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Oncologic Efficacy of CT-Guided Percutaneous Radiofrequency Ablation of Renal Cell Carcinomas

Ronald J. Zagoria1, Michael A. Traver2, David M. Werle2, Molly Perini1, Satoru Hayasaka1 and Peter E. Clark2,3

1 Department of Radiology, Wake Forest University Health Sciences, Medical Center Blvd., Winston-Salem, NC 27157-1008.
2 Department of Urology, Wake Forest University Health Sciences, Winston-Salem, NC.
3 Present address: Department of Urology, Vanderbilt University School of Medicine, Nashville, TN.


Figure 1
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  		Fig. 1A —Multifocal papillary renal cell carcinoma (RCC) in 79-year-old man with diabetes. Contrast-enhanced CT scan shows 2.3-cm solid mass (arrow) that enhanced 24 H from unenhanced scan. This tumor was biopsied and proven to be papillary RCC. Simple renal cyst is also visible.

 

Figure 2
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  		Fig. 1B —Multifocal papillary renal cell carcinoma (RCC) in 79-year-old man with diabetes. Contrast-enhanced CT scans at levels different from A show bilateral solid renal tumors (arrows). Each had imaging characteristics similar to biopsy-proven RCC and each enhanced greater than 30 H. On basis of these findings, these tumors were diagnosed as papillary RCCs. All of these tumors have been successfully treated with radiofrequency ablation.

 

Figure 3
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  		Fig. 1C —Multifocal papillary renal cell carcinoma (RCC) in 79-year-old man with diabetes. Contrast-enhanced CT scans at levels different from A show bilateral solid renal tumors (arrows). Each had imaging characteristics similar to biopsy-proven RCC and each enhanced greater than 30 H. On basis of these findings, these tumors were diagnosed as papillary RCCs. All of these tumors have been successfully treated with radiofrequency ablation.

 

Figure 4
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  		Fig. 1D —Multifocal papillary renal cell carcinoma (RCC) in 79-year-old man with diabetes. Contrast-enhanced CT scans at levels different from A show bilateral solid renal tumors (arrows). Each had imaging characteristics similar to biopsy-proven RCC and each enhanced greater than 30 H. On basis of these findings, these tumors were diagnosed as papillary RCCs. All of these tumors have been successfully treated with radiofrequency ablation.

 

Figure 5
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  		Fig. 2A —Radiofrequency ablation technique for treatment of a renal cell carcinoma (RCC) in a 78-year-old woman with diabetes and chronic congestive heart disease. Before treatment, unenhanced (A) and contrast-enhanced (B) CT scans show solid 2.4-cm enhancing mass (arrow, B) in upper pole of right kidney. This mass was biopsy-proven RCC.

 

Figure 6
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  		Fig. 2B —Radiofrequency ablation technique for treatment of a renal cell carcinoma (RCC) in a 78-year-old woman with diabetes and chronic congestive heart disease. Before treatment, unenhanced (A) and contrast-enhanced (B) CT scans show solid 2.4-cm enhancing mass (arrow, B) in upper pole of right kidney. This mass was biopsy-proven RCC.

 

Figure 7
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  		Fig. 2C —Radiofrequency ablation technique for treatment of a renal cell carcinoma (RCC) in a 78-year-old woman with diabetes and chronic congestive heart disease. CT image with patient prone during ablation procedure shows radiofrequency electrode tip (arrow) traversing RCC.

 

Figure 8
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  		Fig. 2D —Radiofrequency ablation technique for treatment of a renal cell carcinoma (RCC) in a 78-year-old woman with diabetes and chronic congestive heart disease. Contrast-enhanced CT image obtained at end of ablation session shows normal enhancement of kidney with no enhancement in treated area, which encompasses tumor. Small gas bubbles are seen in area of treatment, expected finding resulting from tissue boiling during ablation.

 

Figure 9
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  		Fig. 2E —Radiofrequency ablation technique for treatment of a renal cell carcinoma (RCC) in a 78-year-old woman with diabetes and chronic congestive heart disease. Forty-nine months after ablation, unenhanced (E) and contrast-enhanced (F) CT scans show no enhancing tissue in treated tumor. This is interpreted as no evidence of residual tumor.

 

Figure 10
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  		Fig. 2F —Radiofrequency ablation technique for treatment of a renal cell carcinoma (RCC) in a 78-year-old woman with diabetes and chronic congestive heart disease. Forty-nine months after ablation, unenhanced (E) and contrast-enhanced (F) CT scans show no enhancing tissue in treated tumor. This is interpreted as no evidence of residual tumor.

 

Figure 11
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  		Fig. 3A —Residual viable renal cell carcinoma (RCC) after radiofrequency ablation in 70-year-old man with renal insufficiency. Contrast-enhanced MRI scan (TR/TE, 5.044/1.8) shows 4.3 x 3.7 cm RCC (arrow) in left kidney. This mass enhanced 42% after IV injection of gadolinium. This RCC was treated with radiofrequency ablation.

 

Figure 12
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  		Fig. 3B —Residual viable renal cell carcinoma (RCC) after radiofrequency ablation in 70-year-old man with renal insufficiency. Contrast-enhanced MRI scan (5.044/1.8) obtained as second follow-up scan 5.8 months after radiofrequency ablation shows enhancing (110% increase in signal after IV injection of gadolinium) nodule (arrow) of residual tumor within treated area. This focus of tumor was retreated with radiofrequency ablation.

 

Figure 13
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  		Fig. 3C —Residual viable renal cell carcinoma (RCC) after radiofrequency ablation in 70-year-old man with renal insufficiency. Contrast-enhanced MRI scan (5.044/1.8) obtained 14 months after the second radiofrequency ablation shows no residual viable tumor.

 

Figure 14
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  		Fig. 4 —Kaplan-Meier plot shows tumor-free survival probabilities for various tumor sizes.

 

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