Systematic Review of Contemporary Evidence for the Management of T1 Renal Cell Carcinoma: What IRs Need to Know for Kidney Cancer Tumor Boards

Abstract

Renal cell carcinoma is a relatively common malignancy, with 60 to 70 thousand cases a year in the United States alone. Increased utilization of cross-sectional imaging has led to an increase in the number of early renal cell cancers seen by the medical establishment. In addition, certain patient populations have an increased risk of developing kidney cancers which may mandate aggressive screening protocols. This article discusses the epidemiology of renal cell cancers; discusses the current management guidelines from multiple specialty societies; discusses some of the surgical and interventional techniques used in the treatment of such lesions; and provides a review of the literature regarding treatments of early-stage renal cell cancers.

Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center

“…A technical success, referred to as the complete covering of the lesion by the ice ball on the first post-procedural scan, was achieved in 171 of 174 lesions (98.3%). These results compare favorably with the 94% reported in the study by Cronan et al [ 8 ] and is in line with the rate of 98.9% reported in a recent series by Lim et al [ 39 ]. In general, this outcome depends on technique-related factors like probe positioning, correct completion of the cycles, and visual control of the ice ball [ 10 ].…”

“…This study showed a local recurrence rate of 2.9% at one year, of 2.9% at three years, and of 1.8% at five years, appearing consistent with some studies establishing a local recurrence rate between 0% and 5% in the first three years of follow-up [7,10,12,17,29] and significantly lower compared to others that report recurrence rates ranging from 7% to 16% [6,9,16,42,44,45] at three years. Similarly, long-term results are strongly encouraging, showing a local recurrence at five years of 1.8% against the 3% evident in some studies [8,46] and even 13% in other series [16,42,43].…”

“…Furthermore, this incidence rate disproportionally rose to 72% between 2006 and 2007 [ 4 ]. The incidence rate of RCC is still growing, with an increase of about 2.4% per year, on account of a rising number of abdominal imaging exams performed for non-renal symptoms, determining an incidental diagnosis in more than 50%–60% of cases of renal cancer [ 1 , 3 , 5 , 6 , 7 , 8 , 9 , 10 ]. In particular, recent years showed a considerable increase in incidental detection of the small lesions intended as masses less than 4 cm in size, typically asymptomatic and generally affecting elderly [ 4 ].…”

“…Surgical intervention is still the first treatment of choice with partial nephrectomy being the gold standard treatment for T1 tumors [ 1 , 11 ]. Nephrectomy was historically performed with a radical intent and was then converted to a partial approach, since literature has widely demonstrated superimposable results between the two techniques with comparable five-year survival rates [ 7 , 8 , 12 , 13 ]. The use of partial nephrectomy is driven by the emerging need of a nephron sparing surgery, whose aims are the preservation of as much renal function as possible and the reduction of pain, morbidity, and length of hospitalization [ 14 , 15 ].…”

“…The use of partial nephrectomy is driven by the emerging need of a nephron sparing surgery, whose aims are the preservation of as much renal function as possible and the reduction of pain, morbidity, and length of hospitalization [ 14 , 15 ]. Given these assumptions, in the last two decades, other minimally invasive approaches emerged with thermal ablations representing the most effective and safe alternatives to partial nephrectomy for tumors <3 cm in size [ 1 , 7 , 8 , 10 , 16 , 17 ]. In particular, cryoablation shows meaningful advantages compared to other ablative techniques like radiofrequency ablation, such as the direct visualization of the ice ball and the large volume of treatment [ 2 , 7 , 14 , 18 , 19 ].…”