Letter to the Editor – Brief papers about basic research or clinical experiences
Radiofrequency ablation as an alternative therapy for renal neoplasms in graft recipients. A preliminary study
La ablación por radiofrecuencia como alternativa terapéutica al tratamiento de las neoplasias renales en pacientes trasplantados. Un estudio preliminar
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A preliminary study" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "516" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carmen Rosa Hernández-Socorro, Fernando Henríquez-Palop, Leopoldo Santana-Toledo, Roberto Gallego-Samper, Jose Carlos Rodríguez-Pérez" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Carmen Rosa" "apellidos" => "Hernández-Socorro" "email" => array:2 [ 0 => "chersoc@gmail.com" 1 => "jrodperd@gobiernodecanarias.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Fernando" "apellidos" => "Henríquez-Palop" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Leopoldo" "apellidos" => "Santana-Toledo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Roberto" "apellidos" => "Gallego-Samper" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Jose Carlos" "apellidos" => "Rodríguez-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Ecografía, Radiología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La ablación por radiofrecuencia como alternativa terapéutica al tratamiento de las neoplasias renales en pacientes trasplantados. Un estudio preliminar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 900 "Ancho" => 1000 "Tamanyo" => 84200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasound with contrast of transplanted kidney after RFA treatment of renal tumour. It shows absence of enhancement, indicating tumour destruction.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">For decades, radical nephrectomy (RN) has been considered the gold standard treatment for localised renal cell carcinoma. However, it has become evident that after RN, a significant number of solitary kidney patients have an increased risk of developing chronic kidney disease (CKD).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> Therefore, in situ ablation methods have been developed; radiofrequency ablation (RFA) is being the most used. In transplant patients, renal tumours represent 3% of all neoplasms.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present our preliminary experience of RFA treatment for small renal tumours (SRT) in transplant patients. The results revealed excellent tumour control without deterioration in renal function.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Out of 315 transplant patients being followed-up in our centre, with a median of 16.35 post-transplant years, 5 had renal tumours: 4 in native kidneys and 1 in a transplanted kidney. Only 1 patient had a radical nephrectomy of a native kidney, and the others were treated with RFA between September 2013 and December 2014. All lesions were detected by ultrasound, and were confirmed by with contrast-enhanced ultrasound. Staging was determined by computed tomography (CT) or magnetic resonance imaging (MRI). The demographic characteristics of the patients and the observed lesions are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The comorbidities of the 4 solitary kidney patients with CKD were: 3 had dyslipidaemia, 2 had uncontrolled arterial hypertension and 1 had severe cardiovascular disease.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Percutaneous RFA was performed in the surgical room under general anaesthesia with ultrasound guidance, after ultrasound-guided fine needle aspiration biopsy of the tumour. Treatment was planned so as to obtain a healthy tissue ablation margin of 0.5–1<span class="elsevierStyleHsp" style=""></span>cm width around the tumour to avoid recurrence, and contrast-enhanced ultrasound study was performed after completing treatment to assess the response, and if the case of incomplete tumour destruction, ablation was repeated.