ABSTRACT
The past few decades have seen the role of interventional radiology in the management of renal cancer continue to evolve. Initially it was restricted primarily to the diagnosis and characterization of renal tumours by arteriography with reports in the literature as early as 1954.1 In 1969 transcatheter embolization of renal neoplasms was first suggested.2 With the clinical application of ultrasound in the 1970s and computed tomography (CT) in the 1980s came the ability to diagnose, further characterize, and percutaneously biopsy renal tumours using image guidance. These two modalities, together with magnetic resonance imaging (MRI), continued to develop rapidly and today their use has become widespread. The increased use of imaging has resulted in increasing numbers of small, ‘subclinical’ renal cell carcinomas (RCCs) being detected incidentally at imaging for alternative symptomatology. Diminishing tumour size at the time of detection along with a realization that resection of smaller volume disease leads to significantly improved 5-year survival3-5 has led to a gradual clinical stage migration. This has recently been acknowledged by the UICC (Union Internationale Contre le Cancer, TNM atlas, fourth edition 1997) whereby T1 disease now includes tumours up to 7 cm in diameter, and increasingly tumours smaller than 4 cm are staged as T1a, further reflecting improved outcome. These tumours, by virtue of their size and the fact that they often occur in elderly patients with significant comorbidities, lend themselves to minimally invasive
treatment techniques such as image-guided ablation (IGA). In more advanced disease interventional radiology can offer techniques such as embolization, either as adjuncts to surgery, or in palliation and the future may well see targeted therapy delivered directly to renal tumours enabling higher local concentrations of treatment agent with decreased systemic side effects. Technological advances in fluoroscopy have greatly improved image quality and developments in catheter and guidewire design have allowed safer and deeper vessel cannulation. IGA has recently come of age and radiofrequency ablation (RFA) is now an increasingly commonplace image-guided interventional tool.
