1) Outline the current clinical indications for embolotherapy in patients with renal cell carcinoma. 2) The use of particles and liquid embolic agents for preoperative, palliative, and preablation embolization. 3) List potential complications of embolotherapy in patients with renal cell carcinoma.
Embolotherapy has been used in the management of RCC since the 1970s, although its role has evolved over the years.
Preoperative embolization facilitates resection of large tumors particularly those with renal vein or inferior vena cava extension. It decreases the amount of blood transfusion required during surgery. Embolization also helps palliate tumor-related symptoms such as hematuria, flank pain, or paraneoplastic symptoms in patients who experience them. Finally, embolization may be used as an adjunct to ablative therapies in treating larger tumors. As such, it reduces perfusion-mediated tissue cooling and allows for more effective thermal ablation of these hypervascular tumors.
The recommended technique for embolization of renal tumors is the injection of absolute ethanol with or without a balloon occlusion catheter. However, the use of other embolic agents alone or in combination with various agents may be needed to achieve complete devascularization of the tumor. Incomplete or partial embolization of tumors may result in higher intraoperative blood loss in surgical patients and may lead to recurrence of symptoms in those treated for palliation.
In the modern era of angiography and embolotherapy, it is associated with very low morbidity and mortality.
Ahrar, K,
Transcatheter Therapy in the Management of Renal Cell Carcinoma. Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL.
http://archive.rsna.org/2010/9004197.html
