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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

Laparoscopic picture showing the ablation probes (white arrows) and peripheral fiber-optic temperature monitors (green arrows). The original MWA is shown on the left while the RFA is shown on the right
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Figure 2: Laparoscopic picture showing the ablation probes (white arrows) and peripheral fiber-optic temperature monitors (green arrows). The original MWA is shown on the left while the RFA is shown on the right

Mentions: A transperitoneal approach was used. After exposure of the kidney and localization of the tumor, two 13-gauge, 3.7-cm MWA surgical antennae (Covidien, Valleylab, Boulder, CO, USA) were introduced through separate incisions. Fiber-optic thermal sensors were placed at the tumor periphery via visual and ultrasound (US) guidance utilizing a coaxial guide needle with radiopaque sheath (Huey, Cook Vascular, Inc., Vadergrift, PA, USA). Prior to ablation with the antenna(e) in place, a spring-loaded 16-gauge biopsy needle was utilized to take multiple biopsies under visual and US guidance. The microwave antenna was advanced into the tumor [Figure 2] and MWA commenced with simultaneous peripheral fiber-optic thermometry (Lumasense, Santa Clara, CA, USA) to determine treatment endpoints of >60°C. The microwave system used was the ValleyLab Evident® 915 MHz MW ablation system (Covidien Inc., Boulder, CO, USA) with two 13-gauge, 3.7-cm tip antenna(e) driven at 45 W. Ablation was performed for 23 min at 45 W over three separate deployments. This was based on when the tumor periphery temperatures reached the target temperature as in the techniques previously published.[6] Tumor biopsy showed papillary type RCC, Fuhrman grade II.


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)

Laparoscopic picture showing the ablation probes (white arrows) and peripheral fiber-optic temperature monitors (green arrows). The original MWA is shown on the left while the RFA is shown on the right
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Laparoscopic picture showing the ablation probes (white arrows) and peripheral fiber-optic temperature monitors (green arrows). The original MWA is shown on the left while the RFA is shown on the right
Mentions: A transperitoneal approach was used. After exposure of the kidney and localization of the tumor, two 13-gauge, 3.7-cm MWA surgical antennae (Covidien, Valleylab, Boulder, CO, USA) were introduced through separate incisions. Fiber-optic thermal sensors were placed at the tumor periphery via visual and ultrasound (US) guidance utilizing a coaxial guide needle with radiopaque sheath (Huey, Cook Vascular, Inc., Vadergrift, PA, USA). Prior to ablation with the antenna(e) in place, a spring-loaded 16-gauge biopsy needle was utilized to take multiple biopsies under visual and US guidance. The microwave antenna was advanced into the tumor [Figure 2] and MWA commenced with simultaneous peripheral fiber-optic thermometry (Lumasense, Santa Clara, CA, USA) to determine treatment endpoints of >60°C. The microwave system used was the ValleyLab Evident® 915 MHz MW ablation system (Covidien Inc., Boulder, CO, USA) with two 13-gauge, 3.7-cm tip antenna(e) driven at 45 W. Ablation was performed for 23 min at 45 W over three separate deployments. This was based on when the tumor periphery temperatures reached the target temperature as in the techniques previously published.[6] Tumor biopsy showed papillary type RCC, Fuhrman grade II.

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