ABSTRACT
Although nephron-sparing surgery remains the gold standard treatment for small renal
tumors, minimally invasive image-guided percutaneous ablation is becoming a viable
alternative to operative resection. Percutaneous radiofrequency ablation (RFA) and
cryoablation show high technical success rates, a relatively low incidence of residual
or recurrent tumor, and competitive rates of patient survival. In this review, an
overview of the current status of image-guided percutaneous ablation of renal tumors
is presented, with a focus on procedure indications and patient selection, technical
aspects of ablation procedures, and treatment outcomes and patient follow-up.
KEYWORDS
Percutaneous - ablation - radiofrequency - cryoablation - kidney - renal - tumor
REFERENCES
- 1
Chow W H, Devesa S S, Warren J L, Fraumeni Jr J F.
Rising incidence of renal cell cancer in the United States.
JAMA.
1999;
281
1628-1631
- 2
Pantuck A J, Zisman A, Belldegrun A S.
The changing natural history of renal cell carcinoma.
J Urol.
2001;
166
1611-1623
- 3 American Cancer Society .Cancer Statistics 2008. Atlanta, GA; American Cancer Society
2008
- 4
Luciani L G, Cestari R, Tallarigo C.
Incidental renal cell carcinoma-age and stage characterization and clinical implications:
study of 1092 patients (1982–1997).
Urology.
2000;
56
58-62
- 5
Janzen N K, Kim H L, Figlin R A et al..
Surveillance after radical or nephron sparing surgery for localized renal cell carcinoma
and management of recurrent disease.
Urol Clin North Am.
2003;
30
843-852
- 6
Fergany A F, Hafez K S, Novick A C.
Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year
follow up.
J Urol.
2000;
163
442-445
- 7
Gill I S, Kavoussi L R, Lane B R et al..
Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors.
J Urol.
2007;
178
41-46
- 8
Breda A, Finelli A, Janetschek G, Porpiglia F, Montorsi F.
Complications of laparoscopic surgery for renal masses: prevention, management, and
comparison with the open experience.
Eur Urol.
2009;
55
836-850
- 9
Spaliviero M, Moinzadeh A, Gill I S.
Laparoscopic cryotherapy for renal tumors.
Technol Cancer Res Treat.
2004;
3
177-180
- 10
Hui G C, Tuncali K, Tatli S, Morrison P R, Silverman S G.
Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis
of effectiveness and complication rates.
J Vasc Interv Radiol.
2008;
19
1311-1320
- 11
Gervais D A, McGovern F J, Wood B J et al..
Radiofrequency ablation of renal cell carcinoma: early clinical experience.
Radiology.
2000;
217
665-672
- 12
Atwell T D, Farrell M A, Leibovich B C et al..
Percutaneous renal cryoablation: experience treating 115 tumors.
J Urol.
2008;
179
2136-2141
- 13
Maybody M, Solomon S B.
Image-guided percutaneous cryoablation of renal tumors.
Tech Vasc Interv Radiol.
2007;
10
140-148
- 14
Boss A, Clasen S, Kuczyk M et al..
Magnetic resonance-guided percutaneous radiofrequency ablation of renal cell carcinomas:
a pilot clinical study.
Invest Radiol.
2005;
40
583-590
- 15
Miki K, Shimomura T, Yamada H et al..
Percutaneous cryoablation of renal cell carcinoma guided by horizontal open magnetic
resonance imaging.
Int J Urol.
2006;
13
880-884
- 16
Farrell M A, Charboneau J W, Callstrom M R et al..
Paranephric water instillation: a technique to prevent bowel injury during percutaneous
renal radiofrequency ablation.
AJR Am J Roentgenol.
2003;
181
1315-1317
- 17
Kam A W, Littrup P J, Walther M M et al..
Thermal protection during percutaneous thermal ablation of renal cell carcinoma.
J Vasc Interv Radiol.
2004;
15
753-758
- 18
Gervais D A, Arellano R S, McGovern F J, McDougal W S, Mueller P R.
Radiofrequency ablation of renal cell carcinoma: part 2, lessons learned with ablation
of 100 tumors.
AJR Am J Roentgenol.
2005;
185
72-80
- 19
Cantwell C P, Wah T M, Gervais D A et al..
Protecting the ureter during radiofrequency ablation of renal cell cancer: a pilot
study of retrograde pyeloperfusion with cooled dextrose 5% in water.
J Vasc Interv Radiol.
2008;
19
1034-1040
- 20
Park B K, Kim C K.
Using an electrode as a lever to increase the distance between renal cell carcinoma
and bowel during CT-guided radiofrequency ablation.
