Dai Ying, Covarrubias Diego, Uppot Raul, Arellano Ronald S
Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA 02114; Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Minister of Education), Peking University Cancer Hospital, Beijing Cancer Hospital and Institute, Beijing, China.
Department of Radiology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California.
J Vasc Interv Radiol. 2017 Dec;28(12):1643-1650. doi: 10.1016/j.jvir.2017.05.006. Epub 2017 Jul 1.
To assess clinical efficacy and safety of image-guided percutaneous radiofrequency (RF) ablation of central renal cell carcinoma with adjunctive pyeloperfusion.
Patients with central renal tumors who underwent percutaneous RF ablation between 2005 and 2010 were retrospectively evaluated. Thirty patients with 31 central renal tumors underwent 39 RF ablation sessions. Mean tumor diameter was 3.7 cm (range, 2-7 cm). Median distance between tumor and renal pelvis was 5 mm (range, 0-15 mm). Pyeloperfusion was performed in 27 patients (27/30; 90%). Contrast-enhanced CT or MR imaging was performed to evaluate treatment response.
Technical success of RF ablation was achieved in 38/39 (97.4%) ablation sessions. Primary efficacy was 83.9% (26/31) on first follow-up imaging. One (3.2%) case of local tumor progression was detected 6 months after initial ablation. Secondary efficacy was 96.8% (30/31) after repeat RF ablation for residual tumor or local tumor progression. Median follow-up was 88 months (mean 82.6 mo ± 30.7; range, 9-121 mo). Major complications occurred in 5/39 (12.8%) RF ablation sessions. Complications were significantly higher for tumors located within 5 mm of the renal pelvis or 0 mm of a major calyx (28.6% vs 4.0%; P < .05). Overall survival was 96.0% (95% CI, 88.4%-100.0%), and progression-free survival at 5 years was 80.9% (95% CI, 65.8%-95.9%).
Image-guided percutaneous RF ablation combined with pyeloperfusion has satisfactory clinical efficacy in treating central renal tumors. Although clinically effective, RF ablation of central tumors may also be associated with significant major complications.
评估影像引导下经皮射频（RF）消融联合肾盂灌注治疗中央型肾细胞癌的临床疗效及安全性。
回顾性评估2005年至2010年间接受经皮RF消融的中央型肾肿瘤患者。30例患者的31个中央型肾肿瘤接受了39次RF消融治疗。肿瘤平均直径为3.7 cm（范围2 - 7 cm）。肿瘤与肾盂的中位距离为5 mm（范围0 - 15 mm）。27例患者（27/30；90%）进行了肾盂灌注。采用对比增强CT或MR成像评估治疗反应。
39次消融治疗中有38次（97.4%）实现了RF消融的技术成功。首次随访成像时的主要疗效为83.9%（26/31）。初次消融6个月后检测到1例（3.2%）局部肿瘤进展。对残留肿瘤或局部肿瘤进展进行重复RF消融后，次要疗效为96.8%（30/31）。中位随访时间为88个月（平均82.6个月±30.7；范围9 - 121个月）。39次RF消融治疗中有5次（12.8%）发生了严重并发症。位于距肾盂5 mm内或距主要肾盏0 mm处的肿瘤并发症明显更高（28.6%对4.0%；P <.05）。总生存率为96.0%（95%CI：88.4% - 100.0%），5年无进展生存率为80.9%（95%CI：65.8% - 95.9%）。
影像引导下经皮RF消融联合肾盂灌注治疗中央型肾肿瘤具有满意的临床疗效。虽然中央型肿瘤的RF消融在临床上有效，但也可能与显著的严重并发症相关。
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