Diego Antonio Covarrubias MD, Presenter: Nothing to Disclose

Ronald Steven Arellano MD, Abstract Co-Author: Nothing to Disclose

Ali Devrim Karaosmanoglu MD, Abstract Co-Author: Nothing to Disclose

Debra Ann Gervais MD, Abstract Co-Author: Research grant, Covidien AG

Peter Raff Mueller MD, Abstract Co-Author: Consultant, Cook Group Incorporated

To assess the clinical efficacy of image-guided percutaneous radiofrequency ablation (RFA) of central renal cell carcinoma (RCC).

An interventional radiology database was used to identify patients who underwent image-guided percutaneous RFA for central RCC, defined as tumor extension to the renal sinus fat. Patient (age and gender), tumor (location, size, and subtype) and treatment data (number of ablations and adjunctive procedures) were recorded. Post-RFA imaging was obtained at defined intervals. Residual disease was defined as enhancement in the zone of ablation greater than 10 Hounsfield units. Primary clinical success was defined as absence of residual disease at 1 month post-ablation imaging. Secondary clinical success was defined as absence of residual disease at 1 month imaging following re-treatment. Procedure-related complications were recorded.

Between 2005 and 2011, 31/216 patients (14%) underwent image-guided percutaneous radiofrequency ablation for biopsy-proven central RCC. Mean tumor size was 3.5 cm (range = 2-6 cm) and a mean of 3.5 ablations/tumor (range = 2-6 ablations/tumor) were performed. Twenty-nine of 31 treatments (94%) were performed using adjunctive maneuvers (i.e. pyeloperfusion and/or hydrodissection). The mean follow-up time was 20.5 months (range = 1-48 months). Twenty-seven of 31 tumors demonstrated no evidence of residual disease on follow-up imaging, for a primary clinical success rate of 87%. Four of 31 patients (13%) showed residual disease on the first follow-up exam. Following retreatment, post RFA imaging of these patients showed changes within the zone of ablation consistent with treatment response, for a secondary clinical success rate of 100%. There were 3 complications (10%). One patient developed a ureteral stricture that was managed by ureteral stenting. Two patients developed post-RFA perirenal collections that were managed by percutaneous drainage. 

Image-guided percutaneous RFA of central RCC is associated with a high single-session primary and high secondary clinical success rates with comparably low complication rates.

Image-guided percutaneous RFA may be a minimally invasive treatment option for selected patients with central RCC, despite their proximity to the renal pelvis and central renal vasculature.

Covarrubias, D, Arellano, R, Karaosmanoglu, A, Gervais, D, Mueller, P, Image-guided Percutaneous Radiofrequency Ablation of Central Renal Cell Carcinoma: Assessment of Clinical Success.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11001122.html