Combined transarterial embolization and percutaneous image-guided ablation for the treatment of T1B and central renal tumors in patients with high surgical risk

Objectives: The objectives of the study were to assess the technical success, efficacy, and complications of the combination of transarterial embolization (TAE) followed by percutaneous ablation in treating stage cT1b and central renal tumors. Material and Methods: An institutional registry was reviewed for patients who underwent TAE followed by percutaneous computed tomography (CT)-guided renal ablation from 2007 to 2018. Twenty-eight consecutive patients (median age 69 years; range 45–89 years) with tumor size ranging from 25 to 58 mm (average 45 mm), including 24 patients with T1b tumors and four with central T1a tumors, were identified. Nineteen patients had TAE followed by cryoablation (CA), and nine patients had TAE followed by radiofrequency ablation (RFA). Technical success, local tumor control, and post-procedure complications were retrospectively reviewed. Results: All procedures were technically successful. Local tumor control was achieved in 26 of 28 patients (92.9%) at a median follow-up of 26 months. Local tumor recurrence was found in two of 28 patients, with a median time to local recurrence of 15 months. The recurrences occurred in one patient who had TAE plus CA and in one patient who had TAE plus RFA. Self-limited hematoma and hematuria were minor complications observed in 3 patients (10.7%). Only one patient had a major complication. This patient developed ureteral obstruction and perirenal abscess requiring ureteral stent and percutaneous drainage without long-term sequela. Conclusion: In this cohort of patients, a combination of TAE and percutaneous CT-guided ablation was an effective, well-tolerated, and safe treatment for patients with T1b and central renal tumors.