Richard Sanchez MD, Presenter: Nothing to Disclose

Timothy William I. Clark MD, Abstract Co-Author: Nothing to Disclose

S. William Stavropoulos MD, Abstract Co-Author: Nothing to Disclose

Michael Christopher Soulen MD, Abstract Co-Author: Nothing to Disclose

Jeffrey Ian Mondschein MD, Abstract Co-Author: Nothing to Disclose

Catherine M. Tuite MD, Abstract Co-Author: Nothing to Disclose

Maxim Itkin MD, Abstract Co-Author: Nothing to Disclose

Aalpen Ashokkumar Patel MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Radiofrequency ablation is a nephron-sparing option for renal cell carcinoma (RCC) in poor surgical candidates. Radial array RF devices can result in tines penetrating beyond the renal margins to obtain an adequate treatment margin. We report our initial experience with RCC RF ablation using radial array devices, using an aggressive treatment strategy to displace adjacent viscera away from probe tines.

Methods: A QA database identified 17 patients with 20 sporadic RCC who underwent 21 RFA sessions over a 24 month period. Mean age for this cohort was 72 years (range, 47-89 years). RCC were 1.5 – 10.2 cm diameter; 5 exophytic and 15 parenchymal. RF systems used were RadioTherapeutics (N=14) or RITA (N=6), using probes 2–5 cm in diameter. All ablations used CT guidance with conscious sedation. Adjunctive techniques used during ablation were recorded, as well as instances where ablation mandated penetration of tines beyond the kidney margin. Using volumetric software (Image J, NIH), we calculated pre- and post-treatment tumor volumes from CT/MRI images.

Mean pretreatment tumor volume was 35.4 cm3 (range 1.2–395 cm3). Follow-up ranged from 1–24 months (mean 8.1). During this period, one patient underwent repeat RFA for tumor recurrence. In 11 patients with volumetric follow-up data, mean tumor shrinkage rate was 35% from baseline volume/year. Adjunctive techniques in 4 patients included water injection for displacement of the tail of the pancreas (N=1), displacement of the descending colon (N=2), and superselective embolization prior to RFA of a large (7 cm) tumor. Deliberate penetration of tines beyond the margins of the kidney was performed in 5 cases (24%); no hemorrhage occurred in these cases. No nontarget thermal injuries occurred. Minor complications occurred in 3 ablations (14%), including perirenal (n=2) and subcutaneous (n=1) hematomas; none required transfusion.

Radial array RF devices produce a high rate of local control for RCC with a low complication rate, even when tine penetration of the kidney is required for an adequate tumor treatment margin. Adjacent organs can be protected with adjunctive percutaneous maneuvers.

Sanchez, R, Clark, T, Stavropoulos, S, Soulen, M, Mondschein, J, Tuite, C, Itkin, M, Patel, A, et al, , RF Ablation of Renal Cell Carcinoma Using Radial Array Devices: Initial Experience.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4418953.html