Management of small renal masses

doi:10.1017/CBO9781107338555.022

22 - Management of small renal masses

from Section VI - Organ-specific cancers – renal cell carcinoma

Published online by Cambridge University Press: 05 September 2016

Mansi A. Saksena ,

Debra A. Gervais ,

Michael C. Soulen and

Peter R. Mueller

Edited by

Jean-Francois H. Geschwind and

Michael C. Soulen

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Mansi A. Saksena: Affiliation:
Department of Radiology
Debra A. Gervais: Affiliation:
Massachusetts General Hospital, Boston
Michael C. Soulen: Affiliation:
University of Pennsylvania
Peter R. Mueller: Affiliation:
Department of Radiology
Jean-Francois H. Geschwind: Affiliation:
Yale University School of Medicine, Connecticut
Michael C. Soulen: Affiliation:
Department of Radiology, University of Pennsylvania Hospital, Philadelphia

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Summary

Approximately 61,560 new cases of renal cell carcinoma (RCC) were estimated to be diagnosed in the USA in 2015, with 14,080 cancer-related deaths attributed to cancers of the kidneys and the renal pelvis. More than one-half of these patients were diagnosed incidentally on cross-sectional imaging performed for non-related conditions. Increased incidental detection of small renal masses as well as advances in surgical techniques have led to development of nephron-sparing procedures for treatment in order to preserve renal function. Over the past decade, the options for the treatment of RCC have evolved to include radical nephrectomy as well as partial nephrectomy, laparoscopic nephrectomy and, in selected cases, percutaneous radiofrequency ablation (RFA), microwave ablation (MWA), and cryotherapy. Each therapy has unique clinical applications and benefits. This article illustrates various treatment modalities used in the therapy of RCC, with special emphasis on percutaneous ablative techniques.

Clinical overview

RCC accounts for 85% of all renal tumors and is slightly more common in men than in women (1.6:1.0). Symptomatic RCC usually presents with a triad of flank pain, hematuria, and a palpable abdominal mass. Hematuria, either gross or microscopic, in any patient usually warrants evaluation by a computed tomographic (CT) scan. Other non-specific symptoms include weight loss, anemia, or fatigue. However, almost one-half of patients are asymptomatic at diagnosis and have incidentally detected tumors on cross-sectional imaging. Certain genetic syndromes such as von Hippel–Lindau (VHL) disease increase the incidence of RCC (accounting for approximately 2% of cases of RCC). Other risk factors include smoking, hypertension, obesity, and end-stage renal disease resulting in dialysis.

Clear-cell RCC is the most common histological subtype and is associated with VHL syndrome and end-stage renal disease (Table 22.1). Other inherited forms include familial clear-cell RCC. Papillary RCC, when sporadic, has a prominent male preponderance and is associated with almost 90% 5-year survival rates prior to metastatic spread. Papillary RCC has a lesser incidence of metastases than clear-cell but, when metastatic, is harder to treat. Papillary RCC is also seen in end-stage renal disease and in several familial syndromes. Other less common cell types include chromophobe RCC and collecting-duct RCC.

Type: Chapter
Information: Interventional Oncology
Principles and Practice of Image-Guided Cancer Therapy
, pp. 203 - 213

DOI: https://doi.org/10.1017/CBO9781107338555.022 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2016

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References

1. SEER Stat Fact Sheets: Kidney and Renal Pelvis Cancer. http://seer.cancer.gov/statfacts/html/kidrp.html (accessed December 7, 2015).

2. Cohen, HT, McGovern, FJ. Renal-cell carcinoma. N Engl J Med 2005; 353: 2477–2490.Google Scholar

3. Walther, MM, Choyke, PL, Glenn, G, et al. Renal cancer in families with hereditary renal cancer: Prospective analysis of a tumor size threshold for renal parenchymal sparing surgery. J Urol 1999; 161: 1475–1479.Google Scholar

4. Herring, JC, Enquist, EG, Chernoff, A, et al. Parenchymal sparing surgery in patients with hereditary renal cell carcinoma: 10-year experience. J Urol 2001; 165: 777–781.Google Scholar

5. Gervais, DA, Arellano, RS, Mueller, PR. Percutaneous radiofrequency ablation of renal cell carcinoma. Eur Radiol 2005; 15: 960–967.Google Scholar

6. Gervais, DA, Arellano, RS, Mueller, P. Percutaneous ablation of kidney tumors in nonsurgical candidates. Oncology (Williston Park) 2005; 19: 6–11.Google Scholar

