cryoablation: outcome at 3 years. J Urol 2005; 173(6): 1903–1907.
10. Chosy SG, Nakada SY, Lee FT Jr et al. Monitoring renal cryosurgery: predictors of tissue necrosis in swine. J Urol 1998; 159(4): 1370–1374.
11. Campbell SC, Krishnamurthi V, Chow G et al. Renal cryosurgery: experimental evaluation of treatment parameters. Urology 1998; 52(1):29-33.
12. Permpongkosol S, Nielsen ME, Solomon SB. Percutaneous renal cryoablation. Urology 2006; 68(1 Suppl): 19–25.
13. Deane LA, Clayman RV. Review of minimally invasive renal therapies: Needle-based and extracorporeal. Urology 2006; 68(1 Suppl): 26–37.
14. Schwartz BF, Rewcastle JC, Powell T et al. Cryoablation of small peripheral renal masses: a retrospective analysis. Urology 2006; 68(1 Suppl): 14–18.
15. Stein RJ, Kaouk JH. Renal cryotherapy: a detailed review including a 5-year follow-up. BJU Int 2007; 99(5 Pt B): 1265–1270.
16. Wyler SF, Sulser T, Ruszat R et al. Intermediate-term results of retroperitoneoscopy-assisted cryotherapy for small renal tumors using multiple ultrathin cryoprobes. Eur Urol 2007; 51(4): 971–979.
17. Silverman SG, Tuncali K, vanSonnenberg E et al. Renal tumors: MR imaging-guided percutaneous cryotherapy--initial experience in 23 patients. Radiology 2005; 236(2): 716–724.
18. Gupta A, Allaf ME, Kavoussi LR et al. Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation: initial clinical experience. J Urol 2006; 175(2): 447–452.
19. Shingleton WB, Sewell PE Jr. Cryoablation of renal tumors in patients with solitary kidneys. BJU Int 2003; 92(3): 237–239.
20. Milner J, Borge M, Sharma S et al. Percutaneous CT guided saline mobilization of colon to facilitate renal cryoablation of small renal tumors. J Urol 2005; 173 (Suppl): 320. Abst 1181.
21. Shingleton WB, Sewell PE Jr. Percutaneous renal cryoablation of renal tumors in patients with von Hippel-Lindau disease. J Urol 2002; 167(3): 1268–1270.
22. Bachmann A, Sulser T, Jayet C et al. Retroperitoneoscopy-assisted cryoablation of renal tumors using multiple 1.5 mm ultrathin cryoprobes: a preliminary report. Eur Urol 2005; 47(4): 474–479.
23. Warlick CA, Lima GC, Allaf ME et al. Clinical sequelae of radiographic iceball involvement of collecting system during computed tomography-guided percutaneous renal tumor cryoablation. Urology 2006; 67(5): 918–922.
24. Aron M, Gill IS. Minimally invasive nephron-sparing surgery (MINSS) for renal tumors part I: laparoscopic partial nephrectomy. Eur Urol 2007; 51(2): 337–346.
25. Ljungberg B, Alamdari FI, Rasmuson T et al. Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy. BJU Int 1999; 84(4): 405–411.
26. Stein AJ, Mayes JM, Mouraviev V et al. Persistent contrast enhancement several months after laparoscopic cryoablation of the small renal mass may not indicate recurrent tumor. J Endourol 2008; 22(11): 2433–2439.
27. Hasan W, Gill IS, Spaliviero M et al. Renal cryoablation: 4-year follow-up. J Urol 2004; 171: 438, Abs 1657.
28. Sung GT, Gill IS, Hsu TH et al. Effect of intentional cryo-injury to the renal collecting system. J Urol 2003; 170(2 Pt 1): 619–622.
29. Janzen NK, Perry KT, Han KR et al. The effects of intentional cryoablation and radio frequency ablation of renal tissue involving the collecting system in a porcine model. J Urol 2005; 173(4): 1368–1374.
30. Brashears JH 3rd, Raj GV, Crisci A et al. Renal cryoablation and radio frequency ablation: an evaluation of worst case scenarios in a porcine model. J Urol 2005; 173(6): 2160–2165.
