Available ablation energies to treat cT1 renal cell cancer: emerging technologies

P. J. Zondervan,K. P. Van Lienden,D. M. De Bruin,M. Buijs,O. M. van Delden

doi:10.1007/s00345-018-2546-6

P. J. Zondervan, K. P. Van Lienden + Show 3 more

Open Access

https://doi.org/10.1007/s00345-018-2546-6

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Abstract

PurposeAn increasing interest in percutaneous ablation of renal tumors has been caused by the increasing incidence of SRMs, the trend toward minimally invasive nephron-sparing treatments and the rapid development of local ablative technologies. In the era of shared decision making, patient preference for non-invasive treatments also leads to an increasing demand for image-guided ablation. Although some guidelines still reserve ablation for poor surgical candidates, indications may soon expand as evidence for the use of the two most validated local ablative techniques, cryoablation (CA) and radiofrequency ablation (RFA), is accumulating. Due to the collaboration between experts in the field in biomedical engineering, urologists, interventional radiologists and radiation oncologists, the improvements in ablation technologies have been evolving rapidly in the last decades, resulting in some new emerging types of ablations.MethodsA literature search was conducted to identify original research articles investigating the clinical outcomes of new emerging technologies, percutaneous MWA, percutaneous IRE and SABR, in patients with primary cT1 localized renal cell cancer.ResultsDue to the collaboration between experts in the field in biomedical engineering, urologists, interventional radiologists and radiation oncologists, the improvements in ablation technologies have been evolving rapidly in the last decades. New emerging technologies such as microwave ablation (MWA), irreversible electroporation (IRE) and stereotactic ablative radiotherapy (SABR) seem to be getting ready for prime time.ConclusionThis topical paper describes the new emerging technologies for cT1 localized renal cell cancer and investigates how they compare to CA and RFA.

Highlights

With the increasing use of cross-sectional imaging, the subsequent rise in incidence of Small renal masses (SRM), the evolution of new local ablative technologies and the aging population, percutaneous ablation of localized Renal cell cancer (RCC) in both fit and unfit patients is gaining more interest
CA and radiofrequency ablation (RFA) are the most studied techniques to date with the longest outcomes reported and both are advised as the designated modalities for SRMs in the various guidelines [1,2,3,4]
A potential disadvantage of Microwave ablation (MWA) is the unpredictability of the ablation zone as compared to CA, but this may be resolved as technology improves

Summary

Introduction

With the increasing use of cross-sectional imaging, the subsequent rise in incidence of SRMs, the evolution of new local ablative technologies and the aging population, percutaneous ablation of localized RCC in both fit and unfit patients is gaining more interest. New competing emerging technologies such as MWA, IRE and stereotactic ablative radiotherapy (SABR) are increasingly used or under clinical investigation and appear promising The scope of this topical paper is to describe these emerging technologies and assess their potential roles as compared to the current standard techniques CA and RFA. Besides the fact that there was less blood loss, fewer complications and less decline in postoperative renal function in favor of MWA, no difference was found in local recurrence-free survival with a median follow-up of 32 months. The major drawback is that any residual or recurrence during follow-up was mostly not proven with pathology but only on imaging The limitation of these studies is their retrospective nature, the relatively short followup, and the small tumor sizes. A potential disadvantage of MWA is the unpredictability of the ablation zone as compared to CA, but this may be resolved as technology improves

Design

Study Design

Findings

Compliance with ethical standards