Percutaneous Image-guided Radiofrequency Ablation of Renal Neoplasms: Seven-year Local Experience
WK Tsang, SF Lee, HY Cheung, PY Lui, KY Tam
Hong Kong J Radiol 2013;16:17-26
DOI: 10.12809/hkjr1312136
Objective: To evaluate the safety and efficacy of image-guided radiofrequency ablation of renal neoplasms in our centre in Hong Kong.
Methods:Records of all patients who underwent this procedure in our centre from February 2004 to March 2011 were retrospectively reviewed. The indications for non-surgical treatment, individual tumour characteristics, procedural details, complications, and follow-up results were evaluated.
Results:Over the study period, seven renal tumours from seven patients were treated with radiofrequency ablation. The most common reasons for non-surgical treatment were comorbidities and anticoagulant-related bleeding diatheses. All the patients were male, and had a mean age of 70 (standard deviation, 10.6) years. Six tumours from six patients were included under the intention-to-cure group; five tumours in this group were small (≤3 cm) and exophytic, while one was large (>3 cm) and parenchymal. One patient with bilateral renal cell carcinomas was included for palliation of haematuria. His 11-cm locally advanced left renal cell carcinoma was ablated. In total, 10 sessions of radiofrequency ablation were performed. Four patients had a single ablation session and three underwent two ablation sessions. Technical success without major complication was achieved in all sessions. There was complete tumour eradication in the entire intention-to-cure group after one (n=4) to two (n=2) ablation sessions. In the patient receiving palliation, radiofrequency ablation transiently aborted his disabling haematuria.
Conclusions:Percutaneous image-guided radiofrequency ablation can be a safe and highly effective treatment for small renal tumours in favourable positions. This technique could be regarded as a nephron-sparing treatment for non-surgical candidates. It also has a role in palliation of metastatic or locally advanced disease.
中文摘要
經皮穿刺影像引導下射頻消融治療腎腫瘤：七年本地經驗
曾慧勤、李醒芬、張皓琬、呂沛欣、譚家盈
目的：評估香港一所中心進行經皮穿刺影像引導下射頻消融術治療腎腫瘤的安全性及成功率。
方法：回顧從2004年2月至2011年3月於本中心接受影像引導下射頻消融術的腎癌患者的病例紀錄，評估非手術治療適應症、腫瘤的個體特徵、治療程序細節、併發症及隨訪結果。
結果：研究期間共7名腎腫瘤患者（7例）接受射頻消融術。進行非手術治療的最普遍原因為患者有 並存病以及因機體抗凝引致的出血傾向。所有病人均為男性，平均年齡70歲（標準差10.6歲）。6名 患者（6例）屬意向治癒組，其中5名患者有小腫瘤（即3 cm或以下）並屬外生性，另1名患者有大腫 瘤（即3 cm以上）並屬實性。1名有雙側腎細胞癌的病人為緩解血尿症狀而被納入舒緩治療組，對其 局部晚期的左腎細胞癌（11 cm）進行消融術。總計操作完成了10次射頻消融術。4名患者接受單次 的消融術，另3名患者接受兩次的消融術。在研究期間各消融術均達至技術性成功並沒有嚴重的併發 症。意向治癒組中分別接受單次消融術（4例）及兩次消融術（2例）的6名病人的腫瘤均得以治癒。 另1名接受舒緩治療的患者，其持暫性的血尿均能在每次射頻消融後的1個月內完全停止。
結論：對於體積小並處於優勢位置的腎腫瘤，經皮穿刺影像引導下射頻消融治療不但安全，而且高 度有效。對選擇非手術方法的患者來說，射頻消融可視作一種腎單位保留術。而對於腫瘤轉移或有 局部進展的患者來說，射頻消融有緩解的作用。