Radiology Department, Basurto University Hospital, Bilbao, Spain.
Eur Urol. 2010 Mar;57(3):459-65. doi: 10.1016/j.eururo.2009.11.025. Epub 2009 Nov 13.
Radiofrequency ablation (RFA) is a minimally aggressive, therapeutic alternative for renal tumors. It can be an alternative to nephrectomy in patients with previous nephrectomy, bilateral tumors, von Hippel-Lindau disease, or small renal carcinomas and in those with contraindications for surgery.
To assess the effectiveness of the treatment of renal tumors by RFA in the short and medium term and to identify the possible complications and the factors that determine therapeutic success.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of patients with renal tumors treated with RFA between May 2005 and December 2008 was performed in a tertiary academic hospital. Patients were selected among those with previous nephrectomy, bilateral neoplasms, von Hippel-Lindau disease, surgical risk, comorbidity, advanced age, or patient's refusal to surgery. Tumors with evidence of extrarenal extension were excluded. Patients were followed up for 10-50 mo using computed tomography and magnetic resonance imaging.
Ultrasound-guided RFA was performed on 65 tumors (range: 1.2-5.3 cm) of 58 patients using multitined electrodes.
Incomplete ablation rate, therapeutic success rate, and complications rate.
Therapeutic success was achieved in 59 of 65 tumors (91%): 53 in a single session, 5 in two sessions, and 1 in three sessions. A significant relationship was observed between size and growth pattern of the tumor and both therapeutic success and incomplete ablation rates. Therapeutic success in tumors >5 cm was 60%. Complications were detected in 10 patients (13%); 5% were considered major complications. Limitations include the lack of pathologic studies to confirm a complete ablation and the lack of a control group to compare with the results of those who underwent nephrectomy.
RFA is safe and effective in renal tumors. Corticomedullary lesions and tumors >3 cm have greater possibility of incomplete ablation. In tumors >5 cm, RFA has a significant failure rate.
射频消融（RFA）是一种微创的治疗方法，适用于治疗肾肿瘤。对于既往接受过肾切除术、双侧肿瘤、von Hippel-Lindau 病、小肾癌或有手术禁忌的患者，以及那些不能接受手术的患者，RFA 可以作为肾切除术的替代方法。
评估 RFA 治疗肾肿瘤的短期和中期疗效，并确定可能的并发症和决定治疗成功的因素。
设计、地点和参与者：回顾性分析 2005 年 5 月至 2008 年 12 月期间在一家三级学术医院接受 RFA 治疗的肾肿瘤患者。患者的选择标准为既往接受过肾切除术、双侧肿瘤、von Hippel-Lindau 病、手术风险、合并症、高龄或患者拒绝手术。排除有肾外侵犯证据的肿瘤。采用计算机断层扫描和磁共振成像对患者进行 10-50 个月的随访。
对 58 例患者的 65 个肿瘤（范围：1.2-5.3cm）进行超声引导下 RFA 治疗，采用多齿电极。
不完全消融率、治疗成功率和并发症发生率。
65 个肿瘤中有 59 个（91%）达到治疗成功：53 个肿瘤单次治疗成功，5 个肿瘤分两次治疗成功，1 个肿瘤分三次治疗成功。肿瘤的大小和生长模式与治疗成功率和不完全消融率之间存在显著关系。>5cm 肿瘤的治疗成功率为 60%。10 例（13%）患者出现并发症，其中 5%为严重并发症。局限性包括缺乏病理研究来证实完全消融，以及缺乏对照组来比较接受肾切除术患者的结果。
RFA 治疗肾肿瘤是安全有效的。皮质髓质病变和>3cm 的肿瘤更有可能出现不完全消融。>5cm 的肿瘤 RFA 治疗失败率较高。
