Abstract
Purpose: The aim of this retrospective study was to assess the safety and effectiveness of laser ablation (LA) in patients with small renal cell carcinomas (RCC) and increased risk of bleeding.Material and methods: From 2013 to 2017, nine patients (six males, three females, aged 68.5 ± 12.2 years) at high risk of bleeding underwent ultrasonography-guided LA for an RCC. Patients were considered at increased risk of bleeding because of impairment of coagulation parameters, concomitant antiplatelet therapy, or at-risk location of the tumor (one, five, and three patients, respectively). RCC diameter ranged from 11 to 23 mm. According to tumor size, two or three laser fibers were introduced through 21-gauge needles and 1800 J per fiber were delivered in 6 min with a fixed power of 5 W. Major and minor complications, technical success, and primary and secondary technical effectiveness and tumor recurrence were recorded.Results: Just one Grade 1 complication was observed: a small asymptomatic hematoma that spontaneously resolved. Technical success was 100%, 1 month technical efficacy was 88.9% (8/9 patients). One patient with residual tumor was successfully retreated 1 month later, and secondary efficacy rate was 100%. No local tumor recurrence occurred during a median follow-up of 26 months (range 11–49 months).Conclusions: LA is safe and effective in the treatment of small RCC and might represent a valid option in patients with increased risk of bleeding.
Highlights
The detection rate of renal cell carcinoma (RCC) has increased over the last few years, mainly due to the increased number of incidentally diagnosed cases during diagnostic cross-sectional studies
The Cardiovascular and Interventional Radiology Society of Europe (CIRSE) published the guidelines for percutaneous ablation of small RCC, recommending radiofrequency ablation (RFA) and cryoablation (CRA) as the most studied and most suitable modalities to ablate tumors up to 5 cm in diameter, and mentioning microwave ablation (MWA) as an interesting and increasingly used technique, at present it is less investigated than RFA and CRA, and some concerns exist concerning its higher risk of pelvicalyceal injury [2]
Laser ablation (LA) uses laser optical fibers to deliver energy to the tissue [6,7]. It is less investigated than RFA and MWA, laser ablation (LA) is currently used in many centers to treat primary and metastatic liver cancers, with results that are comparable to MWA and RFA [8,9,10,11,12,13]
Summary
The detection rate of renal cell carcinoma (RCC) has increased over the last few years, mainly due to the increased number of incidentally diagnosed cases during diagnostic cross-sectional studies. Image-guided ablation therapies are increasingly used as a valid option for patients unsuitable for surgery in several different clinical scenarios. They have been proposed as a safe and effective alternative to surgery in small RCC, as these therapies can result in up to 100% of tumor ablation and are less invasive and more nephron-sparing [4,5]. The Cardiovascular and Interventional Radiology Society of Europe (CIRSE) published the guidelines for percutaneous ablation of small RCC, recommending radiofrequency ablation (RFA) and cryoablation (CRA) as the most studied and most suitable modalities to ablate tumors up to 5 cm in diameter, and mentioning microwave ablation (MWA) as an interesting and increasingly used technique, at present it is less investigated than RFA and CRA, and some concerns exist concerning its higher risk of pelvicalyceal injury [2]
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