University Hospitals Leuven, Department of Urology, Leuven, Belgium.
Panminerva Med. 2010 Dec;52(4):319-29.
The success of radio frequency ablation (RFA) into various surgical fields has fueled the interest of the urological community to study its application in small renal masses (SRM). However, some controversies remain regarding its oncologic efficacy. This paper reviews the effects of technical factors and tumor/tissue characteristics on 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. The authors have performed a Medline database search regarding the treatment of SRM by RFA from 2003 through August 2010. To evaluate technical factors and tissue characteristics influencing treatment success, and the evaluation of treatment success by imaging and histopathology, papers were selected when they provided detailed descriptions on one or more of these items. For the analysis of oncologic outcomes, the selection was limited to series that treated a minimum of 20 patients or a minimum follow-up of 48 months and reported effectiveness based on follow-up imaging. Technical evolutions and correct patient/tumor selection produced increasingly higher success rates with RFA. Even though tumor skipping has been described in preclinical studies and early clinical trials, this does not seem to influence efficacy of the procedure. Indeed, a 8.7% retreatment rate exists. However, accepting this potential downside, final ablative success rate is 94.1% at intermediate term follow-up. Complications after RFA are less frequent and more often minor compared to surgical series. The present analysis reveals that RFA achieves a high intermediate-term ablative success rate when accepting an 8.7% re-ablation rate. Complication rates are low and usually minor. Based on this data, RFA represents an attractive minimal 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 treatment of SRM.
射频消融（RFA）在各个外科领域的成功激发了泌尿外科界研究其在小肾肿瘤（SRM）中的应用的兴趣。然而，其肿瘤学疗效仍存在一些争议。本文回顾了技术因素和肿瘤/组织特征对治疗成功的影响，讨论了治疗后影像学和组织病理学评估治疗成功的方法，并强调了最近更大规模 RFA 系列的中期肿瘤学结果。作者对 2003 年至 2010 年 8 月期间通过 RFA 治疗 SRM 的 Medline 数据库进行了搜索。为了评估影响治疗成功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成功的方法，当论文提供了关于这些项目中的一个或多个详细描述时，就选择了这些论文。为了分析肿瘤学结果，选择仅限于至少治疗 20 例患者或随访至少 48 个月并根据随访影像学报告有效性的系列。技术发展和正确的患者/肿瘤选择使 RFA 的成功率越来越高。尽管在临床前研究和早期临床试验中已经描述了肿瘤跳跃现象，但这似乎并不影响该手术的疗效。事实上，存在 8.7％的再次治疗率。但是，接受这种潜在的缺点，在中期随访中最终消融成功率为 94.1％。与手术系列相比，RFA 后的并发症较少且通常较轻。目前的分析表明，接受 8.7％的再消融率，RFA 可实现较高的中期消融成功率。并发症发生率低，通常较轻。基于这些数据，RFA 为 SRM 提供了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人群中。长期随访数据有望证实 RFA 在治疗 SRM 中的作用。