31. Johnson DB, Solomon SB, Su LM et al. Defining the complications of cryoablation and radio frequency ablation of small renal tumors: a multi-institutional review. J Urol 2004; 172(3): 874–877.
32. Gervais DA, McGovern FJ, Arellano RS et al. Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005; 185(1): 64–71.
33. Shingleton WB, Sewell PE Jr. Percutaneous renal tumor cryoablation with magnetic resonance imaging guidance. J Urol 2001; 165(3): 773–776.
34. Hegarty NJ, Kaouk JH, Remer EM et al. Laparoscopic renal cryoablation: oncological outcomes at 5 years. J Endourol 2006; 20 (Suppl 1): A12.
35. Davol PE, Fulmer BR, Rukstalis DB. Long-term results of cryoablation for renal cancer and complex renal masses. Urology 2006; 68(1 Suppl): 2–6.
36. Cestari A, Guazzoni G, dell'Acqua V et al. Laparoscopic cryoablation of solid renal masses: intermediate term followup. J Urol 2004; 172(4 Pt 1): 1267–1270.
37. Lawatsch EJ, Langenstroer P, Byrd GF et al. Intermediate results of laparoscopic cryoablation in 59 patients at the Medical College of Wisconsin. J Urol 2006; 175(4): 1225–1229.
38. Atwell TD, Farrell MA, Leibovich BC et al. Percutaneous renal cryoablation: experience treating 115 tumors. J Urol 2008; 179(6): 2136–2140.
39. Bandi G, Wen CC, Hedican SP et al. Cryoablation of small renal masses: assessment of the outcome at one institution. BJU Int 2007; 100(4): 798–801.
40. Veltri A, De Fazio G, Malfitana V et al. Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients. Eur Radiol 2004; 14(12): 2303–2310.
41. Varkarakis IM, Allaf ME, Inagaki T et al. Percutaneous radio frequency ablation of renal masses: results at a 2-year mean followup. J Urol 2005; 174(2): 456–460.
42. Matin SF, Ahrar K, Cadeddu JA et al. Residual and recurrent disease following renal energy ablative therapy: a multi-institutional study. J Urol 2006; 176(5): 1973–1977.
43. Zagoria RJ, Traver MA, Werle DM et al. Oncologic efficacy of CT-guided percutaneous radiofrequency ablation of renal cell carcinomas. AJR Am J Roentgenol 2007; 189(2): 429–436.
44. Breen DJ, Rutherford EE, Stedman B et al. Management of Renal Tumors by Image-Guided Radiofrequency Ablation: Experience in 105 Tumors. Cardiovasc Intervent Radiol 2007; 30(5): 936–942.
45. Stern JM, Svatek R, Park S et al. Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumors. BJU Int 2007; 100(2): 287–290.
46. Levinson AW, Su LM, Agarwal D et al. Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass. J Urol 2008; 180(2): 499–504.
47. Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174(2): 323–331.
48. Ni Y, Mulier S, Miao Y et al. A review of the general aspects of radiofrequency ablation. Abdom Imaging 2005; 30(4): 381–400.
49. Wissniowski TT, Hänsler J, Neureiter D et al. Activation of tumor-specific T lymphocytes by radio-frequency ablation of the VX2 hepatoma in rabbits. Cancer Res 2003; 63(19): 6496–6500.
50. Hoey MF, Mulier PM, Leveillee RJ et al. Transurethral prostate ablation with saline electrode allows controlled production of larger lesions than conventional methods. J Endourol 1997; 11(4): 279–284.
51. Zagoria RJ, Hawkins AD, Clark PE et al. Percutaneous CT-guided radiofrequency ablation of renal neoplasms: factors influencing success. AJR Am J Roentgenol 2004;183(1): 201-207.
52. Boss A, Clasen S, Kuczyk M et al. Image-guided radiofrequency ablation of renal cell carcinoma. Eur Radiol 2007; 17(3): 725–733.
53. McAchran SE, Lesani OA, Resnick MI. Radiofrequency ablation of renal tumors: past, present, and future. Urology 2005; 66(5 Suppl): 15–22.
