Efficacy and Safety of Combined Embolization and Radiofrequency Ablation in Stage 1 Renal Cell Carcinomas

Abstract

Purpose To retrospectively evaluate outcomes of a combined interventional approach to stage 1 (cT1cN0cM0) renal cell carcinomas (RCCs) by transarterial embolization (TAE) followed by percutaneous CT-guided radiofrequency ablation (RFA) in patients ineligible for surgery.

Materials and Methods 13 patients (9 male, 4 female, 69.6 ± 16.6 y/o) with 14 RCCs (largest diameter: 40.4 ± 6.7 mm, cT1a: 4, cT1b: 10) were treated by RFA a median of one day after TAE in a single center. Indications for minimally invasive interventional therapy were bilateral RCCs (n = 4), RCCs in a single kidney after nephrectomy (n = 3), increased surgical risk due to comorbidities (n = 4), and rejection of surgical therapy (n = 2). Technical success, effectiveness, safety, ablative margin, cancer-specific survival, overall survival, and tumor characteristics were analyzed.

Results All RCCs were successfully ablated after embolization with a minimum ablative margin of 1.2 mm. The median follow-up was 27 (1–83) months. There was no residual or recurrent tumor in the ablation zone. No patient developed metastasis. Two minor and two major complications occurred. Four patients with severe comorbidities died during follow-up due to causes unrelated to therapy. The 1-year and 5-year overall survival was 74.1 % each. Cancer-specific survival was 100 % after 1 and 5 years. There was no significant decline in mean eGFR directly after therapy (p = 0.226). However, the mean eGFR declined from 62.2 ± 22.0 to 50.0 ± 27.8 ml/min during follow-up (p < 0.05).

Conclusion The combination of TAE and RFA provides an effective minimally invasive therapy to stage 1 RCCs in patients ineligible for surgery. The outcomes compare favorably with data from surgery.

Key Points: 

• Interventional treatment by TAE and ablation is a safe and effective alternative to surgery in stage 1 RCCs.

• Focal therapy of RCCs preserves renal function.

• A small ablative margin appears to be sufficient in the ablation of RCCs.

Citation Format

• Wessendorf J, König AM, Heers H et al. Efficacy and Safety of Combined Embolization and Radiofrequency Ablation in Stage 1 Renal Cell Carcinomas. Fortschr Röntgenstr 2022; 194: 1020 – 1025

Zusammenfassung

Ziel Retrospektive Evaluation der Ergebnisse eines kombinierten Behandlungsansatzes aus blander Embolisation und perkutaner, CT-gesteuerter Radiofrequenzablation (RFA) bei Nierenzellkarzinomen (NZK) im Stadium 1 (cT1cN0cM0) bei Patienten, die für eine operative Therapie nicht geeignet sind.

Material und Methode 13 Patienten (9 Männer, 4 Frauen, 69,6 ± 16,6 Jahre) mit 14 NZKs (größter Durchmesser: 40,4 ± 6,7 mm, cT1a: 4, cT1b: 10) wurden in einem Zentrum mittels blander Embolisation gefolgt von einer RFA behandelt. Behandlungsindikationen für diese interventionelle Therapie waren bilaterale NZKs (n = 4), NZKs in einer Einzelniere nach Nephrektomie (n = 3), erhöhtes chirurgisches Risiko aufgrund von Komorbiditäten (n = 4) und Ablehnung einer operativen Therapie (n = 2). Technischer Erfolg, Wirksamkeit, Sicherheit, Ablationszone, tumorspezifisches Überleben, Gesamtüberleben und Tumorcharakteristika wurden untersucht.

Ergebnisse Alle NZKs wurden erfolgreich nach Embolisation abladiert. Der minimale Ablationsrand betrug 1,2 mm. Die mediane Nachsorgedauer betrug 27 (1–83) Monate. Es wurden weder Residualtumore noch Lokalrezidive beobachtet. Kein Patient entwickelte Metastasen. Es traten 2 “minor”- und 2 “major”-Komplikationen auf. 4 Patienten mit schweren Komorbiditäten verstarben während der Nachsorge. Die Todesursachen waren nicht therapieassoziiert. Das 1-Jahres- und 5-Jahres-Überleben betrug je 74,1 %. Das tumorspezifische Überleben nach 1 und 5 Jahren betrug je 100 %. Die eGFR zeigte direkt nach der Behandlung keine signifikante Veränderung (p = 0.226). Im Verlauf der Untersuchung reduzierte sich die eGFR jedoch von 62,2 ± 22,0 auf 50,0 ± 27,8 ml/min (p < 0,05).

Schlussfolgerung Die Kombination aus Embolisation und RFA ist eine sichere und effektive Therapie zur Behandlung von Patienten mit NZKs im Stadium 1, die für eine operative Therapie nicht geeignet sind. Die Ergebnisse dieser Studie sind mit den Ergebnissen der operativen Therapie vergleichbar.

Kernaussagen: 

• Eine interventionelle Therapie aus Embolisation und Ablation ist eine sichere und effektive Alternative zur operativen Therapie des frühen NZK.

• Eine fokale Therapie des NZK schont die Nierenfunktion.

• Zur ablativen Behandlung des NZK scheint ein geringer Sicherheitsabstand ausreichend zu sein.

Key words

radiofrequency ablation - transarterial embolization - tumor ablation - tumor embolization - renal cell carcinoma

Publication History

Received: 10 December 2021

Accepted: 03 February 2022

Article published online:
10 March 2022

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