The role of arterial embolization in renal cell carcinoma

Twenty-five years ago arterial embolization was introduced to facilitate th e surgical excision of the carcinomatous kidney or to palliate symptoms, su ch as haemorrhage from non-resectable tumours. The role of this technique i n the therapeutic armamentarium has been a source of debate in the literatu re. We reviewed all the available literature. A total of 389 papers were ev aluated. Fifty-one publications and 3225 case histories met explicit entry criteria for inclusion. Until now no prospective randomized study of this a pproach to the management of renal carcinoma has been published. In the maj ority of studies the patients are grouped together irrespective of indicati on, i.e. pre-operative or palliative. Few articles are prospective or conta in clear information regarding tumour stage, indication and adequate follow -up. Although we are not able to distinguish with certainty the effect of e mbolization on the course of the disease, it seems that complete pre-operat ive renal artery embolization facilitates the excision of large vein-invadi ng tumours. The optimal delay between embolization and operation is probabl y one day. The embolization material of choice is ethanol. Palliative embol ization in non-operable tumours with serious haemorrhage seems to have been successful in most cases. The scientific basis for the implementation of r enal artery embolization in renal cell carcinoma is weak. We believe that e ither controlled trials or parallel prospective cohort studies should be un dertaken to compare treatment of selected locally advanced renal carcinomas with and without embolization.