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Radiofrequency interstitial tumor ablation (RITA) is a new modality of treatment of renal cancer: Ex-vivo and in vivo experience

par Zlotta, Alexandre ;Raviv, Gil;Wilschutz, Thierry;Peny, Marie-Odile ;Van Gansbeke, Daniel ;Schulman, Claude
Référence British journal of urology, 80, SUPPL. 2, page (140)
Publication Publié, 1997

Article révisé par les pairs

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Résumé :

Small size renal tumors are increasingly diagnosed and frequently treated by nephron-sparing surgery. Tumors can be successfully ablated by radiofrequcncy (RF) which creates very localized necrotic lesions. RITA has been used in human kidneys in an ex-vivo experiment to assess the necrotic lesions produced on a model close to the physiological conditions and then in 4 patients with localized renal cancer prior to radical nephrectomy. In the ex-vivo model, 4 kidneys freshly removed were treated with bipolar RF energy through 2 needles introduced in the renal parenchyma and temperatures recorded with several thermocouples. The renal artery was perfused with a 37°C physiological renql blood flow perfusion monitored by a computer. Two lesions in each pole of each kidney including the cortex and the medulla were produced. In vivo, 2 patients with 2-5 cm unique tumors were treated just prior to nephrectomy under general anesthesia and 1 patient with a peripheral 2 cm upper pole tumour was treated percutaneously under ultrasound guidance with local anesthesia only, 1 week prior to surgery. Temperatures and lesion size were comparable in the vivo and ex-vivo experiments. Maximum temperature at the active needles ranged from 84°C to 113°C with 10 to 14 watts applied during 10 to 14 min. Lesions created were on average 2 ×1.7×1.8 cm after RITA treatment. Microscopic examination showed a stromal oedema with intensive pyenosis. In vivo, tolerance of RITA as an anesthesia-free procedure was excellent. One tumour was completed destroyed by RITA without damage to the adjacent tissue. These preliminary studies demonstrate the ability of RITA to produce localized extensive necrosis in kidney parenchyma and tumours. Further studies should evaluate this new minimally invasive treatment modality in small size kidney tumors considered for nephron-sparing surgery.SR.