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.
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.