Rationale and Objectives
Cancer of the kidney is the third most common cancer of the urinary tract, and renal cell carcinoma is the most lethal of all genitourinary tumors. The incidental discovery of renal cell carcinoma has increased with increased use of cross-sectional imaging. Concomitantly, minimally invasive ablative technologies, including image-guided cryoablation, radiofrequency ablation, and others, have evolved as therapeutic options for small renal masses.
Materials and Methods
Between 2006 and 2009, 111 patients (age range, 31–91 years; mean age, 70 years) underwent percutaneous computed tomography–guided thermal ablation for suspected renal cell carcinoma at two major academic centers. Outcomes data were retrospectively collected and analyzed to compare recurrence rates for patients undergoing radiofrequency ablation ( n = 41) versus cryoablation ( n = 70).
Results
There were four cases of suspicious enhancement on follow-up computed tomography or magnetic resonance imaging in each group, with cumulative imaging recurrence rates of 11% and 7% for radiofrequency ablation and cryoablation, respectively. Log rank test analysis revealed no significant difference between rates of imaging recurrence between the two groups ( P = .6044).
Conclusions
These results suggest that the use of cryoablative technology will result in similar outcomes compared with radiofrequency ablation.
Accounting for 3.5% of all malignancies, cancer of the kidney is the third most common cancer of the urinary tract behind prostate cancer and transitional cell carcinoma of the urinary bladder . There were an estimated 58,000 new cases of renal cell carcinoma in 2009, with 13,000 deaths attributable to the disease, manifesting as the most lethal of all genitourinary tumors. The incidental discovery of renal cell carcinoma has risen dramatically during recent years because of the increased use of cross-sectional imaging . During the same time, minimally invasive techniques have evolved from nephron-sparing laparoscopic techniques to percutaneous image-guided ablations. For small renal masses (SRMs; <3 cm), percutaneous ablation guided by computed tomography (CT) or magnetic resonance imaging (MRI) is becoming the standard of care .
Concomitant with this evolution, multiple ablative modalities have become available, including radiofrequency ablation (RFA), cryoablation, percutaneous ethanol instillation, microwave, ultrasound, and more. A large body of literature is accumulating, composed of reports and single-arm series of percutaneous ablations in this setting . RFA and cryoablation are the two most commonly used techniques. To our knowledge, however, no comparative reports have been generated thus far.
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Materials and methods
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Results
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Table 1
Distribution of Histologic Review of Ablated Lesions
Clear Cell Renal Cell Carcinoma Papillary Type Renal Cell Carcinoma Oncocytoma Angiomyolipoma Insufficient Tissue for Definitive Diagnosis 74 (67%) 18 (16%) 9 (8%) 4 (4%) 6 (6%)
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Table 2
Summary of Collected Data and Rate of Recurrence for RFA and Cryoablation of Small Renal Masses
Variable RFA Cryoablation Number of cases 41 70 Suspicious enhancement on follow-up 4 4 Recurrence confirmed on histologic biopsy 0 0 Estimated imaging recurrence at 10 months 11% 7%
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Discussion
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