Interventionelle Therapie von Nierentumoren

Nierentumoren werden immer früher entdeckt. Im Frühstadium liegt nur sehr selten eine Metastasierung vor, sodass lokale Therapieverfahren wie die perkutane Ablation effektiv eingesetzt werden können. Bei fortgeschrittenen Nierenzellkarzinomen ist die transarterielle Embolisation auch in der palliativen Situation ein wichtiger Therapiebaustein.

Abstract

Renal tumors are being discovered increasingly earlier. In early-stage disease, metastases are rare, providing the rationale for the effective use of local therapies such as percutaneous ablation. In advanced renal cell carcinoma, particularly in the palliative setting, transarterial embolization is also an important therapeutic option.

Kernaussagen

• Die perkutane Ablation von Nierentumoren ist eine effektive Therapiemöglichkeit, die sowohl bei malignen als auch bei ausgewählten benignen Tumoren in kurativer Intention eingesetzt werden kann.

• Die perkutanen Ablationsverfahren sind bei Nierenzellkarzinomen im Stadium cT1a der operativen Therapie hinsichtlich tumorspezifischen Überlebens weitgehend ebenbürtig.

• Durch den Einsatz begleitender Maßnahmen, wie transarterieller Embolisation, perkutaner Hydrodissektion oder Pyeloperfusion, kann die perkutane Ablation auch bei komplexen Tumoren sicher und effektiv eingesetzt werden.

• Die transarterielle Embolisation ist vor allem in der palliativen Situation zur Kontrolle von Hämaturie und Flankenschmerz ein effektiver Therapiebaustein.

Schlüsselwörter

Nierenzellkarzinom - Angiomyolipom - Nierentumor - Ablation - Kryoablation - Radiofrequenzablation - Mikrowellenablation - Biopsie

Keywords

renal cell carcinoma - angiomyolipoma - kidney tumor - ablation - cryoablation - radiofrequency ablation - microwave ablation - biopsy

