European urology supplements vol:6 issue:2 pages:233-233
Annual Congress of the European Association of Urology edition:22 date:2007
Introduction & Objectives: Percutaneous Radiofrequency Ablation (RFA) is increasingly
being used in the treatment of small renal cell carcinomas (RCC), especially in patients who
are elderly and unfit for major surgery. We aimed to evaluate the safety and intermediate term
patient outcome in our Belgian multicentre experience with RFA.
Material & Methods: A total of 50 RCC’s were treated in 43 patients between December
2003 and July 2006. Median patient age was 74y (range 50-86). All patients underwent 1
RFA session. The monopolar Cool-tip® RF system (Tyco Valleylab, Boulder, CO, USA) was
used and guided by ultrasound or CT. Patients underwent 6-monthly contrast-enhanced CT
or MRI during follow-up. Tumors with complete loss of contrast enhancement were considered
Results: Fifteen lesions were exophytic, 17 were exophytic-parenchymal, 15 were
parenchymal and 3 were central. Median tumor size was 18 mm (range 8-50). 13 patients
underwent a tumor biopsy prior to the ablation. 9 biopsies confirmed RCC aetiology, 4 were
undetermined. A 12 min treatment cycle was used for each tumor, but in one 10 mm lesion,
a 6 min cycle was used and in 4 larger lesions (25-50 mm), a 17 min cycle was used. Median
follow-up was 14 months (range 1-32). Minor complications included 4 limited subcapsular
haematomas, 3 transient intercostal nerve paraesthesias and 1 wound infection. Major
complications included 1 large perirenal haematoma, necessitating transfusion and 1 duodenal
perforation, which was treated conservatively, but eventually needed open surgical repair.
14/15 (93.3%) exophytic, 16/17 (94.1%) exophytic-parenchymal, 15/15 (100%) parenchymal
and 2/3 (66%) central lesions were successfully ablated. Two patients with unsuccessfully
ablated tumors underwent subsequent nephrectomy, 1 was treated conservatively and had a
stable rim of contrast enhancement during further follow-up. One patient developed a small
lung metastasis and underwent metastasectomy. Overall local cancer control was 94%. No
cancer related deaths occurred, 5 (10%) patients died of non-cancer related causes.
Conclusions: Percutaneous RFA for small RCC is feasible in older and unfit patients in a
multicentre trial. Complication rates are acceptable, with a minor complication rate of 16% and
major complication rate of 4%. Overall local cancer control was 94%. Success rates are higher
in exophytic and parenchymal lesions than in central lesions.