Slotboom, T. (Thialda) (2014) The diagnostic value of the RENAL-score in predicting the technical effectiveness and complications of thermal ablation, a retrospective analysis of 161 renal tumors. thesis, Medicine.
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Abstract
Introduction The incidence of renal tumors increases, partly due to western lifestyle habits (cigarette smoking and obesity) partly due to an increase of cross-sectional imaging. For these early and therefore often low staged tumors, a minimal invasive image guided treatment tool appeared: thermal or energy-based ablation. An image guided procedure that eliminates the tumor cells from inside out seems to be a more suitable and curable treatment solution for the more frail patients with a renal tumor. We describe the pre- and post-procedural features of patients ablated for a renal tumor. We applied the RENAL-score (originally a surgical anatomical renal tumor classification system: radius; exophytic/endophytic; nearness to collecting system or sinus; anterior/posterior; location relative to polar lines) to renal tumors treated with thermal ablation (radiofrequency- (RFA) and microwave ablation (MWA)) to determine whether this score can be used as a diagnostic value for predicting technical effectiveness (outcome) and complications. Materials & Methods For this study patients ablated for a renal tumor in the Netherlands Cancer Institute- Antoni van Leeuwenhoek hospital (NKI-AVL) in the period from 2006 until 2013 were retrospectively analyzed. All suitable renal tumors were scored on a pre-ablation CT- scan according to the RENAL-score. The association between RENAL-score (including individual tumor components) and technical effectiveness (technical outcome) of ablative treatment (one month post ablation) and complications was assessed. Results A total of 146 patients with 161 renal tumor ablations were included. Median age was 66 years (range 23-88), median patients performance score (according to the ASA Physical Status Classification System 1-4) of 2 with 61 patients with renal comorbidity (42%). After the first month post-ablation, 18 (11%) ablation zones showed residual tumor. With a median follow-up of 13.5 months (range 6-85), 143 (89%) renal ablation zones turned out to be tumor free. For these outcomes, no significant association was found for the different thermal ablation techniques: RFA and MWA. Of 161 renal tumors, 138 were scored according to the RENAL-score. No significant association was found for the RENAL-score and complications. However, significant association was found for the following individual RENAL-score elements: radius in cm, radius score, nearness to the collecting system in mm and nearness-score. Tumor radius in cm and tumor nearness in mm were correlated. Conclusion RENAL-score is not predictive for technical effectiveness and complications of thermal ablations of renal tumors. However RENAL-score items, tumor radius score and tumor nearness score, were significantly associated with technical effectiveness.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hirdes, Dr. W.H. |
| Supervisor name: | Horenblas, Prof. S. and Prevoo, Drs. W. and Bex, Dr. A. and Antoni van Leeuwenhoek Instituut |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:00 |
| Last Modified: | 25 Jun 2020 11:00 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2046 |
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