Sponsored Links / Ads
 

Bladder/Kidney/Testicular

Image-guided ablation for Renal Cell Carcinoma: An Update 
  Submitted By: J. Louis Hinshaw, M.D.

Printer Friendly Version

Posted Jan 1, 2012

Image-guided ablation for Renal Cell Carcinoma: An Update

Authors: J. Louis Hinshaw, MD, Fred T. Lee, Jr., MD, and Julie Ruma, MD


University of Wisconsin-Madison Department of Radiology








Introduction

Renal cell carcinoma (RCC) is a very common clinical problem with an estimated 58,240 patients diagnosed in 2010 [1]. This represents a doubling in the number of RCCs diagnosed in the last 50 years, and a five-fold increase in the diagnosis of small, less than 3 cm tumors over the last 20 years [1]. Identifying these tumors at a smaller size has a significant impact on patient prognosis for two reasons. One is that there are few available effective chemotherapies and as a result, the only hope for cure is surgical resection or physical destruction of the tumor. The smaller the tumor at diagnosis, the more likely it is that complete treatment will be possible. The other is that smaller tumors generally have a more indolent natural history and a lower likelihood of developing metastatic disease. Historically, renal cancers were frequently diagnosed in the advanced stages once they began to cause symptoms related to mass effect from the tumor itself, or blood in the urine. As a result, it was often incurable. There are three primary reasons for the increase in RCC diagnosis, especially smaller tumors: 1) the use of cross-sectional imaging has increased dramatically during this time and these renal tumors are identified incidentally on imaging performed for other reasons (e.g. motor vehicle accident, abdominal pain, etc.) 2) improvements in CT, US, and MRI technology now make it possible to identify even very small renal tumors that previously would not have been appreciated and 3) there is a small, but real increase in the rate of renal cancer in the United States, the cause of which is unknown.

Radical nephrectomy (removal of the entire kidney along with the tumor) was for many years the standard of care for the treatment of renal cell carcinoma. However, this has changed over the last several decades as surgical techniques have improved and smaller tumors have been diagnosed. Partial nephrectomy (removal of the tumor and a small margin of normal kidney) has now become the standard of care for the treatment of small RCCs in most centers, and is increasingly performed laparoscopically, limiting the associated morbidity. Clinical studies have shown that this less invasive therapy is as effective as, and safer than radical nephrectomy for the treatment of small RCCs without evidence of local or distant spread [2, 3].

Because of the success achieved with these less traumatic procedures, other even less invasive techniques have been developed to treat small RCC. Cryoablation (the use of cold to destroy cancer cells) was initially introduced in this setting as an intra-operative technique performed while directly visualizing the tumor at the time of surgery. Clinical experience has shown that laparoscopic cryoablation is an effective means of treating small RCC, with results essentially equivalent to partial nephrectomy [4, 5]. At that time, approximately 5-10 years ago, image-guided percutaneous (directly through the skin) ablation was being increasingly utilized in the treatment of cancer in other organ systems, particularly the liver [6-9]. This has led to increasing utilization of percutaneous and laparoscopic ablative techniques for small RCC. These techniques are often only available at tertiary care medical centers, but have had extremely promising early results [10-12]. They can be used as curative procedures for smaller renal cell carcinomas, and can also be utilized in some settings as a palliative (treatment meant to improve quality of life and extend life without expectation of cure) intervention for larger tumors, as well as for the treatment of local recurrences and distant metastases in some settings. The future is very promising for ablation of renal cell carcinoma because it is proving to have comparable efficacy to surgical techniques, but with a superior safety profile, less expense, more rapid recovery and it can often be performed in severely ill patients who would not tolerate a surgical procedure [10-16].

For a complete review of the current ablation technologies, please see our manuscript “Image guided tumor ablation, a technical overview of a less invasive cancer treatment”, also available on cancernews.com. This manuscript will specifically review the issues associated with image-guided ablation of RCC.

Are you a good candidate for image-guided ablation?

