Radiofrequency ablation and cryoablation for renal cell carcinoma
- Andrew Hines-Peralta, MD
Andrew Hines-Peralta, MD
- Chief of Interventional Radiology
- VA Medical Center - Washington
- Johns Hopkins Suburban Hospital
- S Nahum Goldberg, MD
S Nahum Goldberg, MD
- Director of Abdominal Intervention and Tumor Ablation
- Minimally-Invasive Tumor Therapies Laboratory
- Beth Israel Deaconess Medical Center
- Section Editors
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
There are over 50,000 new cases of renal cell carcinoma (RCC) diagnosed each year in the United States, and the incidence has been increasing over time. (See "Epidemiology, pathology, and pathogenesis of renal cell carcinoma".)
The average size of these RCCs at presentation is decreasing, and more patients are presenting with small, localized lesions. In addition, there is an increasing awareness of the importance of preserving renal function, if this can be accomplished without compromising the oncologic outcome. (See "Diagnostic approach, differential diagnosis, and treatment of a small renal mass" and "Definitive surgical management of renal cell carcinoma", section on 'Partial nephrectomy'.)
Sharply delineated areas of very high or low temperature can be created in a minimally invasive fashion with either radiofrequency ablation (RFA), cryoablation, or microwave ablation. These temperature extremes are used to produce tumor cell death. Emerging technologies, such as non-thermal irreversible electroporation (IRE) can also induce cell death and are in early clinical trials . These minimally invasive technologies are rapidly gaining acceptance in selected patients as alternatives to surgery for many tumors, including RCC.
The increasing acceptance of RFA and cryoablation for kidney tumors is based upon favorable outcomes in initial studies, a low incidence of serious complications, less immediate morbidity than with surgery, lower cost, and the ability to treat patients in the outpatient setting. Optimal application of these ablative techniques requires interventional radiologists and urologists who are experienced and skilled in the application of the technology.
The potential benefits of these ablative techniques must be balanced against limited long-term, comparative efficacy data. In addition, multiple treatment sessions may be required because of difficulties in monitoring the extent of ablation, particularly for tumors greater than 4 cm in diameter. Furthermore, these ablative techniques may not be appropriate for large lesions or tumors near the renal hilum.
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- Patient selection
- Choice of ablative technique
- Radiofrequency ablation
- Microwave ablation
- Emerging technologies
- Surveillance after ablation
- Percutaneous versus laparoscopic ablation
- RFA versus cryoablation
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS