Radiofrequency ablation for T1a tumors in a solitary kidney: promising intermediate oncologic and renal function outcomes
Raman D. Jay; Thomas James; Lucas M. Steven; Bensalah Karim; Lotan Yair; Trimmer Clayton; Cadeddu A. Jeffrey;
Department of Urology, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
OBJECTIVE: The experience with radiofrequency ablation (RFA) in solitary kidneys is limited in numbers and follow-up. Therefore, we report our oncologic and renal function outcomes of RFA for T1a tumors in patients with a solitary kidney.
METHODS: From April 2000 to August 2007, 242 patients were treated with RFA for renal cortical masses. Sixteen patients with localized tumors < 4 cm in a solitary kidney were identified. Clinical and radiographic data were reviewed to assess indications, complications, disease recurrence, and renal function.
RESULTS: Twenty-one renal masses were ablated in 16 patients with a solitary kidney. The mean patient age was 66.1 years, and the mean tumor size was 2.6 cm (range, 1.1-4.0). Preoperative biopsy was diagnostic of renal cell carcinoma (RCC) in 75% of cases. At a mean follow-up of 30.7 months (range, 1.5-66.0), 14/16 (88%) patients had no radiographic evidence of disease recurrence. One patient with three masses in a solitary kidney had a local recurrence managed by salvage RFA. The other patient with a local failure also had severe baseline renal insufficiency with progression to end stage renal disease 2.5 years following RFA and underwent a radical nephrectomy. Mean glomerular filtration rate (GFR) decreased from 54.2 ml/min/1.73m2 preoperatively to 47.5 ml/min/1.73m2 at last follow-up (p = 0.015). There were no major complications, and four patients had minor complications which resolved without intervention.
CONCLUSION: Radiofrequency ablation is an attractive alternative for the management of patients with T1a renal cortical tumors in a solitary kidney. Renal function appears to be adequately maintained with promising oncologic outcomes at 2.5 years.