Patient selection may be the most important consideration in ensuring excellent results after image-guided tumor ablation. Ablative therapy is not an appropriate choice for most people diagnosed with RCC. If a patient is able to tolerate resection and is an appropriate candidate, surgery is still considered the standard of care for most patients. A thorough imaging evaluation should be performed prior to initiating any therapy and should include a complete staging evaluation. This often includes contrast-enhanced computed tomography of the chest, abdomen, and pelvis, with MRI as an alternative if there is a contraindication to CT contrast. The diagnosis of RCC is generally made based upon the imaging findings alone, but biopsy (sampling of the tumor) is becoming more common, particularly for smaller tumors, since the type and grade of the tumor can be helpful for determining the need for, and type of intervention that is most appropriate. Patients with metastatic disease may be a candidate for treatment of the primary tumor depending on numerous clinical and tumor-related factors and these patients should be seen by a physician knowledgeable in the treatment of metastatic RCC for a complete evaluation and consideration of potential treatment options. The imaging work up may also include: ultrasonography (US) of the kidney and/or inferior vena cava, as well as magnetic resonance imaging (MRI) with or without venography (evaluation of the veins) to evaluate for the severity of disease.

The size of the tumor is a critical consideration when considering different therapies. As tumor size increases, the likelihood of metastatic disease increases, and in addition, ablative procedures become progressively more difficult, less likely to be successful, and more likely to be associated with complications. With today’s technology and techniques, tumors 5 cm or smaller have a reasonable chance of a complete treatment and tumors less than 3 cm in diameter can almost always be effectively treated with image-guided ablation. Although less reliable, it may be reasonable to attempt image-guided tumor ablation in patient with tumors up to 9 cm in diameter, if there are no other treatment options [15].

The location of the tumor is also an important consideration when deciding if a tumor can be effectively treated with ablative techniques. Tumors located around the periphery of the kidney are relatively easy to treat, while tumors located centrally are not only more difficult to completely treat, but also more likely to be associated with significant complications, particularly injury to the renal collecting system (renal pelvis and ureter), which carries urine from the kidney to the bladder. Injury to the ureter can result in obstruction of urine outflow and threaten the function of the kidney. Tumors located along the anterior aspect of the kidney can also be difficult because of the risk of injuring adjacent bowel. Although this is an uncommon complication, it can be life-threatening. Techniques like hydrodissection (using fluid to push the adjacent structures away from the tumor) can often allow these procedures to be safely performed, but additional planning is necessary to ensure a safe outcome.

Overall, with the current technology and techniques, image-guided tumor ablation is best suited to patients with peripheral tumors less than five centimeters in diameter. However, each case is unique and if a patient is severely ill and cannot tolerate surgery, has RCC in both kidneys, has poor renal function, or has a syndrome (such as Von Hippel Lindau) that makes them susceptible to developing multiple RCCs in their lifetime, then image-guided tumor ablation becomes a more viable consideration even for patients who fall outside of these guidelines.

Technology

Cryoablation and radiofrequency ablation are the primary modalities utilized for RCC ablation, but microwave ablation is a rapidly developing technology that promises to become a very robust alternative energy source and early clinical results are promising [22,23,24]. High intensity focused ultrasound (HIFU) does have potential advantages and is under continued development, but is not a clinically viable alternative at this time [19].

Cryoablation

Cryoablation is the antithesis of the other thermal ablation techniques, utilizing cold rather than heat to cause tissue destruction. When tissues are frozen, multiple processes occur that lead to cellular death: crystals form within the cells and the cells expand, damaging the cell. When the cells are subsequently thawed, this results in cellular disruption and death. Temperatures as low as -160 degree C can be achieved with this technique, and tissues cooled to less than approximately -20 degree C are irreparably damaged, especially when there is rapid freezing and thawing.