Publikationsverlauf

Artikel online veröffentlicht:
05. Juni 2025

• Literatur

• 1 Bukavina L, Bensalah K, Bray F. et al. Epidemiology of Renal Cell Carcinoma: 2022 Update. Eur Urol 2022; 82: 529-542
• 2 Chawla SN, Crispen PL, Hanlon AL. et al. The natural history of observed enhancing renal masses: Meta-analysis and review of the world literature. J Urol 2006; 175: 425-431
• 3 Goldstein HM, Medellin H, Beydoun MT. et al. Transcatheter embolization of renal cell carcinoma. Am J Roentgenol Radium Ther Nucl Med 1975; 123: 557-562
• 4 Karalli A, Ghaffarpour R, Axelsson R. et al. Transarterial Chemoembolization of Renal Cell Carcinoma: A Prospective Controlled Trial. J Vasc Interv Radiol 2017; 28: 1664-1672
• 5 de Souza PL, Aslan P, Clark W, Nour R. et al. RESIRT: A Phase 1 Study of Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres in Patients With Primary Renal Cell Carcinoma. Clin Genitourin Cancer 2022; 20: 442-451
• 6 Borojeni S, Borojeni A, Panayotopoulos P. et al. Study of Renal and Kidney Tumor Vascularization Using Data from Preoperative Three-dimensional Arteriography Prior to Partial Nephrectomy. Eur Urol Focus 2020; 6: 112-121
• 7 Lane BR, Abouassaly R, Gao T. et al. Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older. Cancer 2010; 116: 3119-3126
• 8 Hollingsworth JM, Miller DC, Daignault S. et al. Five-year survival after surgical treatment for kidney cancer: a population-based competing risk analysis. Cancer 2007; 109: 1763-1768
• 9 Campbell SC, Clark PE, Chang SS. et al. Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I. J Urol 2021; 206: 199-208
• 10 Ljungberg B, Bex A, Albiges L. et al. EAU Guidelines on renal cell carcinoma 2024. Arnhem; The Netherlands: European Association of Urology;: 2024
• 11 Widdershoven CV, Aarts BM, Zondervan PJ. et al. Renal biopsies performed before versus during ablation of T1 renal tumors: implications for prevention of overtreatment and follow-up. Abdom Radiol (NY) 2021; 46: 373-379
• 12 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). S3-Leitlinie Diagnostik, Therapie und Nachsorge des Nierenzellkarzinoms, Langversion 5.0, AWMF-Registernummer: 043–017OL. 2024 Zugriff am 27. Februar 2025 unter: https://www.leitlinienprogramm-onkologie.de/leitlinien/nierenzellkarzinom/
• 13 Krokidis ME, Orsi F, Katsanos K. et al. CIRSE Guidelines on Percutaneous Ablation of Small Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2017; 40: 177-191
• 14 Finelli A, Ismaila N, Bro B. et al. Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017; 35: 668-680
• 15 Allen BC, Chen MY, Childs DD. et al. Imaging-guided radiofrequency ablation of cystic renal neoplasms. AJR Am J Roentgenol 2013; 200: 1365-1369
• 16 Wessendorf J, König A, Heers H. et al. Repeat Percutaneous Radiofrequency Ablation of T1 Renal Cell Carcinomas is Safe in Patients with Von Hippel-Lindau Disease. Cardiovasc Intervent Radiol 2021; 44: 2022-2025
• 17 Silverman SG, Pedrosa I, Ellis JH. et al. Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment. Radiology 2019; 292: 475-488
• 18 Klatte T, Ficarra V, Gratzke C. et al. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy. Eur Urol 2015; 68: 980-992
• 19 Camacho JC, Kokabi N, Xing M. et al. R.E.N.A.L. (Radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines) nephrometry score predicts early tumor recurrence and complications after percutaneous ablative therapies for renal cell carcinoma: a 5-year experience. J Vasc Interv Radiol 2015; 26: 686-693
• 20 Papa M, Biondetti P, Colombo R. et al. sABLATE: a simplified ABLATE score for prediction of complications and outcome in percutaneous thermal ablation of renal lesions. Med Oncol 2021; 38: 126
• 21 Schmit GD, Kurup AN, Weisbrod AJ. et al. ABLATE: a renal ablation planning algorithm. AJR Am J Roentgenol 2014; 202: 894-903
• 22 Li S, Huang J, Jang S. et al. Utility of the RENAL Nephrometry Scoring System in Predicting Adverse Events and Outcomes of Percutaneous Microwave Ablation of Renal Tumors. J Vasc Interv Radiol 2022; 33: 695-701
• 23 Papa M, Suardi N, Losa A. et al. ABLATE: a score to predict complications and recurrence rate in percutaneous treatments of renal lesions. Med Oncol 2020; 37: 26
• 24 Uhlig J, Strauss A, Rücker G. et al. Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis. Eur Radiol 2019; 29: 1293-1307
• 25 Uhlig J, Kokabi N, Xing M. et al. Ablation versus Resection for Stage 1A Renal Cell Carcinoma: National Variation in Clinical Management and Selected Outcomes. Radiology 2018; 288: 889-897