7. McDougal, WS, Gervais, DA, McGovern, FJ, et al. Long-term followup of patients with renal cell carcinoma treated with radio frequency ablation with curative intent. J Urol 2005; 174: 61–63.Google Scholar

8. Gervais, DA, Arellano, RS, McGovern, FJ, et al. Radiofrequency ablation of renal cell carcinoma: Part 2, lessons learned with ablation of 100 tumors. AJR Am J Roentgenol 2005; 185: 72–80.Google Scholar

9. Gervais, DA, McGovern, FJ, Arellano, RS, et al. Renal cell carcinoma: Clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology 2003; 226: 417–424.Google Scholar

10. Novick, AC. Nephron-sparing surgery for renal cell carcinoma. Annu Rev Med 2002; 53: 393–407.Google Scholar

11. Chiou, YY, Hwang, JI, Chou, YH, et al. Percutaneous radiofrequency ablation of renal cell carcinoma. J Chin Med Assoc 2005; 68: 221–225.Google Scholar

12. Silverman, SG, Tuncali, K, vanSonnenberg, E, et al. Renal tumors: MR imaging-guided percutaneous cryotherapy – initial experience in 23 patients. Radiology 2005; 236: 716–724.Google Scholar

13. Goldberg, SN, Gazelle, GS, Mueller, PR. Thermal ablation therapy for focal malignancy: A unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174: 323–331.Google Scholar

14. Tacke, J, Mahnken, A, Roggan, A, et al. Multipolar radiofrequency ablation: First clinical results. Rofo 2004; 176: 324–329.Google Scholar

15. Tacke, J, Mahnken, AH, Gunther, RW. Percutaneous thermal ablation of renal neoplasms. Rofo 2005; 177: 1631–1640.Google Scholar

16. Lee, JM, Han, JK, Choi, SH, et al. Comparison of renal ablation with monopolar radiofrequency and hypertonic-saline-augmented bipolar radiofrequency: In vitro and in vivo experimental studies. AJR Am J Roentgenol 2005; 184: 897–905.Google Scholar

17. Lee, FT Jr., Haemmerich, D, Wright, AS, et al. Multiple probe radiofrequency ablation: Pilot study in an animal model. J Vasc Interv Radiol 2003; 14: 1437–1442.Google Scholar

18. Hsu, TH, Fidler, ME, Gill, IS. Radiofrequency ablation of the kidney: Acute and chronic histology in porcine model. Urology 2000; 56: 872–875.Google Scholar

19. Munver, R, Threatt, CB, Delvecchio, FC, et al. Hypertonic saline-augmented radiofrequency ablation of the VX-2 tumor implanted in the rabbit kidney: A short-term survival pilot study. Urology 2002; 60: 170–175.Google Scholar

20. Zlotta, AR, Wildschutz, T, Raviv, G, et al. Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: Ex vivo and in vivo experience. J Endourol 1997; 11: 251–258.Google Scholar

21. Walther, MC, Shawker, TH, Libutti, SK, et al. A phase 2 study of radio frequency interstitial tissue ablation of localized renal tumors. J Urol 2000; 163: 1424–1427.Google Scholar

22. Michaels, MJ, Rhee, HK, Mourtzinos, AP, et al. Incomplete renal tumor destruction using radio frequency interstitial ablation. J Urol 2002; 168: 2406–2409; discussion, 2409–2410.Google Scholar

23. Rendon, RA, Kachura, JR, Sweet, JM, et al. The uncertainty of radio frequency treatment of renal cell carcinoma: Findings at immediate and delayed nephrectomy. J Urol 2002; 167: 1587–1592.Google Scholar

24. Gervais, DA, McGovern, FJ, Arellano, RS, et al. Radiofrequency ablation of renal cell carcinoma: Part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005; 185: 64–71.Google Scholar

25. Higgins, LJ, Hong, K. Renal ablation techniques: state of the art. AJR Am J Roentgenol 2015; 205: 735–741.Google Scholar

26. Hong, B, Du, X, Zhao, Y, Chen, G, et al. Characteristics of laparoscopic microwave ablation with renal tissue: Experimental in vivo study using a porcine model. Int J Hyperthermia 2015; 31 (8): 930–936.Google Scholar

27. Silverman, SG, Tuncali, K, Adams, DF, et al. MR imaging-guided percutaneous cryotherapy of liver tumors: Initial experience. Radiology 2000; 217: 657–664.Google Scholar