Early in its development, cryoablation could not be performed percutaneously (through the skin) because the required probes were too large to use safely. Therefore, it was performed at the time of surgery, when the tumor could be directly visualized and any associated bleeding could be addressed. However, there have been technical advances in the equipment that have resulted in much smaller probes and cryoablation is now utilized percutaneously. Clinical studies have been performed to date and the largest trial reported had almost 100% complete treatment of tumors even up to 7.3 cm in diameter [11]. The advantages of performing the procedure percutaneously, if possible, is that it is associated with a shorter recovery time, shorter hospital stay, less complications, and a significantly lower cost, but with no associated decrease in efficacy [17].

There are several potential advantages of cryoablation over the heat-based ablation modalities. The main advantage is that the iceball formed during the ablation is highly visible with CT, US, and MRI. This allows very precise control of the ablation and limits injury to adjacent structures (Figure 1). The area of ablation is not nearly so well-defined or controlled with the heat-based ablation modalities. Also, much larger ablations can be performed with cryoablation (up to approximately 12 cm) as compared with the currently available heat-based ablation modalities (maximum of approximately 7 cm).
Figure 1: US-guided cryoablation of renal cell carcinoma of the left kidney in a woman with Von-Hippel Lindau Disease (VHL). VHL puts the patient at risk for having multiple renal cell carcinomas during their life.



Figure 1: a) Contrast-enhanced MRI image through the abdomen prior to cryoablation. The renal cell carcinoma is identified as an avidly enhancing rounded mass along the posterior left kidney (arrow).




Figure 1: b) Grey-scale US image prior to the ablation. The renal cell carcinoma is identified as a rounded mass extending off the posterior kidney (arrows). Note the dark area next to the mass, which represents a renal cyst.



Figure 1: c) Grey-scale US image during the ablation. The renal cell carcinoma is now obscured by the iceball that has formed around the cancer (arrow).



Figure 1: d) Contrast-enhanced MRI image through the abdomen after the cryoablation. The mass is no longer enhancing, showing that it has been devascularized and is no longer viable (arrow).


The primary disadvantages of cryoablation are the perceived increased risk of bleeding associated with the procedure as compared with the heat-based ablation modalities, the expense and logistics of the equipment (particularly the high pressure argon gas tanks), and the lack of familiarity with the technique. Interestingly, no increase in bleeding was identified after cryoablation of the liver as compared with RF ablation when it was studied in a porcine model, and very few cases of severe bleeding have been seen with clinical renal cryoablation, suggesting that the increased risk of bleeding may not be significant [18,23].

Radiofrequency Ablation

Radiofrequency (RF) ablation is currently the most frequently utilized percutaneous ablation modality. It has been more extensively studied and more widely utilized clinically. During RFA, high-frequency alternating electrical current (~500 kHz) is passed through a needle (electrode) that is positioned within the tumor. The electrical current results in oscillation of the ions directly adjacent to the electrode and this results in frictional heating of these tissues. The heat is subsequently propagated through the tissues. Any tissue heated to more than 50-60 degree C dies immediately and any tissue heated to above approximately 40 degree C will die if the temperature is maintained for an adequate period of time. The time necessary to result in cell death depends on the temperature and tissue type.

Although there were significant improvements in technology during the early development of RF that allowed larger ablations to be obtained, significant technical barriers continue to limit this technology. In particular, the deposition of RF energy into tissues is limited by the electrical impedance (resistance to current flow) that develops as the ablation progresses, thus limiting the volume of tissue that can be destroyed at one time. As a result, the size of tumor that can be effectively treated by RF is smaller than what is possible with cryoablation. When applied clinically, the results have shown excellent success in treating tumors less than 3 cm in diameter, moderate success with tumors in the 3-5 cm range and low success rates when treating tumors greater than 5 cm in diameter (Figure 2).


Figure 2: US-guided percutaneous RF ablation of renal cell carcinoma of the right kidney.


Figure 2: a) Contrast enhanced MRI image through the abdomen prior to RF ablation. The renal cell carcinoma is identified as an avidly enhancing mass extending off the posterior aspect of the right kidney (arrow).



