UroToday - A group from the Medical University of Vienna, Austria presented their data on high-intensity focused ultrasound (HIFU) for the treatment of small renal tumors. They showed data that HIFU works by a targeted homogeneous ablation of renal tissue. The objective of their clinical phase I study was to evaluate the feasibility of laparoscopic HIFU ablation of small renal masses with respect to homogeneity and extent of necrosis obtained with this technique.

Between November 2006 and August 2007, 16 kidneys with solitary renal lesions were treated with a newly developed 4.0MHz laparoscopic HIFU probe. They researchers targeted renal masses under ultrasonic control with a focal ablation zone of 3.5cm. In 3 patients a defined marker lesion was placed prior to laparoscopic radical nephrectomy. In 13 patients with a mean mass size of 2.5 cm the tumor was completely ablated by curative intent, followed by laparoscopic partial nephrectomy in 12. One patient only had post HIFU biopsies and was followed-up using radiographs. Specimens were analyzed by whole mount histology.

The mean HIFU ablation time was 22 minutes, with power levels ranging between 30-38W, with a mean targeted volume of 10.2 (9-23) cm??. By histological evaluation, marker lesions showed homogeneous thermal damage that was consistent with irreversible tissue damage. Of the 15 tumors removed after HIFU 10 showed complete, homogeneous ablation of the entire tumor. Two had a 1-3 mm rim of viable tissue immediately adjacent to where the HIFU probe was approximated to the tumor. In one patient with borderline mass size, a rim of tissue 1-2mm distal to the focal ablation zone could not be ablated. One tumor showed a central area of vital tissue made up of about 20% of its volume. There were no HIFU related complications.

Presented by: H.C. Klingler, MD, et al at the European Association of Urology - 23rd Annual EAU Congress - March 26 - 29, 2008 - Milan, Italy

Reported by UroToday Contributing Editor Christopher P. Evans, MD, FACS

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