Download PDF
Semin intervent Radiol 2019; 36(05): 367-373
DOI: 10.1055/s-0039-1696650
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Thermal Ablation of T1a Renal Cell Carcinoma: The Clinical Evidence

Shamar Young
1   Department of Radiology, University of Minnesota, Minneapolis, Minnesota
,
Jafar Golzarian
2   Department of Radiology and Surgery, University of Minnesota, Minneapolis, Minnesota
,
J. Kyle Anderson
3   Department of Urology, University of Minnesota, Minneapolis, Minnesota
› Author Affiliations
Further Information

Publication History

Publication Date:
02 December 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Renal cell carcinoma (RCC) is most commonly diagnosed at an early (T1a) stage and is typically amenable to several effective treatments. The current gold standard therapy is partial nephrectomy, given its decreased morbidity and similar oncologic outcomes when compared with radical nephrectomy. Thermal ablation is an evolving definitive therapy for T1a RCC which is even less invasive than partial nephrectomy. This article reviews the evidence for thermal ablation in the treatment of T1a RCC and compares outcomes of existing ablation modalities with surgical management.

Keywords

renal cell carcinoma - partial nephrectomy - cryoablation - thermal ablation - microwave ablation - radiofrequency ablation
 

  • References

  • 1 Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International variations and trends in renal cell carcinoma incidence and mortality. Eur Urol 2015; 67 (03) 519-530
    CrossrefPubMedGoogle Scholar
  • 2 Khiatani V, Dixon RG. Renal ablation update. Semin Intervent Radiol 2014; 31 (02) 157-166
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol 2001; 166 (05) 1611-1623
    CrossrefPubMedGoogle Scholar
  • 4 Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P. Surgical management of renal tumors 4 cm. or less in a contemporary cohort. J Urol 2000; 163 (03) 730-736
    CrossrefPubMedGoogle Scholar
  • 5 Nguyen MM, Gill IS, Ellison LM. The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program. J Urol 2006; 176 (6, Pt 1): 2397-2400 , discussion 2400
    CrossrefPubMedGoogle Scholar
  • 6 Gill IS, Aron M, Gervais DA, Jewett MA. Clinical practice. Small renal mass. N Engl J Med 2010; 362 (07) 624-634
    CrossrefPubMedGoogle Scholar
  • 7 Campbell S, Uzzo RG, Allaf ME. , et al. Renal mass and localized renal cancer: AUA guideline. J Urol 2017; 198 (03) 520-529
    CrossrefPubMedGoogle Scholar
  • 8 European Association of Urology Guidelines. 2018 edition. European Association of Urology Guidelines Office; Arnhem, The Netherlands: 2018
  • 9 Finelli A, Ismaila N, Russo P. Management of small renal masses: American Society of Clinical Oncology Clinical Practice Guideline Summary. J Oncol Pract 2017; 13 (04) 276-278
    CrossrefPubMedGoogle Scholar
  • 10 National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) Kidney Cancer. Version 3. 2018 . Available at: https://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf . Published January 15, 2018. Updated February 6, 2018. Accessed April 10, 2019
    PubMed
  • 11 Xing M, Kokabi N, Zhang D, Ludwig JM, Kim HS. Comparative effectiveness of thermal ablation, surgical resection, and active surveillance for T1a renal cell carcinoma: a Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked population study. Radiology 2018; 288 (01) 81-90
    CrossrefPubMedGoogle Scholar
  • 12 Andrews JR, Atwell T, Schmit G. , et al. Oncologic outcomes following partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2019; 76 (02) 244-251
    CrossrefPubMedGoogle Scholar
  • 13 Pierorazio PM, Johnson MH, Patel HD. , et al. Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol 2016; 196 (04) 989-999
    CrossrefPubMedGoogle Scholar
  • 14 Rivero JR, De La Cerda III J, Wang H. , et al. Partial nephrectomy versus thermal ablation for clinical stage T1 renal masses: systematic review and meta-analysis of more than 3,900 patients. J Vasc Interv Radiol 2018; 29 (01) 18-29
    CrossrefPubMedGoogle Scholar
  • 15 Guan W, Bai J, Liu J. , et al. Microwave ablation versus partial nephrectomy for small renal tumors: intermediate-term results. J Surg Oncol 2012; 106 (03) 316-321
    CrossrefPubMedGoogle Scholar
  • 16 Thompson RH, Atwell T, Schmit G. , et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol 2015; 67 (02) 252-259
    CrossrefPubMedGoogle Scholar
  • 17 Kunkle DA, Uzzo RG. Cryoablation or radiofrequency ablation of the small renal mass : a meta-analysis. Cancer 2008; 113 (10) 2671-2680
