Percutaneous ablation techniques for renal cell carcinoma: current status and future trends

Abstract

Percutaneous ablation is an increasingly applied technique for the treatment of localized renal tumors, especially for elderly or co-morbid patients, where co-morbidities increase the risk of traditional nephrectomy. Ablative techniques are technically suited for the treatment of tumors generally not exceeding 4 cm, which has been set as general consensus cutoff and is described as the upper threshold of T1a kidney tumors. This threshold cutoff is being challenged, but with still limited evidence. Percutaneous ablation techniques for the treatment of renal cell carcinoma (RCC) include radiofrequency ablation, cryoablation, laser or microwave ablation; the main advantage of all these techniques over surgery is less invasiveness, lower complication rates and better patient tolerability. Currently, international guidelines recommend percutaneous ablation either as intervention for frail patients or as a first line tool, provided that the tumor can be radically ablated. The purpose of this article is to describe the basic concepts of percutaneous ablation in the treatment of RCC. Controversies concerning techniques and products and the need for patient-centered tailored approaches during selection among the different techniques available will be discussed.

Long-Term Follow-Up Outcomes after Percutaneous US/CT-Guided Radiofrequency Ablation for cT1a-b Renal Masses: Experience from Single High-Volume Referral Center

“…This can be partially explained by an increase in known risk factors, such as smoking or obesity, but also to the increasing incidental detection of small tumors during imaging exams performed for other reasons [2,3]. Radical or partial nephrectomy is still considered the first choice treatment [4], while image-guided thermal ablation has been proposed as an effective minimally invasive alternative, with reported good results and low complications [5][6][7][8]. Image-guided thermal ablations have been demonstrated to be particularly effective in the treatment of small kidney cancers < 4 cm [8,9].…”

“…Among different ablative techniques, radiofrequency ablation (RFA) has been one of the first applied in the treatment of kidney cancer [8,10,11]. Ultrasound (US), providing real time visualization, represents the most widely used technique for guiding ablations in the abdomen, particularly in Europe and Asia [12,13], while computed tomography (CT) is preferred in several centers, mainly in the United States [14,15].…”

Heating technology for malignant tumors: a review

“…This concept has been further explored to develop a probe for transurethral treatment of prostate cancer allowing full or focal gland ablation under MR-guidance [247]. The imaging [154,155,189,193,214] LI: Liver [50,70,82,83,101,145,146,159,163,193,196,[215][216][217][218][219] LU: Lung [87,88,99,114,138,144,157,169,190] PA: [86,93,95,137,158,185,[193][194][195] [150][151][152][153]191] Open circles represent explorative (small/few phase I/II) use and solid black circles represent many/large phase I/II trials, retrospective analyses or phase III evidence.…”

“…RFA and MWA are both widely used to ablate thoracic and gastrointenstinal tumors, e.g., liver [142,145,146,263], lung [142,[147][148][149], thyroid [150][151][152][153], kidney [154,155], breast [156], esophagus [144,157] and pancreas [158]. MWA is deemed capable of creating larger and more spherical ablation zones than RFA and thus clinical results of MWA are comparable to RFA for smaller lesions, but may be better for larger lesions [145,146].…”

Image-guided thermal ablation of central renal tumors with retrograde cold pyeloperfusion technique: a monocentric experience

“…Therefore, a minimally invasive treatment able to achieve tumor cure with preservation of renal function would be extremely useful for these patients. Over the last decade, percutaneous thermal ablation therapies including radiofrequency ablation (RFA), cryoablation and, more recently, microwave ablation (MWA) have emerged as a feasible and effective alternative to surgical approaches, and are particularly applied in patients who are unfit for surgery or with previous ipsi-or contralateral renal surgeries [6][7][8][9]. However, considering the higher risk of injury to the collecting system [10] and incomplete tumor ablation [11,12] that these imageguided thermal ablations pose for centrally located renal tumors, protective maneuvers such as pyeloperfusion or hydrodissection have been implemented and applied [13][14][15] giving new chances of cure to many patients with solitary kidneys, compromised renal function, multiple RCCs or comorbid medical conditions.…”