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients remained in the hospital for 24<span class="elsevierStyleHsp" style=""></span>h, and a follow-up abdominal ultrasound was performed before discharge, to confirm the absence of complications. Follow-up was at 1 month, then every 3 months during the first year, and every 6 months during the subsequent 2 years, which was when local recurrence was most common (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Follow-up included contrast-enhanced ultrasound, and CT or MRI if required. Success was defined as the absence of contrast in the arterial phase, indicating complete destruction of the tumour.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The mean duration of the procedure was 60<span class="elsevierStyleHsp" style=""></span>min (range, 45–70<span class="elsevierStyleHsp" style=""></span>min). The success rate was 100%. The median follow-up time was 4.75 months. There were no complications or incomplete ablations. Regarding microscopic examination, the patient with the transplanted kidney tumour had type I papillary carcinoma. The other patients, with native kidney tumours, had renal cell carcinomas. Only one patient did not have a biopsy because radiologically the tumour behaved like a renal cell carcinoma, and the patient elected to be treated percutaneously. In the follow-ups completed to date, no patients have shown local recurrence or distal metastases. None of the patients had significant changes in renal function pre- and post-RFA. In our series, the mean creatinine levels of the 4 patients before RFA and after a mean of 3.2 months of RFA were 1.51 and 1.57<span class="elsevierStyleHsp" style=""></span>mg/dL, respectively.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis of renal tumour is increasing in older patients with comorbidities and renal failure. Treatment requires techniques that preserve renal parenchyma. Several authors have described favourable experiences of RFA in SRT, in terms of both local tumour control and preservation of renal function.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Three of our tumours measured less than 3<span class="elsevierStyleHsp" style=""></span>cm; one tumour measured 3.1<span class="elsevierStyleHsp" style=""></span>cm, which received 2 sessions of RFA in the same surgical procedure, for complete tumour ablation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Tumours adjacent to the great vessels tend undergoes a “heat sink” effect, and conversely the ablative effect on exophytic tumours is higher, due to the insulating effect of surrounding perirenal fat that allows higher temperatures.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> In our series, 2 tumours were located in the superior pole and 2 in the middle third.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The success rate of RFA is 90–100%<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>; our patients had success in all treated tumours without local recurrence.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,8</span></a></p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">RFA offers the advantage of being able to maintain patients’ renal function sufficiently to not require a dialysis programme, thus avoiding transplantectomy. Transplant patients with native kidney tumours do not have to undergo periodic radiological follow-up to assess tumour growth, and are able to continue their previously established immunosuppressive treatment.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Conclusions" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hernández-Socorro CR, Henríquez-Palop F, Santana-Toledo L, Gallego-Samper R, Rodríguez-Pérez JC. La ablación por radiofrecuencia como alternativa terapéutica al tratamiento de las neoplasias renales en pacientes trasplantados. Un estudio preliminar. Nefrologia. 2015;35:514–516.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 900 "Ancho" => 1000 "Tamanyo" => 84200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasound with contrast of transplanted kidney after RFA treatment of renal tumour. It shows absence of enhancement, indicating tumour destruction.