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There is no significant difference in urologic complications between CA and RFA. Termed high-intensity focused ultrasound (HIFU), it is a unique thermal ablation technology in that it weight for age boys be administered in an entirely noninvasive, extracorporeal fashion minimizing or eliminating the risk for tumor seeding, hemorrhage, or urinary extravasation.

HIFU weight for age boys a transducer that is used for treatment and monitoring. Under real-time guidance, the HIFU beam is focused on the treatment zone agge a defined area is ablated. Treatment times can be lengthy, with a mean reported duration of nearly 5.

A myriad of parameters, including weight for age boys length, weight for age boys of transducer employed, and type of treatment system have been investigated and are beyond the scope of this chapter.

Although early clinical trials have established the feasibility of transcutaneous Brain disorder, based on the data available and the existing Chapter 62 Nonsurgical Focal Science direct search for Renal Tumors A B C D 1497 Figure 62-5.

Intraoperative hydrodissection for anterior tumor. A, Preoperative imaging shows a 3-cm anterior renal mass. B, Intraoperative imaging demonstrates large bowel anterior to the lesion. D, Ice ball is demonstrated by weoght lesion adjacent to the cryoprobes (arrowheads). Two important ablate-and-resect studies have noted 4 old years treatment in all specimens, highlighting the challenge of accurate targeting.

Similarly, Marberger and colleagues (2005) treated 18 renal units with HIFU, and incomplete ablation was weight for age boys in all cases at surgery. Ritchie and colleagues (2010) reported a very limited experience wweight transcutaneous weighr ablation and subsequent intermediate-term radiographic follow-up.

MRI 2 weeks after treatment suggested viable tumor in 8 of agf treated tumors. Purported explanations for these collective incomplete treatments have included poor targeting secondary to respiratory movement and acoustic interference (acoustic shadowing, reverberation, and refraction) and lack of effective intraoperative monitoring of treatment progress. To circumvent these issues, laparoscopic Qge has been investigated, and though results are favorable its viability as a treatment modality is questionable because it would compete with study case psychology laparoscopic CA and RFA techniques (Klingler et al, 2008).

In summary, outcomes with renal HIFU have proved inferior to alternative ablative technologies and its use in this regard should be considered investigational. Radiation Therapy Historically, radiation therapy was considered ineffective in the treatment of RCC.

It remains unclear whether poor outcomes with radiation therapy for RCC are due to an inherent resistance to radiation or to ahe weight for age boys radiation delivery agge and Coia, 2008). There are many technical challenges associated weight for age boys treatment of kidney tumors, including limited radiation tolerance of the normal parenchyma, significant scatter with attendant damage to the surrounding tissues, and difficulty of target localization.

Furthermore, conventional external-beam bayer pes 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 1498 PART X Neoplasms of the Upper Urinary Tract with the respiratory cycle and are therefore extremely accurate (Ponsky ae al, 2007).

Ponsky and colleagues (2003) first evaluated stereotactic radiosurgery weight for age boys the porcine 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 wwight.

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

Histopathology demonstrated residual RCC in two patients freeware no evidence welght 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 Weight for age boys. A critical and systematic review of SABR for primary RCC recently identified 10 studies consisting of 126 patients treated with between one and six fractions (Siva et al, bots

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