Department of Urology, University Hospitals Leuven, Leuven, Belgium.
J Endourol. 2010 May;24(5):721-8. doi: 10.1089/end.2009.0677.
The introduction of radiofrequency ablation (RFA) into other fields of surgery has fueled the interest to study its application in small renal masses (SRM). Some controversies remain, however, regarding its oncologic efficacy. We review technical factors and tissue characteristics that influence treatment success, discuss the evaluation of treatment success by post-treatment imaging and histopathology, and highlight intermediate-term oncologic outcomes of recent, larger RFA series.
A search of the MEDLINE database regarding the treatment of SRM by RFA was performed from 2003 through August 2009. For the purpose of describing technical factors and tissue characteristics that influence treatment success and the evaluation of treatment success by imaging and histopathology, articles were selected when they provided detailed descriptions of one or more of these items. For the analysis of oncologic outcomes, the selection was limited to series in which a minimum of 20 patients were treated and that provided effectiveness based on follow-up imaging.
Technical evolutions and correct patient/tumor selection have led to increasingly higher success rates being achieved by RFA. Even though tumor skipping has been described in preclinical studies and early clinical studies, this does not seem to influence final success. Indeed, a 8.6% re-treatment rate has to be taken into account. Accepting this, the final ablative success rate is 93.8% at intermediate-term follow-up. Complications after RFA are less frequent and more often minor compared with surgical series.
The present analysis reveals that RFA achieves a high intermediate-term ablative success rate when accepting a 8.6% reablation rate. Complication rates are low and mostly minor. Those facts render RFA an attractive minimally invasive treatment for SRM, especially in the growing elderly patient population with multiple comorbidities. Long-term follow-up data are expected to confirm the role of RFA in the management of SRM.
射频消融（RFA）在其他外科领域的应用激发了人们对其在小肾肿瘤（SRM）治疗中应用的兴趣。然而，其在肿瘤学疗效方面仍存在一些争议。我们综述了影响治疗效果的技术因素和组织特征，讨论了治疗后影像学和组织病理学评估治疗效果的方法，并强调了最近较大规模 RFA 系列的中期肿瘤学结果。
对 2003 年至 2009 年 8 月 MEDLINE 数据库中关于 RFA 治疗 SRM 的文献进行了检索。为了描述影响治疗效果的技术因素和组织特征以及影像学和组织病理学评估治疗效果的方法，我们选择了详细描述这些内容的文章。为了分析肿瘤学结果，我们的选择仅限于至少治疗 20 例患者并提供基于随访影像学的有效性的系列研究。
技术发展和正确的患者/肿瘤选择使 RFA 的成功率不断提高。尽管在临床前研究和早期临床研究中已经描述了肿瘤跳跃现象，但这似乎并不影响最终的治疗效果。事实上，需要考虑 8.6%的再治疗率。接受这个再治疗率，在中期随访中，最终的消融成功率为 93.8%。与手术系列相比，RFA 后的并发症较少且更轻微。
目前的分析表明，接受 8.6%的再消融率，RFA 可达到较高的中期消融成功率。并发症发生率低且多为轻微。这些事实使得 RFA 成为治疗 SRM 的一种有吸引力的微创治疗方法，特别是在患有多种合并症的日益增长的老年患者群体中。长期随访数据有望证实 RFA 在 SRM 治疗中的作用。
