Introduction and Objectives
Along with abetter access to a better imaging technologies the number of small renal cell carcinomas (RCC), that are diagnosed has been increased. Smaller lesions are more possible to be treated with little invasive, nephron-sparing methods. Unfortunately even the most promising laparoscopic partial nephrectomy is not without drawbacks. Additionally there are more and more data that some of these small lesions may be not very aggressive. So especially in older or otherwise-not-healthy patients any aggressive techniques may appear to be not justified. This is causing that new modes of treatment such as radiofrequency ablation (RFA), that is based on thermal destruction of abnormal tissue with the heat delivered by needle probe introduced into the lesion under ultrasound control, seems to be an interesting alternative.
Material and Methods
We are presenting results of a treatment of 13 patients with RCC in the single kidney that have been subjected to RFA since 2003. 17 lesions were treated with 23 RFA sessions performed. The average age of the patients was 66 (55–75). The medium size of the tumor was 33mm (21–45). Patients were qualified to this treatment because of a poor general health status or concomitant oncological disease in other organs, or because of multiple lesions in the kidney. The protocol was approved by local Ethical Committee. The tumor were diagnosed by CT with features characteristic for renal cell carcinoma. The result was assessed by CT, where no growth and no contrast enhancement were considered as a good result. Medium follow-up was 30.7 months.
There were no complications during the RFA. In one case with multiple tumorsa ureteral stricture developed and was later treated surgically. Size of the tumor and its localization proved to singificantly influence the results. In tumors less than 30 mm in diameter good results were achieved in 89% and in tumors >30 mm in 62%. In cases with central localization of the tumor the good results were confirmed in 62% and in peripherial lesions in 89%. Minimal invasiveness of the procedure made it possible to safely repeat the treatment enabling improving the result further. Mean creatinine before was 1.31 mg/% (±0.51), and two week after was 1.43 mg% (±0.54).
In our opinion RFA of small RCC in single kidney is a valuable minimally invasive alternative to surgery. Particularly, in cases with some contraindications to the operation. Best results may be achieved in lesions smaller than 30mm located peripherally. RFA is relatively easy and enables preservation of the functioning part of the kidney. It can be also repeated enabling to eradicate the tumor completely. Additional aspect, that has been a matter of debate recently, is that some of these small tumors may be of low malignant potential and any currently used aggressive techniques either open or laparoscopic, may be questionable, especially in old and otherwise-ill patient.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.