Figure 2: b) Grey-scale US image prior to the ablation. The renal cell carcinoma is identified as a rounded mass extending off the posterior kidney (arrows).



Figure 2: c) Grey-scale US image during RF ablation. The renal cell carcinoma is now obscured by the gas bubbles that form as the tissue water boils during the RF ablation (arrows).




Figure 2: d) Contrast enhanced MRI image through the abdomen after RF ablation and resection. The renal cell carcinoma is now devascularized and non-enhancing (arrow).


The primary disadvantages of RF ablation are that it is relatively painful, both during and after the ablation, which means that general anesthesia may be necessary during the procedure, and narcotic pain relievers may be required for some period of time afterwards (usually less than 24 hours, at which time the pain decreases significantly). It is also more likely to injure the renal collecting system than cryoablation, although significant injuries can occur with both modalities [25].

Microwave

Microwave (MW) ablation is promising. There are currently 6 systems available for clinical use in the United States with varying cooling methods, antenna sizes and designs [20]. Microwave ablation (MW) is similar to RF in that it causes heating of the tissues to cause cellular damage and death. However, the mechanism of heating and the degree and speed of heating possible with microwave is significantly better. It should be stressed that because of the complexities of the technology, very different results will be seen with different systems. Microwave technology has several advantages over RF that offers better and more consistent ablation of tumors of all types. MW ablation makes use of the same energy as a standard microwave oven, but deposits that energy directly into the tissues around the probe. Since it heats a volume of tissue around the applicator, it is more efficient than radiofrequency ablation and the tissues can be heated to higher temperatures more rapidly. Transmission of heat through the tissue is not limited by charring or desiccation as in RF. Recent work has shown that microwave ablation with high power tri-axial antennas created larger ablation zones in the kidney than RF with similarly sized applicators [21]. Early clinical studies have also shown promising results, but larger studies will be needed to confirm both the efficacy and safety of this powerful technology in the setting of RCC [22].



Figure 3: US-guided microwave ablation of a left renal cell carcinoma in a 65 year old male with history of right renal cell carcinoma and right nephrectomy


Figure 3: a) Contrast enhanced CT image through the abdomen demonstrates an enhancing mass extending off the anterior aspect of the left kidney.



Figure 3: b) Non contrast CT image prior to ablation demonstrates hydrodissection. D5 water mixed with iodinated contrast is injected through a needle (arrow) to help displace colon and the pancreatic tail superiorly.



Figure 3: c) Non contrast CT image during ablation shows the tip of the microwave probe (arrow) is located within the left renal mass. Subsequently the ablation is performed and gas bubbles from boiling tissue develops in and around the tumor.


Figure 4: US-guided microwave ablation of a right renal cell carcinoma


Figure 4: a) CT image through the abdomen demonstrates an exophytic mass extending off the posterior aspect of the right kidney (arrow).



Figure 4: b) US images before and during ablation. The renal cell carcinoma is obscured by the gas bubbles that form as the tissue water heats during the microwave ablation



Figure 4: c) CT images before and after microwave ablation. 5% dextrose in water (“sugar water”) is injected to protect nearby structures. The ablation zone is visualized (white arrows), as is the now ablated tumor (red arrow).



Figure 4: d) MRI image 7 months post ablation demonstrating devascularized and non-enhancing right renal cell carcinoma (arrow).


High-intensity Focused Ultrasound

High-intensity Focused Ultrasound (HIFU) is in theory the optimal technology for performing ablation because it is completely non-invasive. HIFU uses highly focused ultrasound energy to vibrate tissues at a specific location, causing frictional heating similar to RF and MW, but without the need for an invasive applicator. Significant heating of the tissue can occur if the focused US energy is directed at the target tissue for an adequate period of time. Because of the current limitations in technology, this is accomplished by ablating small volumes of tissue at a time, with numerous overlapping ablations needed to destroy any significant volume of tissue (resulting in prolonged procedure times, often measured in hours). Since the target tumor moves with patient breathing, heart beats, and movement, ensuring destruction of every cell within a malignant tumor (cancer) is problematic. As a result, the primary use for HIFU has been in the treatment of uterine fibroids, a benign tumor of the uterus where HIFU has been effective at treating the symptoms associated with fibroids, but often does not achieve complete destruction of the tumor. Some of these limitations are being addressed with advanced computer targeting systems, and these advances may eventually overcome these problems.

