腎細胞癌に対する経皮的ラジオ波焼灼術を用いた腎温存療法 - 4症例7腫瘍の治療経験 -

Abstract

腎細胞癌4症例(平均59歳, 男女各2例)の7腫瘍に対してCTガイド下に経皮的ラジオ波焼灼術(RFA)を行った.全例, imperative caseであった.2例はvon-Hippel Lindau(VHL)病に伴う遺伝性多発性腎細胞癌で, 他の2例は両側同時発生例, 原因不明の胸水に伴う呼吸機能障害例であった.腫瘍の平均径は4.5cmで, 最高出力は平均94W, 最高温度は平均82℃, 焼灼時間は平均11分, 手術時間は平均91分であった.平均観察期間6.3ヵ月における外方突出型3症例の局所制御率は42.9%(3/7腫瘍)であった.VHL病を持った2例には, 肺転移, 膵転移, 腫瘍の成長がみられた.合併症に重篤なものはなく, 疼痛, 嘔気, 腎被膜下血腫, 微熱などであった.腎細胞癌に対するRFAは, 症例によっては低侵襲, かつ良好な局所制御が可能であるが, 適応には慎重な検討が必要だと考えられた

We report 7 renal cell carcinomas in 4 patients treated by percutaneous image-guided radiofrequency ablation (RFA). The mean age of the patients was 59 years (male: 2, female: 2). All 4 were imperative cases. Two patients (5 tumor) had hereditary multiple renal cell carcinomas with von Hippel-Lindau (VHL) disease. The other two patients had sporadic renal cell carcinomas. RFA was performed guided by computed tomography under conscious sedation with local anesthetics. The mean size of the treated tumors was 4.5 (1.8-8.1) cm. Impedance-regulated RF energy from a generator at 94 (45-130) watts was applied at 11 (8-14) min intervals. The average procedure time was 91 (45-165) minutes. The maximum tissue temperature reached 82 (56-91) degrees C immediately after ablation. Three of the 7 lesions (42.9 %) were locally well controlled during the mean follow-up period of 6.3 (4-9) months. The two patients with VHL disease developed visceral metastasis after There were no major complications. Minor complications encountered included flank pain, nausea, perinephritic hematoma and fever. Although percutaneous image-guided RFA showed limited success in large or central renal tumors, the therapy against small exophytic renal tumors would be well tolerable and successful.