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Salvage Radiofrequency Ablation Achieves Effective Local Control of Recurrent Renal Cell Carcinoma
Sarah P. Psutka, MD, Ali Daha, BA, Debra Gervais, MD, Adam S. Feldman, MD.
Massachusetts General Hospital, Boston, MA, USA.

Introduction: Radiofrequency ablation (RFA) has emerged as a safe and efficacious minimally invasive option to manage small renal tumors in patients for whom comorbidities preclude surgical treatment. Salvage surgical excision of ipsilateral disease recurrence after ablative therapy may be complicated by extensive perinephric fibrosis, precluding repeat nephron-sparing therapy, and complicating radical resection, in patients who are poor surgical candidates at baseline. There are no reports in the literature which analyze outcomes and complications following salvage RFA (sRFA) of recurrent disease. The aim of this study was to describe our management of recurrent renal tumors after RFA, assessing overall efficacy, complications, and safety of sRFA.
Methods: Between 1998 and 2008, 313 patients underwent RFA for renal cell carcinoma. Recurrent disease (RD) was defined as detectable new enhancing tissue in the ipsilateral kidney in the prior RFA-cavitation site after a complete response was documented. De novo tumors in other locations within the same kidney were excluded. We retrospectively compared patients who developed recurrent disease (RD+, N = 15, 5.1%) with patients who remained disease free after achieving a complete response (RD-, N = 296, 95%), specifically assessing tumor characteristics (size, location, pre-RFA biopsy pathology), complications of RFA, and disease-free survival. Mean follow-up was 3 years (SD 2.1).
Results: RD+ and RD- groups did not differ significantly in age, gender, tumor type or size. RD+ groups had a higher proportion of centrally located tumors (3/15, 20%) in comparison to RD - (17/296, 5.7%), p = 0.04. Mean time to disease recurrence was 1.47 years (SD 0.75, range 0.5-3.5 yrs). Of the 15 patients with RD, 7 patients underwent sRFA, 6 patients elected observation due to comorbitidies precluding further treatment, one patient received chemotherapy for widespread metastatic disease and one patient underwent attempted salvage partial nephrectomy, which was aborted due to extensive tumor burden and perirenal fibrosis. There were no complications related to sRFA. Of those who underwent sRFA, local recurrences were successfully ablated in 100% of cases with a single salvage RFA treatment. None of these sRFA cases developed locally recurrent disease at an average of 3 years follow-up.
Conclusions: Recurrent disease after RFA remains challenging to treat due to the significant comorbidities of the patients who are ultimately selected for ablative treatment of renal cell carcinoma. Recurrent disease was more likely to occur in centrally located tumors. Salvage RFA successfully achieves local control in these patients without increased rates of complications.


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