Veltri Andrea, De Fazio Giuseppina, Malfitana Valeria, Isolato Giuseppe, Fontana Dario, Tizzani Alessandro, Gandini Giovanni
Institute of Diagnostic and Interventional Radiology, University of Turin, Via Genova 3, 10126 Turin, Italy.
Eur Radiol. 2004 Dec;14(12):2303-10. doi: 10.1007/s00330-004-2413-2. Epub 2004 Jul 27.
Minimally invasive treatment for small renal cell carcinoma (RCC) can be necessary in selected patients and, anyway, is desirable. In situ ablation techniques, including RFA, have been developed. The aim of this study is to evaluate the feasibility, safety and short-term local effectiveness of percutaneous US-guided RFA in a small series, as well as mid-term patient outcome. Thirteen patients with a total of 18 tumors (17 small lesions, 35 mm in size or less, and a larger one, 75 mm in size) underwent 19 RFA sessions. Seven patients had a solitary kidney, and three suffered from VHL disease, too. We treated four lesions in a patient with a bilateral tumor. In another patient, three lesions were ablated. Seventeen tumors were RCC; one was a metastasis from lung cancer. Eight lesions were parenchymal, six exophytic, two parenchymal/exophytic, one parenchymal/central and one central. A monopolar RF system with multitined expandable electrode needles was used. The 35-mm lesion underwent two sessions; the 75-mm lesion was treated with transcatheter arterial embolization before RFA. Tumors with complete loss of contrast enhancement at short-term CT (or MR) were considered successfully treated. Percutaneous US-guided RFA was always feasible without major complications. The success rate after a single treatment in tumors less than 35 mm in size was 88.2% (15/17) and rose to 94.1% (16/17) after the second treatment of the largest lesion. After a mean 14-month follow-up, no successfully treated lesions recurred locally. Only the patient with metastasis from lung cancer died from disease progression in a further location, while all other patients are alive, with renal function still sufficient to avoid dialysis. US guidance allows an easy and safe percutaneous approach for RFA of small non-parahilar RCC. The treatment is locally effective and can be proposed as a minimally invasive therapy for patients with contraindications to surgery or to those expressing an informed consent. Based on the results of this study and of the literature, mid-term results on the clinical usefulness are very encouraging.
对于部分小肾癌（RCC）患者，微创治疗可能是必要的，无论如何，这种治疗方式都是可取的。包括射频消融（RFA）在内的原位消融技术已经得到发展。本研究的目的是评估在一小系列患者中经皮超声引导下RFA的可行性、安全性和短期局部疗效，以及中期患者的预后。13例患者共18个肿瘤（17个小病灶，大小为35mm或更小，1个较大病灶，大小为75mm）接受了19次RFA治疗。7例患者为单肾，3例还患有VHL病。我们对1例双侧肿瘤患者的4个病灶进行了治疗。在另1例患者中，3个病灶接受了消融。17个肿瘤为RCC；1个为肺癌转移灶。8个病灶为实质内型，6个为外生性，2个为实质内/外生性，1个为实质内/中央型，1个为中央型。使用了带有多针可扩张电极针的单极射频系统。35mm的病灶接受了2次治疗；75mm的病灶在RFA前接受了经导管动脉栓塞治疗。短期CT（或MR）检查显示对比增强完全消失的肿瘤被视为治疗成功。经皮超声引导下RFA总是可行的，且无重大并发症。小于35mm的肿瘤单次治疗后的成功率为88.2%（15/17），最大病灶第二次治疗后成功率升至94.1%（16/17）。平均随访14个月后，所有成功治疗的病灶均未局部复发。只有肺癌转移患者死于远处疾病进展，而所有其他患者均存活，肾功能仍足以避免透析。超声引导为小的非肾门旁RCC的RFA提供了一种简便、安全的经皮途径。该治疗局部有效，可作为手术禁忌患者或签署知情同意书患者的微创治疗方法。基于本研究及文献结果，中期临床应用结果非常令人鼓舞。