• 26 Xing M, Kokabi N, Zhang D. et al. Comparative Effectiveness of Thermal Ablation, Surgical Resection, and Active Surveillance for T1a Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked Population Study. Radiology 2018; 288: 81-90
• 27 Caputo PA, Zargar H, Ramirez D. et al. Cryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis. Eur Urol 2017; 71: 111-117
• 28 Chang X, Zhang F, Liu T. et al. Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes. J Urol 2015; 193: 430-435
• 29 Thompson RH, Atwell T, Schmit G. et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015; 67: 252-259
• 30 Knight A, Gunn AJ. Percutaneous Ablation of T1b Renal Cell Carcinoma: An Overview. Curr Oncol Rep 2024; 26: 754-761
• 31 An J, Packiam VT, Chennamadhavuni A. et al. Patient Characteristics and Survival Outcomes of Non-Metastatic, Non-Clear Cell Renal Cell Carcinoma. Front Oncol 2022; 11
• 32 Lay AH, Faddegon S, Olweny EO. et al. Oncologic Efficacy of Radio Frequency Ablation for Small Renal Masses: Clear Cell vs Papillary Subtype. J Urol 2015; 194: 653-657
• 33 Liu N, Huang D, Cheng X. et al. Percutaneous radiofrequency ablation for renal cell carcinoma vs. partial nephrectomy: Comparison of long-term oncologic outcomes in both clear cell and non-clear cell of the most common subtype. Urol Oncol 2017; 35: 530.e1-530.e6
• 34 Bodard S, Boudhabhay I, Dariane C. et al. Percutaneous Thermal Ablation for Renal Tumors in Patients with Birt-Hogg-Dubé Syndrome. Cancers (Basel) 2022; 14: 4969
• 35 Fernández-Pello S, Hora M, Kuusk T. et al. Management of Sporadic Renal Angiomyolipomas: A Systematic Review of Available Evidence to Guide Recommendations from the European Association of Urology Renal Cell Carcinoma Guidelines Panel. Eur Urol Oncol 2020; 3: 57-72
• 36 Rooseno G, Hakim L, Djojodimedjo T. A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary?. Arch Ital Urol Androl 2023; 95: 12018
• 37 Reinhart HA, Ghaleb M, Davis BR. Transarterial embolization of renal tumors improves surgical outcomes: A case series. Int J Surg Case Rep 2015; 15: 116-118
• 38 Shanmugasundaram S, Cieslak JA, Sare A. et al. Preoperative embolization of renal cell carcinoma prior to partial nephrectomy: A systematic review and meta-analysis. Clin Imaging 2021; 76: 205-212
• 39 Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma. Am J Clin Oncol 2000; 23: 6-12
• 40 May M, Brookman-Amissah S, Pflanz S. et al. Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma. Br J Radiol 2009; 82: 724-731
• 41 Arima K, Yamakado K, Kinbara H. et al. Percutaneous radiofrequency ablation with transarterial embolization is useful for treatment of stage 1 renal cell carcinoma with surgical risk: results at 2-year mean follow up. Int J Urol 2007; 14: 585-590
• 42 Wessendorf J, König AM, Heers H. et al. Efficacy and Safety of Combined Embolization and Radiofrequency Ablation in Stage 1 Renal Cell Carcinomas. Rofo 2022; 194: 1020-1025
• 43 Gunn AJ, Mullenbach BJ, Poundstone MM. et al. Transarterial embolization of renal cell carcinoma as an adjunctive therapy prior to cryoablation: a propensity score matching analysis. Diagn Interv Radiol 2018; 24: 357-363
• 44 Serafin Z, Karolkiewicz M, Strześniewski P. et al. Palliative percutaneous kidney embolization with enbucrilate in patients with renal cell carcinoma: safety and symptom control. Med Sci Monit 2007; 13: 98-104
• 45 Onishi T, Oishi Y, Suzuki Y. et al. Prognostic evaluation of transcatheter arterial embolization for unresectable renal cell carcinoma with distant metastasis. BJU Int 2001; 87: 312-315
• 46 Hu X, Shao YX, Wang Y. et al. Partial nephrectomy versus ablative therapies for cT1a renal masses: A Systematic Review and meta-analysis. Eur J Surg Oncol 2019; 45: 1527-1535
• 47 Kavoussi N, Canvasser N, Caddedu J. Ablative Therapies for the Treatment of Small Renal Masses: a Review of Different Modalities and Outcomes. Curr Urol Rep 2016; 17: 59
• 48 Schwartz MJ, Smith EB, Trost DW. et al. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int 2007; 99: 881-886
• 49 Crocerossa F, Autorino R, Derweesh I. et al. Management of renal cell carcinoma in transplant kidney: a systematic review and meta-analysis. Minerva Urol Nephrol 2023; 75: 1-16
• 50 Miller JM, Julien P, Wachsman A. et al. The role of embolization in reducing the complications of cryoablation in renal cell carcinoma. Clin Radiol 2014; 69: 1045-1049