28. Delworth, MG, Pisters, LL, Fornage, BD, et al. Cryotherapy for renal cell carcinoma and angiomyolipoma. J Urol 1996; 155: 252–254; discussion, 254–255.Google Scholar

29. Gill, IS, Novick, AC, Meraney, AM, et al. Laparoscopic renal cryoablation in 32 patients. Urology 2000; 56: 748–753.Google Scholar

30. Nadler, RB, Kim, SC, Rubenstein, JN, et al. Laparoscopic renal cryosurgery: The Northwestern experience. J Urol 2003; 170: 1121–1125.Google Scholar

31. Uchida, M, Imaide, Y, Sugimoto, K, et al. Percutaneous cryosurgery for renal tumours. Br J Urol 1995; 75: 132–136; discussion, 136–137.Google Scholar

32. Hoffmann, NE, Bischof, JC. The cryobiology of cryosurgical injury. Urology 2002; 60: 40–49.Google Scholar

33. Rupp, CC, Hoffmann, NE, Schmidlin, FR, et al. Cryosurgical changes in the porcine kidney: Histologic analysis with thermal history correlation. Cryobiology 2002; 45: 167–182.Google Scholar

34. Chosy, SG, Nakada, SY, Lee, FT, Jr., et al. Monitoring renal cryosurgery: Predictors of tissue necrosis in swine. J Urol 1998; 159: 1370–1374.Google Scholar

35. Campbell, SC, Krishnamurthi, V, Chow, G, et al. Renal cryosurgery: Experimental evaluation of treatment parameters. Urology 1998; 52: 29–33; discussion, 33–34.Google Scholar

36. Woolley, ML, Schulsinger, DA, Durand, DB, et al. Effect of freezing parameters (freeze cycle and thaw process) on tissue destruction following renal cryoablation. J Endourol 2002; 16: 519–522.Google Scholar

37. Ahrar, K, Matin, S, Wood, CG, et al. Percutaneous radiofrequency ablation of renal tumors: Technique, complications, and outcomes. J Vasc Interv Radiol 2005; 16: 679–688.Google Scholar

38. Farrell, MA, Charboneau, WJ, DiMarco, DS, et al. Imaging-guided radiofrequency ablation of solid renal tumors. AJR Am J Roentgenol 2003; 180: 1509–1513.Google Scholar

39. Mayo-Smith, WW, Dupuy, DE, Parikh, PM, et al. Imaging-guided percutaneous radiofrequency ablation of solid renal masses: Techniques and outcomes of 38 treatment sessions in 32 consecutive patients. AJR Am J Roentgenol 2003; 180: 1503–1508.Google Scholar

40. Su, LM, Jarrett, TW, Chan, DY, et al. Percutaneous computed tomography-guided radiofrequency ablation of renal masses in high surgical risk patients: Preliminary results. Urology 2003; 61: 26–33.Google Scholar

41. Ogan, K, Jacomides, L, Dolmatch, BL, et al. Percutaneous radiofrequency ablation of renal tumors: Technique, limitations, and morbidity. Urology 2002; 60: 954–958.Google Scholar

42. Zagoria, RJ, Hawkins, AD, Clark, PE, et al. Percutaneous CT-guided radiofrequency ablation of renal neoplasms: Factors influencing success. AJR Am J Roentgenol 2004; 183: 201–207.Google Scholar

43. Shingleton, WB, Sewell, PE Jr. Cryoablation of renal tumours in patients with solitary kidneys. BJU Int 2003; 92: 237–239.Google Scholar

44. Shingleton, WB, Sewell, PE, Jr. Percutaneous renal cryoablation of renal tumors in patients with von Hippel–Lindau disease. J Urol 2002; 167: 1268–1270.Google Scholar

45. Shingleton, WB, Sewell, PE, Jr. Percutaneous renal tumor cryoablation with magnetic resonance imaging guidance. J Urol 2001; 165: 773–776.Google Scholar

46. Farrell, MA, Charboneau, JW, Callstrom, MR, et al. Paranephric water instillation: A technique to prevent bowel injury during percutaneous renal radiofrequency ablation. AJR Am J Roentgenol 2003; 181: 1315–1317.Google Scholar

47. Kariya, Z, Yamakado, K, Nakatuka, A, et al. Radiofrequency ablation with and without balloon occlusion of the renal artery: An experimental study in porcine kidneys. J Vasc Interv Radiol 2003; 14: 241–245.Google Scholar

