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Rofo 2017; 189(03): 219-227
DOI: 10.1055/s-0042-115817
Review
© Georg Thieme Verlag KG Stuttgart · New York

Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors – A Systematic Review with Description of Type, Frequency, Risk Factors and Management

Therapieversagen nach bildgeführter perkutaner Radiofrequenzablation (RFA) von Nierentumoren – eine systematische Übersicht mit Beschreibung von Typ, Häufigkeit, Risikofaktoren und Management
Dominik Vollherbst
1   Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
,
Robert Bertheau
2   Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
,
Hans-Ulrich Kauczor
2   Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
,
Boris Alexis Radeleff
2   Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
,
Philippe L. Pereira
3   Clinic for Radiology, Minimally-invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
,
Christof-Matthias Sommer
2   Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
4   Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

18. Mai 2016

06. August 2016

Publikationsdatum:
14. September 2016 (online)

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Abstract

Background Radiofrequency ablation (RFA) is an established treatment for small renal tumors. The objective of this review is to systematically assess the type, frequency, risk factors and management of treatment failure after image-guided percutaneous RFA of renal tumors.

Method 10 studies (967 patients, 1033 tumors) with a mean/median follow-up of ≥ 30 months were systematically identified and analyzed.

Results and Conclusion Image-guided percutaneous RFA of localized renal tumors is very effective. The most common type of treatment failure is residual unablated tumor (5.9 %), followed by local tumor progression (4.7 %). De novo tumors in the kidneys occur in 1.3 % of cases and extra-renal metastases in 2.0 %. Local tumor progression, de novo tumors in the kidneys and extra-renal metastases occur predominantly later than 12 months after initial RFA. Tumor size > 3 cm and central tumor location are the major risk factors for treatment failure. In the case of treatment failure, repeated RFA shows high success rates (86.3 % for residual unablated tumors and 87.5 % for local tumor progression).

Key Points:

  • Treatment failure can be subdivided into residual unablated tumor and local tumor progression.

  • Residual unablated tumor occurs in 5.9 % of cases.

  • Local tumor progression occurs in 4.7 % of cases.

  • Tumor size and location are the major risk factors for treatment failure.

  • Repeated RFA is effective and commonly used for management.

Citation Format

  • Vollherbst D, Bertheau R, Kauczor H et al. Treatment Failure After Image-Guided Percutaneous Radiofrequency Ablation (RFA) of Renal Tumors – A Systematic Review with Description of Type, Frequency, Risk Factors and Management. Fortschr Röntgenstr 2017; 189: 219 – 227

Zusammenfassung

Hintergrund Die Radiofrequenzablation (RFA) ist ein etabliertes Verfahren zur Behandlung von kleinen Nierentumoren. Das Ziel dieser Übersicht ist die systematische Erfassung von Häufigkeit, Typ, Risikofaktoren und Management von Therapieversagen nach bildgeführter perkutaner RFA von Nierentumoren.

Methode Zehn Studien (967 Patienten, 1033 Tumoren) mit einem mittleren/medianen Beobachtungszeitraum von ≥ 30 Monaten wurden systematisch identifiziert und ausgewertet.

Ergebnisse und Schlussfolgerung Die bildgeführte perkutane RFA ist eine sehr effektive Technik zur Behandlung von umschriebenen Nierentumoren. Der residuelle nicht-abladierte Tumor ist der häufigste Typ des Therapieversagens (5,9 %), gefolgt von lokalem Tumorprogress (4,7 %). De-novo-Nierentumoren treten in 1,3 % und extrarenale Metastasen in 2,0 % der Fälle auf. Lokaler Tumorprogress, de-novo-Nierentumoren und extrarenale Metastasen treten vorwiegend später als 12 Monate nach initialer RFA auf. Eine Tumorgröße > 3 cm und eine zentrale Tumorlokalisation sind die Hauptrisikofaktoren für das Therapieversagen. Im Falle eines Therapieversagens zeigt die erneute RFA eine hohe Erfolgsrate (86,3 % für residuelle nicht-abladierte Tumoren und 87,5 % für lokalen Tumorprogress).

Kernaussagen:

  • Therapieversagen kann in residuelle nicht-abladierte Tumoren und lokalen Tumorprogress unterteilt werden.

  • Residuelle nicht-abladierte Tumoren treten in 5,9 % der Fälle auf.

  • Lokaler Tumorprogress tritt in 4,7 % der Fälle auf.

  • Tumorgröße und Tumorlokalisation sind Hauptrisikofaktoren für das Therapieversagen.

  • Die erneute RFA ist effektiv und wird regelmäßig durchgeführt.

Key words

radiofrequency ablation (RFA, RF ablation) - tumor ablation (TA) - image-guided - renal tumor - kidney
 

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