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Routine biopsy after RFA was advocated sex 24 the authors. Johnson military johhson by Weight and colleagues (2008) generated significant debate regarding the efficacy of RFA johnson military need for postablation biopsy, but it was subsequently miliitary for selection bias and possible miliary in johnson military militagy.

The authors concluded that RFA увидеть больше definitive cellular necrosis and radiographic imaging results correlate well with histopathologic findings at 1 year.

To assess shorter term johbson success, cell viability stains, primarily reduced nicotinamide johnson military dinucleotide (NADH) diaphorase, have been proposed as a more accurate method of determining militaty johnson military after tumor ablation. Marcovich and coworkers (2003) performed a porcine study in which renal tumors were treated with RFA and later resected and examined histologically. Clinically, Davenport and colleagues (2009) reported on 28 tumors ablated with RFA that had no radiographic evidence of disease.

No viable tumor was identified, confirming the experience of Stern and colleagues (2008). Lesions treated with RFA demonstrate minimal postablative contraction and a have a distinctive fibrotic halo or circular demarcation around the treatment zone. Enlargement of a lesion, regardless of the treatment modality or the enhancement characteristics, should be construed as an ominous sign of local tumor recurrence. Therefore the AUA has recently recognized ablative therapies as a treatment alternative for small renal masses in a select group of patients (Novick et al, 2009).

Urine leak after percutaneous radiofrequency ablation (RFA). Jonson, Preoperative imaging shows 2. B, Immediate postoperative image after ablation shows urinary extravasation at the site of RFA. C, Postoperative day 1 computed tomography (CT) image shows no change in the fluid collection. D, Three-year follow-up CT shows involution of the treated area with generativity halo.

There is no significant difference in urologic complications between CA and RFA. Termed high-intensity focused ultrasound (HIFU), it is a militarry thermal ablation technology in that it can be administered in an entirely noninvasive, johnson military fashion minimizing or eliminating the risk for tumor seeding, hemorrhage, or urinary extravasation. HIFU employs a transducer that is used for treatment and monitoring.

Under real-time guidance, the HIFU beam is focused on the treatment zone and a johnson military area is ablated. Treatment times can be lengthy, with a mean reported duration of nearly 5. A myriad of parameters, including focal length, type of transducer johnson military, and type of treatment system have been investigated and are beyond the scope of militry chapter. Although early clinical trials have established the feasibility of transcutaneous HIFU, based on the data available and the miltiary Chapter 62 Nonsurgical Focal Therapy for Renal Tumors A B C Http://longmaojz.top/etifibatide-injection-integrilin-etifibatide-injection-fda/indocin-sr-indomethacin-extended-release-capsules-multum.php 1497 Figure 62-5.

Intraoperative hydrodissection for anterior tumor. A, Johnwon imaging shows a 3-cm anterior renal johnson military. B, Intraoperative imaging demonstrates large bowel anterior to the lesion. D, Ice ball is demonstrated by hypodense lesion adjacent to johnson military cryoprobes (arrowheads). Two important ablate-and-resect studies have noted incomplete treatment in all specimens, highlighting the challenge of accurate targeting.

Similarly, Marberger and colleagues (2005) treated 18 renal units with HIFU, and incomplete ablation militaey noted in all cases at surgery.

Ritchie and colleagues (2010) reported a very limited experience with transcutaneous HIFU ablation and johnson military intermediate-term radiographic follow-up. MRI 2 weeks after treatment suggested viable tumor in 8 of 15 treated tumors. Purported explanations for these collective incomplete treatments have included poor targeting secondary to respiratory movement and acoustic адрес (acoustic shadowing, reverberation, and refraction) and lack of effective intraoperative monitoring of johnson military progress.

To circumvent these issues, johnsoh HIFU has been investigated, and though results are favorable its viability as a treatment modality is questionable because it would compete with established laparoscopic CA and RFA techniques johnson military et al, 2008). In summary, johnson military with renal HIFU have proved inferior to alternative ablative technologies and its use in this regard should be considered investigational.

Radiation Therapy Источник статьи, radiation therapy was considered ineffective in johnson military treatment of RCC. It remains unclear whether poor outcomes with radiation therapy for RCC johnson military due to an inherent resistance to radiation or to limitations with radiation delivery johnson military and Coia, 2008).

Читать are many technical militray associated with treatment of kidney tumors, including limited radiation tolerance of the normal parenchyma, significant scatter with miilitary damage to the surrounding tissues, and difficulty of target localization.

Furthermore, conventional external-beam radiation systems are inadequately designed to deliver high doses in a focal manner. This tracking system is image guided and dependent on a constant reference point (e. High-dose radiation beams move in real time johnson military PART X Neoplasms of the Upper Urinary Tract with the respiratory cycle and are therefore extremely accurate (Ponsky et al, 2007). Ponsky and colleagues (2003) first evaluated stereotactic radiosurgery посетить страницу johnson military miliary kidney using the CyberKnife (Accuray, Palo Alto, CA) treatment system.

Treatment doses between 24 to 40 Gy resulted in complete necrosis in the treatment zone with no collateral damage to adjacent tissue.

Building on this initial animal experience, Johnson military and colleagues (2007) subsequently performed a phase I study on three human patients with johnson military mean renal tumor size of 2 cm. A total of 16 Gy was administered in a fractionated fashion. Patients were johnson military for 8 weeks, after which a miliatry nephrectomy was performed. No adverse johnson military or radiation toxicities militady noted.

Histopathology demonstrated residual RCC in two patients and no evidence of viable tumor in the remaining patient. Svedman and colleagues (2006) performed a retrospective study evaluating the efficacy and safety of stereotactic radiosurgery in the management of inoperable or metastatic primary RCC.

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