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Radio-frequency ablation helps preserve nephrons in salvage of failed microwave ablation for a renal cancer in a solitary kidney.

Castle SM, Salas N, Leveillee RJ - Urol Ann (2013)

Bottom Line: Additionally, in MWA, no long-term outcomes have been reported.Subsequently, a laparoscopic RFA (LRFA) with simultaneous peripheral fiber-optic thermometry was performed as salvage therapy.This represents a 15% decrease in estimated glomerular filtration rate (eGFR) (79 to 67 ml/min) post-MWA and no change in eGFR post-RFA.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.

ABSTRACT
Recurrent tumors after renal ablative therapy present a challenge for clinicians. New ablative modalities, including microwave ablation (MWA), have very limited experience in methods of retreating ablation failures. Additionally, in MWA, no long-term outcomes have been reported. In patients having local tumor recurrence, options for surveillance or surgical salvage must be assessed. We present a case to help assess radio-frequency ablation (RFA) for salvage of failed MWA. We report a 63-year-old male with a 4.33-cm renal mass in a solitary kidney undergoing laparoscopic MWA with simultaneous peripheral fiber-optic thermometry (Lumasense, Santa Clara, CA, USA) as primary treatment. Follow-up contrast-enhanced computed tomography (CT) scan was performed at 1 and 4.3 months post-op with failure occurring at 4.3 months as evidenced by persistent enhancement. Subsequently, a laparoscopic RFA (LRFA) with simultaneous peripheral fiber-optic thermometry was performed as salvage therapy. Clinical and radiological follow-up with a contrast-enhanced CT scan at 1 and 11 months post-RFA showed no evidence of disease or enhancement. Creatinine values pre-MWA, post-MWA, and post-RFA were 1.01, 1.14, and 1.17 mg/ml, respectively. This represents a 15% decrease in estimated glomerular filtration rate (eGFR) (79 to 67 ml/min) post-MWA and no change in eGFR post-RFA. Local kidney tumor recurrence often requires additional therapy and a careful decisionmaking process. It is desirable not only to preserve kidney function in patients with a solitary kidney or chronic renal insufficiency, but also to achieve cancer control. We show the feasibility of RFA for salvage treatment of local recurrence of a T1b tumor in a solitary kidney post-MWA.

No MeSH data available.


Related in: MedlinePlus

Contrast-enhanced CT scan depicting renal mass or ablation site (white arrow). (a) Pre-op 4.3-cm renal mass. (b) MWA post-op scan showing ablated tumor. (c) MWA post-op film showing recurrence at anterior portion of ablation zone. (d) RFA post-op scan shows no residual disease at 24 months
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Figure 1: Contrast-enhanced CT scan depicting renal mass or ablation site (white arrow). (a) Pre-op 4.3-cm renal mass. (b) MWA post-op scan showing ablated tumor. (c) MWA post-op film showing recurrence at anterior portion of ablation zone. (d) RFA post-op scan shows no residual disease at 24 months

Mentions: The patient presented in this case report was a 63-year-old male with a previous history of papillary renal cell carcinoma (RCC) of Fuhrman Grade of II for which he received a left radical nephectomy at age 51 in an outside facility. He presented with a 4.33-cm lower pole tumor of his solitary right kidney diagnosed via contrast-enhanced computed tomography (CT) scan [Figure 1a] and came to our facility for evaluation. In addition to previous RCC, this patient had an age-adjusted Charlson Comorbidity Index of 5 and a preoperative creatinine of 1.01 with an estimated glomerular filtration rate (eGFR) of 79 ml/min using the modification of diet in renal disease (MDRD) calculation. Treatment options including tumor extirpation and surveillance were offered as alternatives, and the risk and benefits of MWA were discussed with the patient.


Radio-frequency ablation helps preserve nephrons in salvage of failed microwave ablation for a renal cancer in a solitary kidney.

Castle SM, Salas N, Leveillee RJ - Urol Ann (2013)

Contrast-enhanced CT scan depicting renal mass or ablation site (white arrow). (a) Pre-op 4.3-cm renal mass. (b) MWA post-op scan showing ablated tumor. (c) MWA post-op film showing recurrence at anterior portion of ablation zone. (d) RFA post-op scan shows no residual disease at 24 months
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643323&req=5

Figure 1: Contrast-enhanced CT scan depicting renal mass or ablation site (white arrow). (a) Pre-op 4.3-cm renal mass. (b) MWA post-op scan showing ablated tumor. (c) MWA post-op film showing recurrence at anterior portion of ablation zone. (d) RFA post-op scan shows no residual disease at 24 months
Mentions: The patient presented in this case report was a 63-year-old male with a previous history of papillary renal cell carcinoma (RCC) of Fuhrman Grade of II for which he received a left radical nephectomy at age 51 in an outside facility. He presented with a 4.33-cm lower pole tumor of his solitary right kidney diagnosed via contrast-enhanced computed tomography (CT) scan [Figure 1a] and came to our facility for evaluation. In addition to previous RCC, this patient had an age-adjusted Charlson Comorbidity Index of 5 and a preoperative creatinine of 1.01 with an estimated glomerular filtration rate (eGFR) of 79 ml/min using the modification of diet in renal disease (MDRD) calculation. Treatment options including tumor extirpation and surveillance were offered as alternatives, and the risk and benefits of MWA were discussed with the patient.

Bottom Line: Additionally, in MWA, no long-term outcomes have been reported.Subsequently, a laparoscopic RFA (LRFA) with simultaneous peripheral fiber-optic thermometry was performed as salvage therapy.This represents a 15% decrease in estimated glomerular filtration rate (eGFR) (79 to 67 ml/min) post-MWA and no change in eGFR post-RFA.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.

ABSTRACT
Recurrent tumors after renal ablative therapy present a challenge for clinicians. New ablative modalities, including microwave ablation (MWA), have very limited experience in methods of retreating ablation failures. Additionally, in MWA, no long-term outcomes have been reported. In patients having local tumor recurrence, options for surveillance or surgical salvage must be assessed. We present a case to help assess radio-frequency ablation (RFA) for salvage of failed MWA. We report a 63-year-old male with a 4.33-cm renal mass in a solitary kidney undergoing laparoscopic MWA with simultaneous peripheral fiber-optic thermometry (Lumasense, Santa Clara, CA, USA) as primary treatment. Follow-up contrast-enhanced computed tomography (CT) scan was performed at 1 and 4.3 months post-op with failure occurring at 4.3 months as evidenced by persistent enhancement. Subsequently, a laparoscopic RFA (LRFA) with simultaneous peripheral fiber-optic thermometry was performed as salvage therapy. Clinical and radiological follow-up with a contrast-enhanced CT scan at 1 and 11 months post-RFA showed no evidence of disease or enhancement. Creatinine values pre-MWA, post-MWA, and post-RFA were 1.01, 1.14, and 1.17 mg/ml, respectively. This represents a 15% decrease in estimated glomerular filtration rate (eGFR) (79 to 67 ml/min) post-MWA and no change in eGFR post-RFA. Local kidney tumor recurrence often requires additional therapy and a careful decisionmaking process. It is desirable not only to preserve kidney function in patients with a solitary kidney or chronic renal insufficiency, but also to achieve cancer control. We show the feasibility of RFA for salvage treatment of local recurrence of a T1b tumor in a solitary kidney post-MWA.

No MeSH data available.


Related in: MedlinePlus