One of the limitations of these energy ablation techniques is the lack of pathologic confirmation of tumor death. Instead, the practitioner is relegated to following serial imaging studies to look for evidence of "tumor regression" and "lack of enhancement" as surrogates for oncologic control. Recent published series have demonstrated excellent results regarding tumor ablation with intermediate follow-up, but this study by Uribe and colleagues demonstrates the potential pitfalls associated with these techniques.

Over a two year period, 9 patients were enrolled in an IRB approved clinical trial examining the effect of RFA on small renal masses. Patients were randomized to either an ablate and observe arm (3 patients) or an ablate and resect arm (6 patients), based on their health status and tumor characteristics. Mean tumor size was 4.5 cm (range 2-5.2). Of these 9 patients, two patients in the ablate and observe arm demonstrated significant tumor progression post ablation that are reported in this study. One patient with a 3 cm tumor developed significant progression in the 9 months post ablation (where he was lost to close follow-up), with a quadrupling in tumor size to 18 X 9cm and the development of a renocolic fistula. The other patient demonstrated a 20% increase in tumor size in follow-up. Both patients underwent radical nephrectomy and pathology demonstrated viable tumor in the resected specimens. No data is presented on the ablate and resect specimens.

This study demonstrates the potential pitfalls that can be associated with energy ablative strategies in the management of small renal masses. While the findings in this study would probably be considered outside the norm of those noted at other institutions, in that 22% of tumors demonstrated progression after RFA, it does emphasize the fact that these technologies are not proven to be equivalent to existing surgical approaches, and require further follow-up and refinement before they can be considered mainstream.

Uribe PS, Costabile RA, Peterson AC

Urology: 68(5): 968-971

UroToday.com Surgical Interventions Library

UroToday.com Renal Cancer Section

UroToday.com Laproscopic and Robotic Section

Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

Please log-in or register in order to submit comments.

Powered by AkoComment!