What can you expect for the procedure?

Image-guided tumor ablation is a procedure that has been independently developed and advanced at many different institutions. As a result, there is some variation in how the procedure is performed. This includes which ablation modality is preferentially utilized, whether or not the patient will be under general anesthesia, or have conscious sedation, and what imaging modality is used for guidance and monitoring of the ablation. However, there has been excellent knowledge sharing between the institutions to ensure that critical factors are more uniform.

At our institution, we perform the procedure with the patient in the CT scanner. However, we generally utilize US for guidance and monitoring the ablation and reserve CT for monitoring post-ablation assessment with a contrast-enhanced CT. This allows us to identify any untreated tumor at that time and complete the therapy as needed. Some medical centers will perform this initial evaluation at a later time (1-4 weeks after the ablation) and repeat the treatment at that time if necessary.

The ablation is sometimes performed as an outpatient procedure, although you may spend one night in the hospital for observation after the ablation. If RF or MW was used for your ablation, then you may have significant discomfort for the first 24 hours, after which it will quickly decrease. With cryoablation, there is usually very minimal pain after the procedure. In fact, significant pain afterwards, or pain that increases over time, can indicate that there is post-ablation bleeding, which can be painful and even life-threatening if the blood loss is large enough. Most patients can return to normal activities within a week of the procedure.

Not all ablations can be completed using a percutaneous approach. As a result, laparoscopic assistance or open ablation may be necessary. At our institution, the radiologist performs the procedure in cooperation with a urologist.

Possible Complications

Renal cryoablation and RF ablation have both proven to be extremely safe. Less than 10% of patients encounter a significant complication and most of these complications are relatively minor and self-limited. In comparison, surgery, even relatively non-invasive surgery like nephron-sparing surgery (partial nephrectomy), has a major complication rate of approximately 14% with just under 1% mortality according to a review article published in 2001 [2].

Hemorrhage

Bleeding is the most frequently reported complication. However, the bleeding is usually small volume and limited by the small, contained space surrounding the kidney. If there is a large amount of blood lost, blood transfusions, hospitalization, or even a secondary intervention such as arterial embolization or surgery may be needed.

Collecting system injury

Injury to the renal collecting system and ureter that carries urine from the kidney to the bladder is the most feared complication, as it can threaten the function of the entire kidney (Figure 5).

Figure 5: Ureteral stricture following intra-operative cryoablation of renal cell carcinoma of the right kidney.


Figure 5: a) Contrast-enhanced MRI through the abdomen after cryoablation. The renal cell carcinoma has been fully treated as is identified as a non-enhancing region along the anterior right kidney (arrows).



Figure 5: b) T2-weighted MRI through the abdomen after cryoablation. Unfortunately, the patient has developed a ureteral stricture related to the cryoablation despite attempts in the operating room to protect the ureters. This has resulted in obstruction and hydronephrosis (distention of the collecting system) of the right kidney (arrow). This complication required ureteral stent placement.


Fortunately, this is a relatively infrequent complication and, if anticipated, can often be avoided. It is most frequently seen after treatment of central tumors, or tumors along the lower border of the kidney. In these situations, precautions can be undertaken to make this complication less likely, but sometimes it is not safe to perform ablations in these locations.

Damage to adjacent structures

A potential complication of all ablation techniques is collateral damage to adjacent structures with bowel, nerve, muscle, pancreas (can result in pancreatitis), and the adrenal glands (may result in severe hypertension during the procedure) being the primary considerations.

