Ablation

Another treatment approach for patients who are not good candidates for partial nephrectomy is tumor ablation. “Particularly among those for whom partial nephrectomy is undesirable or contraindicated, ablation is a very good alternative option,” Thomas D. Atwell, MD, of the department of radiology at the Mayo Clinic in Rochester, Minnesota told Cancer Therapy Advisor. At the general session, Dr Atwell will discuss the current efficacy data of thermal ablation for treating renal masses.

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The use of ablation — including cryoablation, radiofrequency ablation (RFA), and microwave ablation (MVA) — to treat SRMs is increasing, though large, long-term studies are needed to confirm outcomes.9 Ablation can be performed percutaneously or surgically.

For cryoablation, a small, prospective, single-arm study suggested that percutaneous cryoablation had a similar efficacy rate at 5 years as partial nephrectomy, and a retrospective study indicated that minor and major complication rates are about 9.2% and 1.8%, respectively. Longer-term data are available for RFA, which also show a similar efficacy rate as partial nephrectomy. There is concern, however, that less local disease control is achieved with ablative therapy compared with partial nephrectomy.10

There are differences among the different ablative techniques, though efficacy outcomes are similar. Ablation is now included in the American Urology Association and ASCO guidelines, though there is no recommendation for a specific technique.

“We have a long history of successful outcomes in the RFA of SRMs,” said Dr Atwell. He noted that cryoablation is a longer procedure, but monitoring with CT or MRI can be done to help ensure the treatment is definitive. RFA can be guided by ultrasound or CT. The rate of bleeding complications is, however, higher with cryoablation than with RFA, Dr Atwell said. Larger SRMs may benefit more from treatment with MVA.

“In appropriate expert hands, ablation will certainly afford a very good option for many patients. I anticipate that with ongoing ablation experience, we will see further proof of the treatment’s durability,” said Dr Atwell.

References

  1. Finelli A, Ismaila N, Bro B, et al. Management of small renal masses: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2017 Jan 17. doi: 10.1200/JCO.2016.69.9645 [Epub ahead of print]
  2. Rowe SP, Gorin MA, Hammers HJ, et al. Imaging of metastatic clear cell renal cell carcinoma with PSMA-targeted 18F-DCFPyL PET/CT. Ann Nucl Med. 2015;29:877-82. doi: 10.1007/s12149-015-1017-z
  3. Gorin MA, Rowe SP, Baras AS, et al. Propsective evaluation of (99m) Tc-sestamibi SPECT/CT for the diagnosis of renal oncocytomas and hybrid oncocytic/chromophobe tumors. Eur Urol. 2016;69:413-6. doi: 10.1016/j.eururo.2015.08.056
  4. Caoili EM, Davenport MS. Role of percutaneous needle biopsy for renal masses. Semin Intervent Radiol. 2014;31:20-6. doi: 10.1055/s-0033-1363839
  5. Borghesi M, Brunocilla E, Volpe A, et al. Active surveillance for clinically localized renal tumors: an updated review of current indications and clinical outcomes. Int J Urol. 2015;22:432-8. doi: 10.1111/iju.12734
  6. Volpe A. The role of active surveillance of small renal masses. Int J Surg. 2016;36(Pt C):518-24. doi: 10.1016/j.ijsu.2016.06.007
  7. Organ M, Jewett M, Basiuk J, et al. Growth kinetics of small renal masses: a prospective analysis from the Renal Cell Carcinoma Consortium of Canada. Can Urol Assoc J. 2014;8(1-2):24-7. doi: 10.5489/cuaj.1483
  8. Pierorazio PM, Johnson MH, Ball MW, et al. Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol. 2015;68(3):408-15. doi: 10.1016/j.eururo.2015.02.001
  9. Khiatani V, Dixon RG. Renal ablation update. Semin Intervent Radiol. 2014;31(2):157-66. doi: 10.1055/s-0034-1373790
  10. Novick AC, Campbell SC, Belldegrun A, et al. Guideline for the management of clinical stage I renal mass. Linthicum, MD: American Urological Association Education and Research, Inc; 2009.

Topics:

Kidney Cancer Renal Cell Carcinoma