Eur Radiol.
2008;
18
743-746
- 21
Allaf M E, Varkarakis I M, Bhayani S B et al..
Pain control requirements for percutaneous ablation of renal tumors: cryoablation
versus radiofrequency ablation – initial observations.
Radiology.
2005;
237
366-370
- 22
Littrup P J, Ahmed A, Aoun H D et al..
CT-guided percutaneous cryotherapy of renal masses.
J Vasc Interv Radiol.
2007;
18
383-392
- 23
Solomon S B, Chan D Y, Jarrett T W.
Percutaneous cryotherapy of kidney tumors.
Am J Urol Rev.
2004;
2
369-371
- 24
Silverman S G, Tuncali K, van Sonnenberg E et al..
Renal tumors MR imaging-guided percutaneous cryotherapy – initial experience in 23
patients.
Radiology.
2005;
236
716-724
- 25
Gill I S, Novick A C, Meraney A M et al..
Laparoscopic renal cryoablation in 32 patients.
Urology.
2000;
56
748-753
- 26
Matin S F, Ahrar K, Cadeddu J A et al..
Residual and recurrent disease following renal energy ablative therapy: a multi-institutional
study.
J Urol.
2006;
176
1973-1977
- 27
Permpongkosol S, Nicol T L, Link R E et al..
Differences in ablation size in porcine kidney, liver, and lung after cryoablation
using the same ablation protocol.
AJR Am J Roentgenol.
2007;
188
1028-1032
- 28
Gervais D A, McGovern F J, Arellano R S, McDougal W S, Mueller P R.
Radiofrequency ablation of renal cell carcinoma. Part 1. Indications, results, and
role in patient management over a 6-year period and ablation of 100 tumors.
AJR Am J Roentgenol.
2005;
185
64-71
- 29
McDougal W S, Gervais D A, McGovern F J, Mueller P R.
Long-term follow-up of patients with renal cell carcinoma treated with radio frequency
ablation with curative intent.
J Urol.
2005;
174
61-63
- 30
Simon C J, Dupuy D E, Mayo-Smith W W.
Microwave ablation: principles and applications.
Radiographics.
2005;
25
S69-S83
- 31
Dick E A, Joarder R, De Jode M G, Wragg P, Vale J A, Gedroyc W M.
Magnetic resonance imaging-guided laser thermal ablation of renal tumours.
BJU Int.
2002;
90(9)
814-822
- 32
Rubinsky B, Onik G, Mikus P.
Irreversible electroporation: a new ablation modality: clinical implications.
Technol Cancer Res Treat.
2007;
6
37-48
- 33
Marberger M, Schatzl G, Kranston D, Kennedy J E.
Extracorporeal ablation of renal tumors with high intensity focused ultrasound.
BJU Int.
2005;
95
52-55
- 34
Klatte T, Marberger M.
High-intensity focused ultrasound for the treatment of renal masses: current status
and future potential.
Curr Opin Urol.
2009;
19
188-191
- 35
Johnson D B, Solomon S B, Su L M et al..
Defining the complications of cryoablation and radiofrequency ablation of small renal
tumors: a multi-institutional review.
J Urol.
2004;
172
874-877
- 36
Smith S, Gillams A.
Imaging appearances following thermal ablation.
Clin Radiol.
2008;
63
1-11
- 37
Merkle E M, Nour S G, Lewin J S.
MR imaging follow-up after percutaneous radiofrequency ablation of renal cell carcinoma:
findings in 18 patients during first 6 months.
Radiology.
2005;
235
1065-1071
- 38
Uppot R N, Silverman S G, Zagoria R J, Tuncali K, Childs D D, Gervais D A.
Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do
it.
AJR Am J Roentgenol.
2009;
192
1558-1570
- 39
Kawamoto S, Solomon S B, Bluemke D A, Fishman E K.
Computed tomography and magnetic resonance imaging appearance of renal neoplasms after
radiofrequency ablation and cryoablation.
Semin Ultrasound CT MR.
2009;
30
67-77
- 40
Gill I S, Remer E M, Hasan W A et al..
Renal cryoablation: outcome at 3 years.
J Urol.
2005;
173
1903-1907
- 41
Janzen N K, Perry K T, Han K R et al..
The effects of intentional cryoablation and radiofrequency ablation of renal tissue
involving the collecting system in a porcine model.
J Urol.
2005;
173
1368-1374
Majid MaybodyM.D.
Section of Interventional Radiology, Department of Radiology, Memorial Sloan-Kettering
Cancer Center
1275 York Avenue, H118A New York, NY 10065
Email: maybodym@mskcc.org