48. Raman, SS, Aziz, D, Chang, X, et al. Minimizing diaphragmatic injury during radiofrequency ablation: Efficacy of intraabdominal carbon dioxide insufflation. AJR Am J Roentgenol 2004; 183: 197–200.Google Scholar

49. Goldberg, SN, Gazelle, GS, Compton, CC, et al. Treatment of intrahepatic malignancy with radiofrequency ablation: Radiologic–pathologic correlation. Cancer 2000; 88: 2452–2463.Google Scholar

50. Pavlovich, CP, Walther, MM, Choyke, PL, et al. Percutaneous radio frequency ablation of small renal tumors: Initial results. J Urol 2002; 167: 10–15.Google Scholar

51. Roy-Choudhury, SH, Cast, JE, Cooksey, G, et al. Early experience with percutaneous radiofrequency ablation of small solid renal masses. AJR Am J Roentgenol 2003; 180: 1055–1061.Google Scholar

52. Veltri, A, Fazio, G de, Malfitana, V, et al. Percutaneous US-guided RF thermal ablation for malignant renal tumors: Preliminary results in 13 patients. Eur Radiol 2004; 14: 2303–2310.Google Scholar

53. Gill, IS, Remer, EM, Hasan, WA, et al. Renal cryoablation: Outcome at 3 years. J Urol 2005; 173: 1903–1907.Google Scholar

54. Moreland, AJ, Ziemlewicz, TJ, Best, SL, et al. High-powered microwave ablation of T1a renal cell carcinoma: Safety and initial clinical evaluation. J Endourol 2014; 28: 1046–1052.Google Scholar

55. Yu, J, Liang, P, Yu, XL, et al. US-guided percutaneous microwave ablation of renal cell carcinoma: Intermediate-term results. Radiology 2012; 263: 900–908.Google Scholar

56. Yu, J, Liang, P, Yu, XL, et al. US-guided percutaeneous microwave ablation versus open radical nephrectomy for small renal cell carcinomas: Intermediate-term results. Radiology 2014; 270: 880–887.Google Scholar

57. Guan, W, Bai, J, Liu, J, et al. Microwave ablation versus partial nephrectomy for small renal tumors: Intermediate-term results. J Surg Oncol 2012; 106: 316–321.Google Scholar

58. Johnson, DB, Solomon, SB, Su, LM, et al. Defining the complications of cryoablation and radio frequency ablation of small renal tumors: A multi-institutional review. J Urol 2004; 172: 874–877.Google Scholar

59. Llovet, JM, Vilana, R, Bru, C, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001; 33: 1124–1129.Google Scholar

60. Liu, C, Frilling, A, Dereskewitz, C, et al. Tumor seeding after fine needle aspiration biopsy and percutaneous radiofrequency thermal ablation of hepatocellular carcinoma. Dig Surg 2003; 20: 460–463.Google Scholar

61. Wood, BJ, Grippo, J, Pavlovich, CP. Percutaneous radio frequency ablation for hematuria. J Urol 2001; 166: 2303–2304.Google Scholar

62. Callstrom, MR, Charboneau, JW, Goetz, MP, et al. Image-guided ablation of painful metastatic bone tumors: A new and effective approach to a difficult problem. Skeletal Radiol 2006; 35: 1–15.Google Scholar

63. Goetz, MP, Callstrom, MR, Charboneau, JW, et al. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: A multicenter study. J Clin Oncol,2004; 22: 300–306.Google Scholar

64. Zagoria, RJ, Chen, MY, Kavanagh, PV, et al. Radio frequency ablation of lung metastases from renal cell carcinoma. J Urol 2001; 166: 1827–1828.Google Scholar

65. Gervais, DA, Arellano, RS, Mueller, PR. Percutaneous radiofrequency ablation of nodal metastases. Cardiovasc Intervent Radiol 2002; 25: 547–549.Google Scholar

66. Dillman, RO, Wiemann, MC, Tai, DF, et al. Phase II trial of subcutaneous interferon followed by intravenous hybrid bolus/continuous infusion interleukin-2 in the treatment of renal cell carcinoma: Final results of cancer biotherapy research group 95–09. Cancer Biother Radiopharm 2006; 21: 130–137.Google Scholar

67. NCCN. Guidelines for patients. 2015. www.nccn.org/patients/guidelines/kidney/index.html (accessed 12/18/2015).