Percutaneous Ablation for Small Renal Masses Appears Safe, Effective
Evidence is strong enough to categorize image-guided ablative therapies as safe and effective nephron-sparing therapies for small renal masses.
There has been steady growth in the use of cryoablation, radiofrequency ablation, and microwave ablation for treating small renal masses in recent years. A review article suggested that the evidence is strong enough to categorize these image-guided ablative therapies as safe and effective nephron-sparing therapies for small renal masses, defined as less than 4 cm.1
The authors of the review acknowledged that larger randomized trials are warranted. However, they found that current data suggest excellent oncologic tumor control and low complication profiles, making percutaneous ablation an important tool for treating renal masses.
“The overall message is that percutaneous ablation is an excellent therapy for small renal cell carcinomas,” study co-author S. William Stavropoulos, MD, professor of radiology and surgery at the University of Pennsylvania in Philadelphia.
Currently, partial nephrectomy (PN) is the standard treatment. However, image guided nephron-sparing ablative techniques including cryoablation, radiofrequency ablation, and microwave ablation are becoming more widely available. These procedures have demonstrated excellent technical success rates and low tumor recurrence rates. These ablative techniques also preserve renal parenchymal volume.
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Due to the increasing use of computed tomography and magnetic resonance imaging, clinicians are increasingly detecting incidental small renal malignancies (stage T1a).
Both the American Urological Association and the European Association of Urology endorse the use of ablative techniques for renal cell carcinomas less than 4 cm as well as for those with syndromes increasing the likelihood of multiple renal cell carcinomas, including the Von Hippel-Lindau and Birt-Hogg-Dubé, according to the review article. The ablative techniques are also favored for patients with morbid obesity, advanced age, multiple comorbidities, or a solitary kidney.
Most studies have compared radiofrequency ablation with PN. One study showed that for sporadic T1a renal tumors, radiofrequency ablation resulted in similar disease-free probability compared to PN in a 3-year actuarial analysis.2