Injury to the bowel, which may be located adjacent to the tumor can be a catastrophic and even fatal complication. As a result, tumors that are located closely adjacent to bowel are either treated with surgical assistance or by utilizing a technique to move the bowel away from the tumor, such as hydrodissection. With this technique sugar water is infused into the space between the tumor and the adjacent bowel or other vulnerable structure, pushing it out of the way. This is generally possible, but if it is not successful, then the procedure may need to be terminated.

A bothersome, but usually time-limited, complication is injury to the nerves that innervate the skin of the abdomen. This can result in a neuropathy (injury to the nerve with associated abnormal sensations along the course of the nerve). If this occurs, the patient will have painful sensations and hypersensitivity that develop immediately after the ablation. The majority of the time, this resolves over the course of 1-2 months and no cases have been reported where the symptoms are permanent. In the meantime, both topical and oral medications can be given to limit the symptoms.


Follow-up after the ablation

Although there is some variability as to the follow up that is required after ablation of a renal tumor, there are some relatively consistent practices as well. Either a contrast enhanced CT or MRI should be performed either immediately after, or soon after the ablation, to ensure that the tumor has been completely treated. If this shows that the tumor has been completely destroyed, then a contrast-enhanced CT or MRI should be performed every 3-12 months after the ablation depending on the tumor type and grade. The length of follow up that is needed is not clear, but you will likely have follow up imaging for at least 5 years after the procedure. If there is evidence to suggest that the tumor has come back on any of these studies, then it should be treated again.

Conclusion

Image-guided tumor ablation is a relatively new technology, but now has a relatively robust clinical experience with excellent results in studies following patients for up to 5 years with small renal cell carcinomas. It is a very safe technique, and short-term results are comparable to those obtained with surgery in patients who have disease that is appropriate for this treatment. Long term results are still pending. At this time, it is most appropriate to recommend this treatment to patients who have small (<5 cm) tumors along the periphery of the kidney and who either cannot, or do not want to have surgical removal.

