L. CARPANESE¹, G. PIZZI¹, G. Vallati², S. GUAGLIANONE¹, M. GALLUCCI¹, M. CRECCO¹; ¹Roma/IT, ²Rome/IT

Purpose
Percutaneous radiofrequency ablation (RF) is considered a valid alternative to surgical resection and its use is widely assessed as treatment of primary and secondary focal liver lesions. Ongoing several multicentric studies are established to assess the indications and clinical efficacy of RF in other types of neoplasms (lung tumour, kidney tumour and prostate tumour). TAE, just like in the hypervascular focal liver lesions, is performed before RF ablation with the purpose of reducing the heat sink effect and the risk of bleeding and to allow an increasing volume of coagulative necrosis. The purpose of this study is to evaluate the role of combined Trans Arterial Embolization (TAE) and Percutaneous Radiofrequency Ablation (RFA) in the treatment of non surgical elegible Kidney larger tumours (> 4 cm)

Material and methods
From January 2004 to December 2005, 11 Patients underwent combined superselective TAE and RF of kidney large tumours (4-8 cm range size diameter, median size 4,5 cm). The indications for RFA were either inoperability due to high cardiovascular or pulmonary risk or the high probability of complete renal failure after surgical enucleation of the tumour, or extra renal disease. There was only one case of solitary kidney. No patient had bilateral or multifocal disease or it was close to the pelvicaliceal system. Percutaneous RFA of the renal cell carcinoma was performed within 4-6 hours after TAE, with RITA 150 watt system under CT guidance.

Results
Combined procedure (TAE+RF) was well tolerated in all patients and an overall inpatient reducing of hospital stay was found. The follow-up was of 3-24 months range with a median time of 9 months. Preliminary results compared with a homogeneous case control group (kind of neoplasm, local extension of disease secondary nodules) did not show any important differences about local recurrence, survival rate, and number of secondary lesions. Patients underwent MAG-3 renal scans,and 24-hour urine collections both prior to, and 6 months after RFA. CT scan was obtained both prior to, immediately after, and 1 month and 6 month after RFA.The only solitary kidney patient didn’t show any decreasing in renal function. Only one complication was found: ureteral fistula and urinoma successfully treated with percutaneous drainage and ureteral stent deployment through radiological rendezvous. Three patients subsequently underwent laparoscopic nephron-sparing surgery.

Conclusion
Our experience, compared with similar showed in literature, shows that the performance of combined procedure (TAE+RF) allows an effective shrinkage of lesion in non surgical eligible renal hypervascular tumours, with low complication rate. Further study and follow-up are necessary to determine long-term oncological efficacy.