Dr Tannouri.F CHU-NDS, Bybols Lebanon MEIH, Bsalim, Lebanon RHUH, Beirut Lebanon ABLATION RENAL CELL CARCINOMA
Health & Medicine
Ablation renal cell carcinoma
Dr Tannouri.FCHU-NDS, Bybols LebanonMEIH, Bsalim, LebanonRHUH, Beirut Lebanon
Ablation renal cell carcinoma
RCCMost common primary renal malignant neoplasm in adults90% of renal tumorsPeaks 55-84 years old20% with metastatic disease2% with simultaneous bilateral diseaseIncreasing incidental detection in the early stage ( widespread use of medical imaging- incidentaloma)
Classification Of RENAL CORTICAL TUMORSSubdivided into benign and malignant neoplasms by documented genetic abnormalities
Benign: Angiomyolipoma and Oncocytoma
Malignant tumors sub-classified into: Conventional Papillary Chromophobe Collecting duct carcinomaMedullary carcinomaUnclassifiable
RCC PROGNOSISDepend on SizeLocalizationTypeRenal function
RCC /PROGNOSIS -STAGESurvival after surgical resection
Suvival for unresectable RCC is 10 HU or >15% with CT and MR imaging, respectively) usually indicate residual viable RCC and primary treatment failureManifests as a focus of nodular or crescentic enhancement on postablation contrast-enhanced CT scans and MR images In cryoablation, a thin peripheral rim of enhancement often persists for several months following therapy
Microwave thermotherapy (MW)
No significant clinical data have been reported to date using this modality.
Major experience with the prostate.Maintaining temperature greater than 60C for 60 sec., causes coagulative necrosis.
Can be done by laparoscopic or percutaneous approach.
Irreversible Electroporation (IRE)
Relative newcomer to the field of tumor ablationVery notable because it is inherently nonthermal (no heat is produced to cause cell death)Cells are eradicated by using several microsecond-to-millisecondlong pulses of electrical current. The pulses generate electric fields up to 3 kV/cm, which cause irreversible damage to the cell membrane, thereby inducing apoptosisHeat sink should have a smaller influence on the ablation zonelesser damage to adjacent organs
HIFUPotentially the least invasive tumor ablation technique (Extracorporeal).Employs beams of ablative US frequency,generated by piezoelectric element,focused by a paraboloid reflector.This beam is focused on the lesion, US lithotripsy.Resulting in thermal destruction - tissue cooking (temp. raise by 70-80 C in the target lesion).Lots of concerns in regard to incomplete tumor ablation, and superficial skin burns.
Intracavitary photon radiationA steriotactic radio-surgery.Used initially for brain tumors.Also applied for radio-resistant RCC metastatic lesions.Deliver targeted high dose radiation for a precise site causing coagulative necrosis, while preserving normal surrounding tissues.Additional experimental and clinical work is necessary to evaluate its role in renal cancer
CONCLUSIONExtensive clinical experience supports the role of percutaneous RF ablation and cryo in the treatment of early-stage RCC in patients who are nonsurgical candidates or unwilling to undergo surgery. Both RF ablation and cryo are well-tolerated procedures that have demonstrated acceptable short- to inter- mediate-term outcomes and a low rate of complications Patients at risk for renal compromise may undergo this procedure effectively with preservation of their renal function