Transarterial embolization (TAE) as add-on to percutaneous radiofrequency ablation (RFA) for the treatment of renal tumors: Review of the literature, overview of state-of-the-art embolization materials and further perspective of advanced image-guided tumor ablation

Die Behandlungsmodalitat des primaren Aderhautmelanoms hat bisher keinen direkten Einfluss auf die Uberlebensprognose des Patienten. Durch die Identifizierung signifikanter Prognoseparameter bezuglich des Risikos, Metastasen eines Aderhautmelanoms zu entwickeln, werden neue Behandlungsstrategien erarbeitet mit dem Ziel, die Entstehung von Metastasen zu verhindern. Dabei spielt die Immuntherapie durch die Entwicklung geeigneter Impfstoffe gegen melanomspezifische Tumorantigene eine zunehmende Rolle. Beim bereits metastasierten Aderhautmelanom betrug bis dato die mittlere Uberlebenszeit ca. 5 Monate. In der letzten Zeit konnte durch die intrahepatische Infusion von Fotemustin die mittlere Uberlebenszeit auf 14 Monate bei selektierten Patienten verlangert werden. Neue Therapieprotokolle werden aufgrund von Chemosensitivitatsuntersuchungen aktuell erarbeitet. Des Weiteren werden immuntherapeutische Modalitaten auch in der Behandlung von Metastasen von Aderhautmelanomen untersucht.

AderhautmelanomAdjuvante Therapie bei Hochrisikopatienten und neue Therapieansätze im metastasierten Stadium

For imaging of renal pathology a broad spectrum of radiologic diagnostic procedures are available which are, sometimes and particularly more recently, competing among each other in their diagnostic yield and relevance. For tumorous lesions ultrasound, computed tomography and magnetic resonance imaging are performed predominantly. Angiography is no longer required with the exception of highly selected cases and in some specific preoperative workup requirements. Until recently, catheter based digital subtraction angiography has been considered as gold standard. However, non-invasive techniques such as CT-angiography and MR-angiography are evolving parallel to their quantum leap of resolutions and readiness to use. Nevertheless, well accepted criteria for quality assessement of these new modalities are still lacking. More comparison studies are urgently warranted. Despite the availability of ultrashort pulse sequences applying the T1 relaxation reduction effect of gadolinium enhanced MR techniques overestimation of renal artery stenosis still poses a substantial problem. Renal intervention implies a variety of procedures such as plain angioplasty, stent placement, embolization of traumatic and both benign and malignant tumors. These methods have emerged over the last two decades from a more experimental nature to a fully accepted treatment option. When renal artery angioplasty is embedded in an aggressive approach including stenting as an adjunct for more complex cases, renal ostial lesions and a well organized follow-up regimen its therapeutic potential for treatment of renal insufficiency, malignant hypertension, for organ preservation bears a very high potential. Provided adequat periinterventional drug regimen restenosis rates may be as low as 10%. In highly selected cases capillary embolization might be used as an alternative to nephrectomy with a similar clinical outcome. Particularly the development of superselective small caliber embolization catheters parallel to further refinement of embolization material has aided to use superselective occlusion techniques in benign vascular lesions and renal trauma.

Angiography and interventional radiology of the kidney

Background and Purpose: Arterial embolization can be an alternative treatment for kidney malignancy. We investigated the efficacy of renal embolization with a combination of an occlusive agent (Eth...

Renal chemoembolization with mitomycin c/Ethibloc: pharmacokinetics and efficacy in an animal model.

Introduction: Preoperative kidney tumor embolization is standard procedure for therapy in advanced kidney cancer. Preoperative embolization has a goal to reduce intraoperative bleeding and also to shorten the time of surgery. Materials and methods: We retrospectively observed 50 patients between 2000-2011, in which the preoperative embolization was performed. Mean age of patients was 64 years. All patients with preoperative embolization were compared with the group of 51 patients from Urology Sarajevo, who underwent nephrectomy without preoperative embolization. Results: Symptoms that are dominating among patients were haematuria and pain. Analysis of mean size of tumors based on CT evaluation showed statistically significance in between the biggest size of tumors in group from Hamburg( 9.11±3cm) and the smallest size of tumors in Sarajevo group (4.94±1.6cm) p=0.0001. Reason for this is difference in selection of patients for treatment in Hamburg from Sarajevo. Conclusion: Kidney as functional finishing organ is extremely suitable for transcatheter therapeutic procedures. The gold standard in the treatment of advanced and metastatic tumor is the nephrectomy. As preparation for nephrectomy in metastatic cancer total capillary embolization is performed. After embolization, surgery is shorter, procedure can be done 24-48 hours after embolization or delayed nephrectomy done 2-3 weeks after the intervention.

/pdf/preoperative-kidney-tumor-embolization-as-procedure-for-9e3khxhmup.pdf

Preoperative Kidney Tumor Embolization as Procedure for Therapy of Advanced Kidney Cancer

PURPOSE: We pointed out the value of catheter embolisation of kidney tumours. METHODS AND PATIENTS: We treated 42 patients with kidney tumours. For peripheral embolisation we placed Histoacryl or Ethibloc into the kidney artery via a transfemoral catheter. 33 patients had haematuria. 8 patients were lost for follow up. 26 patients were treated by embolisation alone and 8 patients were treated before nephrectomy. RESULTS: Haematuria was stopped in 98% and never reoccurred. The intraoperative blood-loss was 600 ml on average. 55% of patients treated by embolisation alone died within the first year. 51% of patients suffered from a slight postinfarction syndrome. One patient died of sepsis and one had pulmonary insufficiency due to AV shunt and pulmonary embolism. CONCLUSIONS: Peripheral embolisation of kidney tumours can be used successfully and is minimal invasive, in case of haematuria and pain. The perioperative risk is reduced due to limited blood loss.

Results of catheter embolization of renal cell carcinoma

[Side effects and complications of intra-arterial tumor therapy--experiences with 577 interventions].

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Results of catheter embolization of renal cell carcinoma

[Side effects and complications of intra-arterial tumor therapy--experiences with 577 interventions].