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34 - Embolotherapy in the Management of Renal Cell Carcinoma

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
Armeen Mahvash ,
Sanaz Javadi  and
Kamran Ahrar
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
Armeen Mahvash
Affiliation:
Assistant Professor, Interventional Radiology Section M.D. Anderson Cancer Center University of Texas Houston, TX
Sanaz Javadi
Affiliation:
Research Intern, M.D. Anderson Cancer Center University of Texas Houston, TX
Kamran Ahrar
Affiliation:
Associate Professor, M.D. Anderson Cancer Center University of Texas Houston, TX
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
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Summary

Renal cell carcinoma (RCC) is an uncommon tumor, accounting for only 3% of all adult malignancies (1), yet of all urological malignancies, it is the most lethal (2). Diagnosis and treatment of RCC have changed dramatically since the 1950s, when the disease was usually diagnosed at an advanced stage on the basis of clinical symptoms of palpable mass, flank pain and hematuria (3). In recent years, routine use of cross-sectional abdominal imaging has resulted in earlier diagnosis (4, 5).

Radical nephrectomy, once believed to be the standard for treatment of RCC, is now used only to treat large tumors that are locally advanced or metastatic at diagnosis. Today, the treatment of choice for smaller tumors (<4 cm in diameter) is partial nephrectomy (6). Energy-ablative techniques such as cryoablation and radiofrequency ablation (RFA) are promising, minimally invasive treatment options for smaller tumors in patients who may not be suitable surgical candidates (7–9).

Embolotherapy has been used as an adjunctive therapy in the management of RCC since the 1970s, although its role has evolved over the years (Table 34.1). At one time, it was thought that preoperative embolization of RCC would result in an immunologic response – that is, a form of autovaccination; therefore, some investigators advocated routine use of preoperative embolization (10). The initial enthusiasm for this practice was dampened by a lack of scientific evidence that embolization of RCC did, in fact, induce a significant immunologic response, and the practice was abandoned.

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 413 - 423
Publisher: Cambridge University Press
Print publication year: 2008

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