Works Cited:
1.SEER, United States Surveillance, Epidemiology and End Results Program. 2010.
2. Uzzo, R.G. and A.C. Novick, Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol, 2001. 166(1): p. 6-18.
3. Fergany, A.F., K.S. Hafez, and A.C. Novick, Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year follow up. J Urol, 2000. 163(2): p. 442-5.
4. Gill, I.S., et al., Renal cryoablation: outcome at 3 years. J Urol, 2005. 173(6): p. 1903-7.
5. Gill, I.S., et al., Laparoscopic renal cryoablation in 32 patients. Urology, 2000. 56(5): p. 748-53.
6. Jungraithmayr, W., et al., Cryoablation of malignant liver tumors: results of a single center study. Hepatobiliary Pancreat Dis Int, 2005. 4(4): p. 554-60.
7. Weber, S.M. and F.T. Lee, Jr., Expanded treatment of hepatic tumors with radiofrequency ablation and cryoablation. Oncology (Williston Park), 2005. 19(11 Suppl 4): p. 27-32.
8. Seifert, J.K., et al., Cryotherapy for liver metastases. Int J Colorectal Dis, 2000. 15(3): p. 161-6.
9. Iannitti, D.A., et al., Laparoscopic cryoablation of hepatic metastases. Arch Surg, 1998. 133(9): p. 1011-5.
10. Mogami, T., et al., Percutaneous MR-guided cryoablation for malignancies, with a focus on renal cell carcinoma. Int J Clin Oncol, 2007. 12(2): p. 79-84.
11. Atwell, T.D., et al., Percutaneous renal cryoablation: experience treating 115 tumors. J Urol, 2008. 179(6): p. 2136-2141.
12. Silverman, S.G., et al., Renal tumors: MR imaging-guided percutaneous cryotherapy--initial experience in 23 patients. Radiology, 2005. 236(2): p. 716-24.
13. Gervais, D.A., R.S. Arellano, and P.R. Mueller, Percutaneous radiofrequency ablation of renal cell carcinoma. Eur Radiol, 2005. 15(5): p. 960-7.
14. Gervais, D.A., R.S. Arellano, and P. Mueller, Percutaneous ablation of kidney tumors in nonsurgical candidates. Oncology (Williston Park), 2005. 19(11 Suppl 4): p. 6-11.
15. Gervais, D.A., et al., Renal cell carcinoma: clinical experience and technical success with radio-frequency ablation of 42 tumors. Radiology, 2003. 226(2): p. 417-24.
16. Gervais, D.A., et al., Radio-frequency ablation of renal cell carcinoma: early clinical experience. Radiology, 2000. 217(3): p. 665-72.
17. Shadid A, H.J., Nakada SY, Hedican S, Moon T, Lee FT Jr., Comparison of cost effectiveness and outcome of percutaneous and laparoscopic renal cryoablation. Abdominal Radiology Course, Society of Gastrointestinal Radiology, 2007. Scientific presentation.
18. Shock, S.A., et al., Hepatic hemorrhage caused by percutaneous tumor ablation: radiofrequency ablation versus cryoablation in a porcine model. Radiology, 2005. 236(1): p. 125-31.
19. Zhou, Yu-Feng. High intensity focused ultrasound in clinical tumor ablation. World J Clin Oncol, 2011 2(1): 8–27.
20. Lubner, M.L., Brace, C.L., et al., Microwave Tumor Ablation: Mechanism of action, Clinical results, and devices. J Vasc Interv Radiol 2010; 21: S192-S203.
21. Laesek P.F., Lee F. T. Jr., et al., Microwave ablation versus radiofrequency ablation in the kidney: high power triaxial antennas create larger ablation zones than similarly sized internally cooled electrodes. J Vasc Interv Radiol 2009; 20:1224-1229.
22. Liang P, Wang Y, et al., Ultrasound guided percutaneous microwave ablation for small renal cancer: initial experience. J Urol. 2008 Sep;180(3):844-8
23. Hinshaw JL, Shadid AM, et al., Comparison of percutaneous and laparoscopic cryoblation for the treatment of solid renal masses. AJR Am J Roengenol 2008; 191(4): 1159-1168.
24. Breen DJ, Rutherford EE, et al., Management of renal tumors by image-guided radiofrequency ablation: experience in 105 tumors. Cardiovasc Intervent Radiol 2007; 30(5):936-942.
25. Hinshaw JL, Johnson BA, Ledwidge ME, Winter TC, Sampson LA, Hedican SP, Nakada SY, Warner TF, Lee FT Jr. Percutaneous radiofrequency and cryoablation of the central kidney in an animal model: Evaluation of collecting system damage. Journal of Interventional Oncology, Spring 2008;1(1):28-37.

* McGahan JP, Brock JN, Tessluk H, Gu WZ, Schneider P, Browning PD. Hepatic ablation with the use of radio-frequency electrocautery in the animal model. J Vasc Interv Radiol 1992;3:291-7  


 


Additional Authors:  

Works Cited:  


Article Links:  
 
  • University of Wisconsin Tumor Ablation Lab
  •  
     
     
  • The Role of Image-guided Tumor Ablation in the Management of Liver Cancer
  •  
     
     
  • Image Guided Tumor Ablation: A Technical Overview of a Less Invasive Cancer Treatment
  •  
     
     
  • CollegeBooks.com - Medical Textbooks - Nursing Textbooks - College Book Store - Medical Bookstore
  •  
     
     
  • Cancer News - Cancer Information
  •  
     
    ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
     
     

    These review articles are the opinions of the authors. Some of the views may be controversial. CancerNews.com™ does not directly endorse the work. We merely present it as part of our service. Please read the disclaimer.



     
     

    An excellent resource for discount books, textbooks, music and supplies.
    {www.collegebooks.com}
     
     

    Search for great prices on apparel, electronics, sporting goods and more. Buy online and save.
    {www.shoppingnews.com}
     



    This site is property of Net Ventures, Inc.
    Disclaimer/Legal