Extracorporeal organotripsy for renal tumours.

Abstract

The conviction that a renal cell carcinoma does not require the entire organ to be removed allows new therapeutic methods to be envisaged that involve only local tissue ablation, rather than the complete removal of the organ. The trend toward minimally invasive options in the management of renal tumours has prompted interest in energy-based ablation techniques as a possible alternative to radical or partial nephrectomy in selected patients. Cryoablation, radiofrequency interstitial tumour ablation, microwave thermotherapy and high-intensity focused ultrasound (HIFU) are among such techniques. HIFU has emerged as the least invasive of the possible tumour ablation methods. The present review addresses the current literature on experimental and clinical application of HIFU for extracorporeal organotripsy of renal tumours. Clinical HIFU applications performed thus far in the treatment of renal tumours have only been experimental in nature. Specific case details were recently provided concerning a patient suffering from a multilocal renal cell carcinoma who underwent HIFU treatment with intent to cure, along with data from short-term (6 months) follow-up examinations. HIFU is a promising but presently experimental procedure. It will achieve routine clinical application when technical problems concerning visualization of the target organ and lesion, precise control of lesion size, complete ablation of the tumour mass and reduction in side effects (skin burns) have been resolved. The objectives of further developments are to optimize ultrasound coupling and to provide on-line ablation evidence. At this time, HIFU should be reserved for selected patients in well designed clinical studies.