Incidental renal tumors in cancer survivors: Minimally invasive management by image-guided thermal ablation.

Abstract

258 Background: To investigate presentation, management and outcome of renal tumors in patients with prior or current history of cancer. Methods: A retrospective review of a database for patients undergoing ablation of renal tumors between January 2012 and June 2014 was performed. For each patient , the following was recorded: Prior or current history of cancer (other than renal cell carcinoma), histology of primary tumor, status of primary cancer (remission or under therapy), size of the renal tumor, thermal ablation technology , complications of ablation, development of metastases from renal tumor, deceased or alive , cause of death and the length of follow up. Results: Ninety five renal ablation procedures were performed in 91 patients between January 2012 and June 2014. Of this subset, 37 patients (27 male and 10 females) with average age 63 years (Age range 53-85 Years) had prior or current history of malignancy (6 patients had more than one primary cancer) other than renal tumor including Prostate(6), colorectal (4), Breast (4) lymphoma (3) and others (20). All renal tumors were discovered incidentally, none of the patients had symptoms related to renal tumors. Twenty four patients were in remission and 13 patients were undergoing therapy for their primary malignancy at the time of ablation. Ablation was performed using radiofrequency (n = 30) or cryoablation (n = 9) for 39 renal lesions with average size of 2.4cm (Range 1.1 to 4 cm). After average of 20 months (range 5-35 months) of observation 34 patients (92%) were still alive. Three patients died of their primary cancer. None of the patients developed complication from the procedure, 1 patient had recurrence after 6 month; for which renal ablation was performed. None of the patients developed metastatic disease from or died of renal cell carcinoma. Conclusions: Staging workup and surveillance imaging studies in cancer patients can lead to incidental detection of primary renal tumors. Minimally invasive therapy with image guided radiofrequency ablation or cryotherapy is feasible, safe and effective. Image guided ablation has no discernable impact on the course of therapy for the primary tumor. Furthermore, it has minimal to no morbidity for patients in remission.