Over the last few years, percutaneous radiofrequency (RF) ablation has been successfully established as a viable treatment modality for small peripheral renal cell carcinoma (RCC). This technique is limited by central tumor location and tumor size. We report the interventional management of a 5.3 cm mixed RCC with central and exophytic parts by combining the RF ablation with embolization, tagging, and retrograde, as well as anterograde cooling. The potential pitfalls of complex hybrid interventions for treating RCC are discussed.
Aged ; Biopsy ; Carcinoma, Renal Cell/pathology/radiography/*surgery ; *Catheter Ablation ; Female ; Humans ; Incidental Findings ; Iodized Oil/therapeutic use ; Kidney Neoplasms/pathology/radiography/*surgery ; Tomography, X-Ray Computed ; Ultrasonography, Interventional

OBJECTIVE: To compare short-, mid-, and long-term follow-up ablation zone volume alterations as well as imaging features on contrast-enhanced computed tomography (CT) after irreversible electroporation (IRE) of primary and secondary liver tumors with findings subsequent to radiofrequency ablation (RFA). MATERIALS AND METHODS: Volume assessment of 39 ablation zones (19 RFA, 20 IRE) after intervention was performed at four time intervals (day 0 [t1; n = 39], day 1–7 [t2; n = 25], day 8–55 [t3; n = 28], after day 55 [t4; n = 23]) on dual-phase CT. Analysis of peripheral rim enhancement was conducted. Lesion's volume decrease relative to the volume at t1 was calculated and statistically analyzed with respect to patient's sex, age, ablation modality (IRE/RFA), and history of platinum-based chemotherapy (PCT). RESULTS: No influence of patient's sex or age on ablation volume was detected. The decrease in ablation zones' volume was significantly larger (p < 0.05 for all time intervals) after IRE (arterial phase, 7.5%; venous phase, 9.7% of initial volume) compared to RFA (arterial phase, 39.6%; venous phase, 45.3% of initial volume). After RFA, significantly smaller decreases in the ablation volumes, in general, were detected in patients treated with PCT in their history (p = 0.004), which was not detected after IRE (p = 0.288). In the arterial phase, peripheral rim enhancement was frequently detected after both IRE and RFA. In the venous phase, rim-enhancement was depicted significantly more often following IRE at t1 and t2 (pt1 = 0.003, pt2 < 0.001). CONCLUSION: As per our analysis, ablation zone volume decreased significantly in a more rapid and more profound manner after IRE. Lesion's remodeling after RFA but not IRE seems to be influenced by PCT, possibly due to the type of cell death induced by the different ablation modalities.
Catheter Ablation* ; Cell Death ; Drug Therapy ; Electroporation* ; Follow-Up Studies ; Humans ; Liver ; Tumor Burden