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "fx1.jpeg" "imagenAlto" => 4184 "imagenAncho" => 2752 "imagenTamanyo" => 561658 ] ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristic of patients and type of lesions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Renal function outcomes in patients treated for renal masses smaller than 4<span class="elsevierStyleHsp" style=""></span>cm by ablative and extirpative techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 11 | 14 |
| 2024 October | 35 | 38 | 73 |
| 2024 September | 45 | 23 | 68 |
| 2024 August | 57 | 67 | 124 |
| 2024 July | 36 | 21 | 57 |
| 2024 June | 55 | 31 | 86 |
| 2024 May | 49 | 34 | 83 |
| 2024 April | 47 | 22 | 69 |
| 2024 March | 45 | 31 | 76 |
| 2024 February | 37 | 40 | 77 |
| 2024 January | 31 | 22 | 53 |
| 2023 December | 45 | 23 | 68 |
| 2023 November | 38 | 22 | 60 |
| 2023 October | 79 | 27 | 106 |
| 2023 September | 55 | 18 | 73 |
| 2023 August | 43 | 30 | 73 |
| 2023 July | 65 | 31 | 96 |
| 2023 June | 76 | 23 | 99 |
| 2023 May | 72 | 33 | 105 |
| 2023 April | 58 | 17 | 75 |
| 2023 March | 73 | 16 | 89 |
| 2023 February | 58 | 18 | 76 |
| 2023 January | 30 | 33 | 63 |
| 2022 December | 38 | 24 | 62 |
| 2022 November | 48 | 24 | 72 |
| 2022 October | 60 | 33 | 93 |
| 2022 September | 36 | 25 | 61 |
| 2022 August | 43 | 37 | 80 |
| 2022 July | 37 | 43 | 80 |
| 2022 June | 39 | 35 | 74 |
| 2022 May | 22 | 25 | 47 |
| 2022 April | 30 | 63 | 93 |
| 2022 March | 48 | 44 | 92 |
| 2022 February | 30 | 37 | 67 |
| 2022 January | 24 | 25 | 49 |
| 2021 December | 33 | 37 | 70 |
| 2021 November | 33 | 35 | 68 |
| 2021 October | 37 | 38 | 75 |
| 2021 September | 53 | 33 | 86 |
| 2021 August | 48 | 38 | 86 |
| 2021 July | 45 | 28 | 73 |
| 2021 June | 45 | 19 | 64 |
| 2021 May | 42 | 36 | 78 |
| 2021 April | 128 | 56 | 184 |
| 2021 March | 50 | 20 | 70 |
| 2021 February | 51 | 22 | 73 |
| 2021 January | 53 | 22 | 75 |
| 2020 December | 32 | 15 | 47 |
| 2020 November | 25 | 6 | 31 |
| 2020 October | 26 | 13 | 39 |
| 2020 September | 25 | 9 | 34 |
| 2020 August | 41 | 8 | 49 |
| 2020 July | 28 | 14 | 42 |
| 2020 June | 33 | 10 | 43 |
| 2020 May | 29 | 13 | 42 |
| 2020 April | 35 | 17 | 52 |
| 2020 March | 39 | 13 | 52 |
| 2020 February | 31 | 22 | 53 |
| 2020 January | 27 | 20 | 47 |
| 2019 December | 46 | 29 | 75 |
| 2019 November | 25 | 22 | 47 |
| 2019 October | 22 | 8 | 30 |
| 2019 September | 24 | 11 | 35 |
| 2019 August | 27 | 22 | 49 |
| 2019 July | 19 | 24 | 43 |
| 2019 June | 22 | 18 | 40 |
| 2019 May | 27 | 29 | 56 |
| 2019 April | 36 | 34 | 70 |
| 2019 March | 25 | 16 | 41 |
| 2019 February | 20 | 19 | 39 |
| 2019 January | 42 | 14 | 56 |
| 2018 December | 114 | 43 | 157 |
| 2018 November | 239 | 19 | 258 |
| 2018 October | 172 | 17 | 189 |
| 2018 September | 108 | 16 | 124 |
| 2018 August | 126 | 21 | 147 |
| 2018 July | 84 | 17 | 101 |
| 2018 June | 68 | 16 | 84 |
| 2018 May | 104 | 16 | 120 |
| 2018 April | 67 | 10 | 77 |
| 2018 March | 46 | 20 | 66 |
| 2018 February | 61 | 6 | 67 |
| 2018 January | 40 | 8 | 48 |
| 2017 December | 55 | 8 | 63 |
| 2017 November | 48 | 12 | 60 |
| 2017 October | 24 | 7 | 31 |
| 2017 September | 28 | 9 | 37 |
| 2017 August | 24 | 7 | 31 |
| 2017 July | 34 | 7 | 41 |
| 2017 June | 46 | 6 | 52 |
| 2017 May | 46 | 5 | 51 |
| 2017 April | 29 | 7 | 36 |
| 2017 March | 18 | 1 | 19 |
| 2017 February | 26 | 7 | 33 |
| 2017 January | 16 | 4 | 20 |
| 2016 December | 47 | 12 | 59 |
| 2016 November | 51 | 14 | 65 |
| 2016 October | 77 | 14 | 91 |
| 2016 September | 91 | 5 | 96 |
| 2016 August | 114 | 3 | 117 |
| 2016 July | 161 | 5 | 166 |
| 2016 June | 99 | 0 | 99 |
| 2016 May | 117 | 0 | 117 |
| 2016 April | 91 | 0 | 91 |
| 2016 March | 68 | 0 | 68 |
| 2016 February | 89 | 0 | 89 |
| 2016 January | 85 | 0 | 85 |
| 2015 December | 96 | 0 | 96 |
| 2015 November | 76 | 0 | 76 |
| 2015 October | 63 | 0 | 63 |
| 2015 September | 41 | 0 | 41 |
Show all
