Long-term oncologic outcomes following radiofrequency ablation with real-time temperature monitoring for T1a renal cell cancer

• Published in: Urologic oncology 2014-10, Vol.32 (7), p.1017-1023
• Main Authors: Lorber, Gideon, M.D, Glamore, Michael, M.D, Doshi, Mehul, M.D, Jorda, Merce, M.D., Ph.D, Morillo-Burgos, Gaston, M.D, Leveillee, Raymond J., M.D., F.R.C.S.-G
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - surgery; Catheter Ablation - methods; Disease-Free Survival; Female; Follow-Up Studies; Humans; Image-guided therapy; Kaplan-Meier Estimate; Kidney Neoplasms - mortality; Kidney Neoplasms - surgery; Laparoscopy; Male; Malignant disease; Middle Aged; Monitoring, Intraoperative - methods; Percutaneous renal surgery; Renal cancer; Retrospective Studies; Thermal ablation; Treatment Outcome; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2014.03.005

Abstract Objective Few studies report long-term follow-up of renal cancer treated by radiofrequency ablation (RFA), thus limiting the comparison of this modality to well-established long-term follow-up series of surgically resected renal masses. Herein, we report long-term oncologic outcomes of renal cancer treated with RFA in a single institution. Methods and materials We retrospectively reviewed patients treated between November 2001 and October 2012 with laparoscopic-guided or computed tomography–guided RFA. All treatments were performed with real-time thermometry ensuring target ablation temperature (>60°C) was adequately reached. Only patients with biopsy-confirmed T1a-category cancer and a follow-up period>48 months were included in our analysis. Follow-up included office visits, laboratory work, and periodic contrast-enhanced imaging. Survival was calculated using the Kaplan-Meier analysis. Overall complications were reported using the Clavien-Dindo scale. Results Of 434 RFA cases, 53 treatments in 50 patients met the inclusion criteria. Of these, 29 were treated with computed tomography–guided RFA and 24 with laparoscopic-guided RFA. The mean follow-up interval was 65.6 months (48.5–120.2), and the mean renal mass size was 2.3 cm (0.3–4.0). There were 4 (7.5%) local recurrences and 1 case of distant metastases with no local recurrence. The 5-year overall survival was 98%, cancer-specific survival was 100%, and recurrence-free survival was 92.5%. The complication rate was 26.4%, which included 71% of Clavien-Dindo grade I and 29% of grade II. Mean estimated glomerular filtration rate preoperatively and at the most recent follow-up visit was 77 and 66 ml/min, respectively. Conclusions When performed on selected patients, while monitoring real-time temperatures to ensure adequate treatment end points, RFA offers favorable long-term oncologic outcomes approaching those reported for partial nephrectomy.