Suna ÖZHAN OKTAR, Seda ALADAĞ KURT, Cem YÜCEL, Gonca ERBAŞ, Sinan SÖZEN, Ali Yusuf ÖNER

The effectiveness of RENAL nephrometry score in ablated renal tumors via radiofrequency ablation or cryoablation

Background/aim: This study aimed to evaluate the clinical efficacy of radiofrequency ablation (RFA) and cryotherapy and to scrutinizethe therapeutic success of the RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location)nephrometry score in terms of possible complications and the predictive status of oncological results.Materials and methods: Forty-five patients with biopsy-proven renal cell carcinomas (32 males, 13 females) treated with RFA andcryotherapy were included. Patients were 22–90 years old (average: 59.2 years). Statistical analyses were performed using SPSS forWindows.Results: A total of 79 lesions with dimensions varying between 0.9 and 4.5 cm (average: 2.2 cm) were ablated. Complete ablationwas achieved for 72 (91.1%) lesions. Six repeat RFA sessions were applied for 4 (5%) lesions with residue/recurrence. The averageRENAL nephrometry scores of lesions that underwent complete ablation and those that developed residue/recurrence were 6.3 and 7.7,respectively. The average recurrence-free survival time was 34.8 months (range: 3–55 months), while it was 44.6 months (range: 6–55months) for cryotherapy and 28.6 months (range: 3–50 months) for RFA.Conclusions: Ablative therapies are minimally invasive and effective methods for treating small renal tumors. RENAL nephrometryscoring is a valuable system for standardizing renal tumors and evaluating the success of ablative therapies, possible complications, andoncological results.

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1. Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK. Rising incidence of small renal masses: a need to reassess treatment effect. Journal of the National Cancer Institute 2006; 98 (18): 1331-1334.
2. Pavlovich CP, Walther MM, Choyke PL, Pautler SE, Chang R et al. Percutaneous radio frequency ablation of small renal tumors: initial results. Journal of Urology 2002; 167 (1): 10-15.
3. Allen BC, Remer EM. Percutaneous cryoablation of renal tumors: patient selection, technique, and postprocedural imaging. Radiographics 2010; 30 (4): 887-900.
4. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation—what should you use and why? Radiographics 2014; 34 (5): 1344-1362.
5. Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. American Journal of Roentgenology 2000; 174 (2): 323-331.
6. Sackenheim MM. Radio frequency ablation: the key to cancer treatment. Journal of Diagnostic Medical Sonography 2003; 19 (2): 88-92.
7. Weber SM, Lee FT. Cryoablation: History, mechanism of action, and guidance modalities. In: van Sonnenberg E, McMullen WN, Solbiati L, Livraghi T, Müeller PR et al. (editors). Tumor Ablation. New York, NY, USA: Springer; 2005. pp. 250-265.
8. Reyes J, Canter D, Putnam S, Simhan J, Smaldone MC et al. Thermal ablation of the small renal mass: case selection using the RENAL-Nephrometry Score. Urologic Oncology 2013; 31 (7): 1292-1297.
9. Higgins LJ, Hong K. Renal ablation techniques: state of the art. American Journal of Roentgenology 2015; 205 (4): 735-741.
10. Kutikov A, Uzzo RG. The RENAL nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. Journal of Urology 2009; 182 (3): 844-853.
11. Sisul DM, Liss MA, Palazzi KL, Briles K, Mehrazin R et al. RENAL nephrometry score is associated with complications after renal cryoablation: a multicenter analysis. Urology 2013; 81 (4): 775-780.
12. Chang X, Ji C, Zhao X, Zhang F, Lian H et al. The application of RENAL nephrometry scoring system in predicting the complications after laparoscopic renal radiofrequency ablation. Journal of Endourology 2014; 28 (4): 424-429.
13. Clark TW, Millward SF, Gervais DA, Goldberg SN, Grassi CJ et al. Reporting standards for percutaneous thermal ablation of renal cell carcinoma. Journal of Vascular and Interventional Radiology 2006; 17 (10): 1563-1570.
14. Janzen NK, Perry KT, Han KR, Kristo B, Raman SS et al. The effects of intentional cryoablation and radio frequency ablation of renal tissue involving the collecting system in a porcine model. Journal of Urology 2005; 173 (4): 1368-1374.
15. Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. Journal of Vascular and Interventional Radiology 2014; 25 (11): 1691-1705.
16. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D et al. Comparison of 1800 laparoscopic and open partial nephrectomies for single renal tumors. Journal of Urology 2007; 178 (1): 41-46.
17. Cooperberg MR, Mallin K, Ritchey J, Villalta JD, Carroll PR et al. Decreasing size at diagnosis of stage 1 renal cell carcinoma: analysis from the National Cancer Data Base, 1993 to 2004. Journal of Urology 2008; 179 (6): 2131-2135.
18. Ficarra V, Novara G, Secco S, Macchi V, Porzionato A et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. European Urology 2009; 56 (5): 786-793.
19. Simmons MN, Ching CB, Samplaski MK, Park CH, Gill IS. Kidney tumor location measurement using the C index method. Journal of Urology 2010; 183 (5): 1708-1713.
20. Schmit GD, Thompson RH, Kurup AN, Weisbrod AJ, Boorjian SA et al. Usefulness of RENAL nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors. Journal of Urology 2013; 189 (1): 30-35.
21. McClure TD, Chow DS, Tan N, Sayre JA, Pantuck AJ et al. Intermediate outcomes and predictors of efficacy in the radiofrequency ablation of 100 pathologically proven renal cell carcinomas. Journal of Vascular and Interventional Radiology 2014; 25 (11): 1682-1688.
22. Camacho JC, Kokabi N, Xing M, Master VA, Pattaras JG et al. RENAL (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines) nephrometry score predicts early tumor recurrence and complications after percutaneous ablative therapies for renal cell carcinoma: a 5-year experience. Journal of Vascular and Interventional Radiology 2015; 26 (5): 686-693.
23. Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK et al. Guideline for management of the clinical T1 renal mass. Journal of Urology 2009; 182 (4): 1271-1279.
24. Sung GT, Gill IS, Hsu TH, Meraney AM, Skacel M et al. Effect of intentional cryoinjury to the renal collecting system. Journal of Urology 2003; 170 (2): 619-622.
25. Zagoria RJ, Hawkins AD, Clark PE, Hall MC, Matlaga BR et al. Percutaneous CT-guided radiofrequency ablation of renal neoplasms: factors influencing success. American Journal of Roentgenology 2004; 183 (1): 201-207.
26. Maxwell AW, Baird GL, Iannuccilli JD, Mayo-Smith WW, Dupuy DE. Renal cell carcinoma: comparison of RENAL nephrometry and PADUA scores with maximum tumor diameter for prediction of local recurrence after thermal ablation. Radiology 2016; 283 (2): 590-597.
27. Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: Part 1, indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. American Journal of Roentgenology 2005; 185 (1): 64-71.
28. Gahan JC, Richter MD, Seideman CA, Trimmer C, Chan D et al. The performance of a modified RENAL nephrometry score in predicting renal mass radiofrequency ablation success. Urology 2015; 85 (1): 125-129