Nakasone Yutaka, Kawanaka Koichi, Ikeda Osamu, Tamura Yoshitaka, Yamashita Yasuyuki
Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Honjo Kumamoto, Japan.
Acta Radiol. 2012 May 1;53(4):410-4. doi: 10.1258/ar.2012.110413. Epub 2012 Mar 5.
Potential drawbacks of percutaneous radiofrequency ablation (RFA) for renal cell carcinoma (RCC) include local recurrence after RFA due to a limited ablation area, massive hemorrhage induced by kidney puncture, and difficulty in visualizing the tumor at CT-guided puncture.
To evaluate retrospectively the technical success, effectiveness, and complications elicited in patients with unresectable RCC following single-session sequential combination treatment consisting of renal arterial embolization followed by RFA.
Ten patients (12 RCCs) who were not candidates for surgery were included in this pilot study. All tumors ranged from 18-66 mm in size (mean 31 ± 3.9 mm), and were percutaneously ablated several hours after embolization of the tumor vessels with iodized oil and gelatin sponges. We evaluated the technical success, effectiveness, effect on renal function, and complications of this treatment. Effectiveness was judged on CT and/or MR images obtained every three months after RFA. The effect on renal function was assessed based on the creatinine level and glomerular filtration rate (GFR) before, one week, and three months after the procedure.
Renal arterial embolization followed by percutaneous RFA was technically successful in all patients. On contrast CT and/or MR images obtained one week and three months after RFA we observed necrosis in the embolized segment of all RCCs. There were no major complications during and after the procedure. All patients reported tolerable pain and a burning sensation during RFA. After the procedure, five patients (50%) experienced back pain, one each manifested fluid collection, subcapsular hematomas, hematuria, or nausea. There were no instances of recurrence during a mean follow-up period of 47 ± 3.8 months. We noted no significant difference in serum creatinine and GFR before and after treatment.
Our pilot study suggests that sequential combination treatment by renal arterial embolization followed by percutaneous RFA is feasible in patients with inoperable RCC. The treatment complications were acceptable and excellent effects were obtained.
经皮射频消融术（RFA）治疗肾细胞癌（RCC）的潜在缺点包括由于消融区域有限导致RFA后局部复发、肾穿刺引起的大量出血以及在CT引导穿刺时难以可视化肿瘤。
回顾性评估在不可切除的RCC患者中，经肾动脉栓塞后再行RFA的单疗程序贯联合治疗的技术成功率、有效性及并发症。
本前瞻性研究纳入10例（12个RCC）不适合手术的患者。所有肿瘤大小在18 - 66mm之间（平均31±3.9mm），在用碘化油和明胶海绵栓塞肿瘤血管数小时后经皮进行消融。我们评估了该治疗的技术成功率、有效性、对肾功能的影响及并发症。有效性根据RFA后每三个月获得的CT和/或MR图像判断。根据术前、术后一周及三个月的肌酐水平和肾小球滤过率（GFR）评估对肾功能的影响。
所有患者经肾动脉栓塞后再行经皮RFA技术上均成功。在RFA后一周和三个月获得的增强CT和/或MR图像上，我们观察到所有RCC栓塞段均有坏死。术中及术后均无严重并发症。所有患者在RFA期间均报告有可耐受的疼痛和烧灼感。术后，5例患者（50%）出现背痛，各有1例出现积液、肾包膜下血肿、血尿或恶心。在平均47±3.8个月的随访期内无复发病例。我们注意到治疗前后血清肌酐和GFR无显著差异。
我们的前瞻性研究表明，对于不可手术的RCC患者，经肾动脉栓塞后再行经皮RFA的序贯联合治疗是可行的。治疗并发症可接受且效果良好。
