The Benefit of Radiofrequency Ablation in Patients With Comorbidities

Patients with small renal masses (SRMs) who are poor candidates for nephron-sparing surgery (NSS) may benefit from radiofrequency ablation (RFA) performed percutaneously, according to a new study published in Videosurgery and Other Miniinvasive Techniques.

A retrospective analysis of medical records identified 103 percutaneous, ultrasound-guided RFA procedures performed on patients with an ASA score ≥ 3 and a biopsy-proven T1a kidney cancer between 2006 and 2012 in the Oncology Centre in Bydgoszcz.

Contrast-enhanced CT scan and tumor biopsy were performed prior to RFA. Clear cell carcinoma (98 cases), chromophobe (3 cases), and papillary cancer (2 cases) were the identified pathologies.

Ultrasound-guided, percutaneous RFA was performed using alternating current (460 kHz) conducted directly to the tumor with a needle electrode. Total ablation time depended on the tumor diameter and ranged from 8 minutes to 30 minutes consisting of 1 to 3 punctures, with each puncture lasting between 8 minutes to 12 minutes.

Average follow-up time was 46 months. The 1-, 3-, and 5-year overall survival (OS) rates were 97%, 90%, and 75%, respectively. Cancer-specific survival (CSS) was 100%.

The authors concluded that radiofrequency ablation performed percutaneously may be used in patients who are poor candidates for NSS due to comorbidities.

“It seems reasonable, then, that a subgroup of elderly patients with SRMs who are poor candidates for surgery may still benefit from a minimally invasive, focal treatment (such as RFA) in comparison to [active surveillance],” the authors wrote. “Nevertheless, further effort is required to elucidate the qualification criteria for NSS, focal ablative treatment and [active surveillance], in elderly, comorbid patients, including oncological effectiveness, risk of complications, risk of cancer progression and life expectancy,” they concluded.

--Kelsey Moroz

 

Reference

Siekiera J, Jasinski M, Mikołajczak W. Radiofrequency ablation of small renal masses in comorbid patients. Wideochir Inne Tech Maloinwazyjne. 2018;13(2):212-214. doi: 10.5114/wiitm.2018.74462. Epub 2018 Mar 21.