Our journal round-up this month includes articles on new techniques to avoid complications, combination therapies, and case studies of renal and adrenal treatment.
Kidney
Percutaneous thermal ablation of renal neoplasms
Rofo 2005;177(12):1631-1640
The authors review thermal methods for treating renal lesions, including RFA, laser-induced thermal ablation, focused ultrasound, microwave ablation, and cryotherapy. They identify RFA as the most promising method of minimally invasive renal tumor treatment, with clinical success rates of more than over 90%. The authors deem cryotherapy promising but express reservations about additional measures needed to control bleeding and the comparative lack of experience with the technique in the organ. Microwave ablation is characterized by small ablation volumes and plays a role as a coagulation tool during resection. Focused ultrasound is the only noninvasive method, but it is still experimental. [Article in German.]
Combination therapies
Improved survival using multi-modality therapy in patients with lung metastases from colorectal cancer: a preliminary study
Oncol Rep 2005;14(6):1571-1576
The Japanese retrospective study assessed the safety, efficacy, and long-term results of multimodality therapy, including RFA and radiotherapy as an additional cytoreductive method for eliciting the marked effects of chemotherapy in treating unresectable lung metastases from colorectal cancer. A total of 21 patients with lung metastasis from colorectal cancer were treated with modified pharmacokinetic modulating chemotherapy (PMC). Eleven were also treated with RFA and/or radiotherapy (multimodality group), and 10 were treated with chemotherapy alone (chemotherapy group). The cumulative three-year survival rate of patients in the multimodality group was 87.5% compared with 33.3% in the chemotherapy group. The course of multimodality therapy was uneventful except for pneumothorax in those who received RFA. Although pneumothorax developed in four of 11 patients treated with RFA, all were able to receive chemotherapy within two weeks after RFA. They conclude that multimodality therapy combined with modified PMC, radiation, and RFA is a feasible choice of treatment in patients with inoperable lung metastases from colorectal cancer.
Prospective study of arterial infusion chemotherapy followed by radiofrequency ablation for the treatment of liver metastasis of gastric cancer
JVIR 2005;16:1747-1751
A Japanese team conducted a prospective study to evaluate the efficacy of hepatic arterial infusion chemotherapy (HAIC) with use of an implanted port followed by RFA for the treatment of liver metastasis of gastric cancer. The team treated seven patients without extrahepatic metastasis, with a mean tumor size of 4.4 cm. The maximum tumor size was reduced to 3 cm or less after HAIC in all patients. The total number of tumors was reduced from 25 to 16. RFA performed for all residual liver tumors resulted in complete tumor necrosis. All but one of the patients are still living without intrahepatic recurrence, with a median survival time of 16.5 months.
Case studies
Ultrasonography-guided percutaneous radiofrequency ablation for treatment of a huge symptomatic hepatic cavernous hemangioma
J Clin Gastroenterol 2006;40(2):167-170
The authors used ultrasound-guided RFA to reduce a symptomatic hemangioma to almost one-third of the original longitudinal diameter. After two sessions of RFA, the hemangioma presenting in the 36-year-old female patient was significantly reduced in size. After 36 months, a follow-up abdominal CT revealed remarkably diminished necrotic areas of the ablated hemangioma.
Percutaneous CT-guided radiofrequency ablation of symptomatic bilateral adrenal metastases in a single session
JVIR 2006;17:175-179
The authors report on a case where CT-guided RFA was used to treat painful bilateral metastases on the adrenal glands. The patient underwent RFA of both adrenal masses in a single session (left adrenal mass, 4.7 cm; right adrenal mass, 4.3 cm), without occurrence of blood pressure instability or other acute complications. Measurement of plasma levels of cortisol, adrenocorticotropic hormone (ACTH), and glucose before and after RFA revealed transient changes that suggested preservation of endocrine feedback mechanisms. The patient experienced marked relief in pain bilaterally. By five days after the procedure, cortisol, ACTH, and glucose levels returned to preprocedural levels. On further follow-up at six months, the patient noted a lack of endocrine sequelae and continued pain relief.
Avoiding complications
Thermal damage of the genitofemoral nerve due to radiofrequency ablation of renal cell carcinoma: a potentially avoidable complication
AJR 2005;185(6):1627-1631
The authors present a technique that may prevent damage to the genitofemoral nerve during percutaneous RFA of renal cell carcinomas. The genitofemoral nerve originates from the upper part of the lumbar plexus and descends laterally along the psoas major muscle. During RFA, nearby healthy nerve tissue could be damaged by heat conductance. The authors used the RFA applicator within the renal tumor as a lever to displace the kidney away from the psoas muscle.