54. Heilbrun ME, Zagoria RJ, Garvin AJ et al. CT-guided biopsy for the diagnosis of renal tumors before treatment with percutaneous ablation. AJR Am J Roentgenol 2007; 188(6): 1500–1505.
55. Crowley JD, Shelton J, Iverson AJ et al. Laparoscopic and computed tomography-guided percutaneous radiofrequency ablation of renal tissue: acute and chronic effects in an animal model. Urology 2001; 57(5): 976–980.
56. Boss A, Clasen S, Kuczyk M et al. Radiofrequency ablation of renal cell carcinomas using MR imaging: initial results. Rofo 2005; 177(8): 1139–1145.
57. Bastide C, Garcia S, Anfossi E et al. Histologic evaluation of radiofrequency ablation in renal cancer. Eur J Surg Oncol 2006; 32(9): 980–983.
58. Brausi M, Castagnetti G, Gavioli M et al. Radiofrequency (RF) ablation of renal tumors does not produce complete tumor destruction: results of a phase II study. Eur Urol suppl 2004; 3: 14–17.
59. Klingler HC, Marberger M, Mauermann J et al. 'Skipping' is still a problem with radiofrequency ablation of small renal tumors. BJU Int 2007;99(5): 1998–1001.
60. Anderson JK, Baker M, Jaffers O et al. Time course of nicotinamide adenine dinucleotide diaphorase staining after renal radiofrequency ablation influences viability assessment. J Endourol 2007; 21(2): 223–227.
61. Boss A, Martirosian P, Schraml C et al. Morphological, contrast-enhanced and spin labeling perfusion imaging for monitoring of relapse after RF ablation of renal cell carcinomas. Eur Radiol 2006; 16(6): 1226–1236.
62. Hasebroock KM, Serkova NJ. Toxicity of MRI and CT contrast agents. Expert Opin Drug Metab Toxicol 2009; 5(4): 403–416.
63. Lewin JS, Nour SG, Connell CF et al. Phase II clinical trial of interactive MR imaging-guided interstitial radiofrequency thermal ablation of primary kidney tumors: initial experience. Radiology 2004; 232(3): 835–845.
64. Traver MA, Werle DM, Clark PE et al. Oncological efficacy and factors influencing the success of CT-guided percutaneous radiofrequency ablation (RFA) on renal neoplasms. J Urol 2006; 175 (Suppl): 360.
65. Weizer AZ, Raj GV, O'Connell M et al. Complications after percutaneous radiofrequency ablation of renal tumors. Urology 2005; 66(6): 1176–1180.
66. Kam AW, Littrup PJ, Walther MM et al. Thermal protection during percutaneous thermal ablation of renal cell carcinoma. J Vasc Interv Radiol 2004; 15(7): 753–758.
67. Desai MM, Aron M, Gill IS. Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor. Urology 2005; 66(5 Suppl): 23–28.
68. Raman JD, Thomas J, Lucas SM et al. Radiofrequency ablation for T1a tumors in a solitary kidney: promising intermediate oncologic and renal function outcomes. Can J Urol 2008; 15(2): 3980–3985.
69. Carini M, Minervini A, Masieri L et al. Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience. Eur Urol 2006; 50(6): 1263–1268; discussion 1269–1271.
70. Hwang JJ, Walther MM, Pautler SE et al. Radio frequency ablation of small renal tumors: intermediate results. J Urol 2004; 171(5): 1814–1818.
71. Pavlovich CP, Walther MM, Choyke PL et al. Percutaneous radio frequency ablation of small renal tumors: initial results. J Urol 2002; 167(1): 10–15.
72. Allaf ME, Varkarakis IM, Bhayani SB et al. Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation--initial observations. Radiology 2005; 237(1): 366–370.
Štítky
Paediatric urologist UrologyČlánok vyšiel v časopise
Urological Journal
2010 Číslo 2
Najčítanejšie v tomto čísle
- SCROTAL ULTRASOUND: PRINCIPLES AND PRACTICE
- Management Renal Tumors
- Tumor markes in renal cancer: help for diagnosis, prognosis, treatment and follow up
- A STANDARDIZED ANATOMICAL CLASSIFICATION OF SMALL RENAL TUMORS