US/CT guided ablative therapies ın small renal masses

Radiofrequency ablation (RFA) and cryotherapy are the popular and increasingly used thermal ablative therapies alternative to the surgery in small renal masses. The aim of this study is to evaluate the effectiveness of the ablative therapies.45 patients (32 men, 13 women; mean age 59,2 years, age range 22-90) were involved in this study. 64 of the lesions were treated with RFA and 15 were treated with cryotherapy. The number of ablated lesions were between 1 to 11 (mean 1,68) and the diameter of lesions were between 0,9 to 4,5 cm (mean 1,9 cm). According to the R.E.N.A.L. nephrometry score, lesions in the low, moderate and high score groupes were 43, 31 and 5, respectively. From the total of 53 sessions of ablations, 32 sessions of RFA (24 percutaneous, 5 intraoperative and 3 laparoscopically) and 15 sessions of cryoherapy (11 percutaneous, 4 intraoperative) were performed. During percutaneous ablations; ultrasound (US), CT and a combination of US and CT guidance was used in 7, 3 and 14 sessions for RFA and 1, 2 and 8 sessions for cryotherapy, respectively. RITA Starburst® Talon electrode was used in all RFA procedures and also Precise? system and Iceseed? cryoablation needles were used in all cryotherapy procedures. Before the ablation, 5 % dextrose solution was injected to the adjacent to the lesion in 8 sessions. After ablation, patients were followed-up with CT and MRI at the first, thirth, sixth months, first year and then with intervals of one year.Pelvicalyceal system damage, decline in kidney function tests in earlier period, skin burn, subcapsuler and perirenal hematoma was developed in different patients for once. Follow-up periods were between 2 to 55 months (mean follow-up 23,6 months). Complete ablation was observed in 38/45 (%84,5) of the cases and 72/79 (%91) of the lesions. 6 sessions of repeat RFA was performed in 5 cases with recurrences of 7/45 (%15,5) patients. 3/45 (%6,6) patient were treated with radical nephrectomy and renal arterial embolisation was performed in 1/45 (%2,2) patient. During the follow-up period, we observed locally progressive desease in only one patient (%2,2). 3/45 (%6,6) of patient were lost due to concomitant morbidity or additional malignities.Ablative therapies are effective and low morbidity treatments in small renal masses. Nephrometry scoring will contribute to standardize the renal tumors, decide the treatment protocole and make a prediction of prognosis.