    CrossrefPubMedGoogle Scholar
  • 18 McCarthy CJ, Gervais DA. Decision making: thermal ablation options for small renal masses. Semin Intervent Radiol 2017; 34 (02) 167-175
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Campbell SC, Novick AC, Belldegrun A. , et al; Practice Guidelines Committee of the American Urological Association. Guideline for management of the clinical T1 renal mass. J Urol 2009; 182 (04) 1271-1279
    CrossrefPubMedGoogle Scholar
  • 20 Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review. J Urol 2008; 179 (04) 1227-1233 , discussion 1233–1234
    CrossrefPubMedGoogle Scholar
  • 21 Atwell TD, Carter RE, Schmit GD. , et al. Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol 2012; 23 (01) 48-54
    CrossrefPubMedGoogle Scholar
  • 22 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
    CrossrefPubMedGoogle Scholar
  • 23 Morgan M, Smith N, Thomas K, Murphy DG. Is Clavien the new standard for reporting urological complications?. BJU Int 2009; 104 (04) 434-436
    CrossrefPubMedGoogle Scholar
  • 24 Atwell TD, Schmit GD, Boorjian SA. , et al. Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol 2013; 200 (02) 461-466
    CrossrefPubMedGoogle Scholar
  • 25 Schmit GD, Thompson RH, Kurup AN. , et al. Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors. J Urol 2013; 189 (01) 30-35
    CrossrefPubMedGoogle Scholar
  • 26 Thompson SM, Schmitz JJ, Thompson RH. , et al. Introduction of microwave ablation into a renal ablation practice: valuable lessons learned. AJR Am J Roentgenol 2018; 211 (06) 1381-1389
    CrossrefPubMedGoogle Scholar
  • 27 Larcher A, Sun M, Dell'Oglio P. , et al. Mortality, morbidity and healthcare expenditures after local tumour ablation or partial nephrectomy for T1A kidney cancer. Eur J Surg Oncol 2017; 43 (04) 815-822
    CrossrefPubMedGoogle Scholar
  • 28 Patel HD, Pierorazio PM, Johnson MH. , et al. Renal functional outcomes after surgery, ablation, and active surveillance of localized renal tumors: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2017; 12 (07) 1057-1069
    CrossrefPubMedGoogle Scholar
  • 29 Larcher A, Meskawi M, Valdivieso R. , et al. Comparison of renal function detriments after local tumor ablation or partial nephrectomy for renal cell carcinoma. World J Urol 2016; 34 (03) 383-389
    CrossrefPubMedGoogle Scholar
  • 30 Atwell TD, Schultz GG, Leibovich BC. , et al. Patient-reported outcomes after percutaneous renal ablation: initial experience. AJR Am J Roentgenol 2019; 212 (03) 672-676
    CrossrefPubMedGoogle Scholar
  • 31 Gratzke C, Barber N, Speakman MJ. , et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. BJU Int 2017; 119 (05) 767-775
    CrossrefPubMedGoogle Scholar
  • 32 Young SJ. Irreversible electroporation and the pancreas: What we know and where we are going?. World J Gastrointest Surg 2015; 7 (08) 138-144
    CrossrefPubMedGoogle Scholar
  • 33 Wendler JJ, Pech M, Köllermann J. , et al. Upper-urinary-tract effects after irreversible electroporation (IRE) of human localized renal-cell carcinoma (RCC) in the IRENE pilot Phase 2a ablate-and-resect study. Cardiovasc Intervent Radiol 2018; 41 (03) 466-476
    CrossrefPubMedGoogle Scholar
  • 34 Wendler JJ, Pech M, Fischbach F. , et al. Initial assessment of the efficacy of irreversible electroporation in the focal treatment of localized renal cell carcinoma with delayed-interval kidney tumor resection (irreversible electroporation of kidney tumors before partial nephrectomy [IRENE] trial-an ablate-and-resect pilot study). Urology 2018; 114: 224-232
    CrossrefPubMedGoogle Scholar
  • 35 Trimmer CK, Khosla A, Morgan M, Stephenson SL, Ozayar A, Cadeddu JA. Minimally invasive percutaneous treatment of small renal tumors with irreversible electroporation: a single-center experience. J Vasc Interv Radiol 2015; 26 (10) 1465-1471
    CrossrefPubMedGoogle Scholar
  • 36 Hasegawa T, Yamanaka T, Gobara H. , et al. Radiofrequency ablation versus cryoablation for T1b renal cell carcinoma: a multi-center study. Jpn J Radiol 2018; 36 (09) 551-558
    CrossrefPubMedGoogle Scholar
  • 37 Atwell TD, Vlaminck JJ, Boorjian SA. , et al. Percutaneous cryoablation of stage T1b renal cell carcinoma: technique considerations, safety, and local tumor control. J Vasc Interv Radiol 2015; 26 (06) 792-799
    CrossrefPubMedGoogle Scholar
  • 38 Alonso-Coello P, Schünemann HJ, Moberg J. , et al; GRADE Working Group. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ 2016; 353: i2016
    PubMedGoogle Scholar