Radiofrequency ablation of kidney tumours and lesions: A review of the literature

Even though radical nephrectomy and partial nephrectomy are accepted standard treatment for small localized renal tumours apart from active surveillance for selected patients, various papers have been published which have intimated that the use of radiofrequency ablation (RFA) is a safe and effective treatment alternative to surgical operations. Aims: To review the literature related to RFA of kidney lesions to ascertain whether RFA of renal lesions, is safe and effective. Methods: Various internet data bases were searched. Results: Radiofrequency has been shown, in number of publications, to be a safe and very effective therapeutic option for small kidney masses that measure less than 3 cm to 4 cm and many studies had illustrated the efficacy of radiofrequency ablation in more than 95% of cases treated. A study that comprised of 143 individuals, reported a recurrence-free survival of 96% with regard to patients who had undergone radiofrequency ablation for T1a kidney tumours, It had also been reported that with regards to patients who subsequently developed recurrent tumours locally, half of them did undergo retreatment by means of radiofrequency ablation and this resulted in 5 of the 6 cases that had undergone re-treatment by means of radiofrequency ablation having long-term control of their disease. Similar recurrence-free survival between radiofrequency ablation treated cases and partial nephrectomy (91.7% following radiofrequency ablation versus 94.6% following partial nephrectomy) has been reported and cancer specific survival has also been illustrated to be similar between patients that were treated by means of radiofrequency ablation and partial nephrectomy (97.2% following radiofrequency ablation versus 100% following partial nephrectomy. It has been re-enforced that both radiofrequency ablation and partial nephrectomy are both effective with regards to the management of small kidney tumours. In relation to kidney tumours that measure more than 3 cm up to 4 cm, mixed outcomes have been obtained and furthermore, local progression as well as incomplete treatment rates greater than 20% have been reported pursuant to radiofrequency ablation of bigger kidney tumours. However, it has been shown that the incompletely treated lesions can be re-treated successfully by means of radiofrequency ablation. It had been iterated that radiofrequency ablation of kidney tumours that measure more than 3 cm could lead to long-term disease control in not more than 80% of individuals treated. Some authors had suggested that additional to considerations related to the size of the tumours, tumours that are centrally located in the kidney should be treated by means of an alternative radiofrequency ablation technique in view of the heat sink as well as risk of damage to the urothelium. Major complications ensuing radiofrequency ablation of kidney tumours have tended to be low (between 5% and 6%) and these major complications have tended to be less than pursuant to cryoablation, partial nephrectomy, and radical nephrectomy. Radiofrequency ablation has been shown to effective for the treatment of Bosniak cyts in the kidney. Radiofrequency ablation has been shown to be effective for the treatment of papillary cell type of renal cell carcinoma as well as for adenocarcinoma and an anecdotal report has shown that the outcome following ablation of papillary tumours is superior to that of adenocarcinoma. Conclusion: RFA is a safe and effective option of treatment for small sized renal cell carcinomas and Bosniak cysts. RFA is associated with minimal complications and good prognosis comparable to that of partial nephrectomy and radical nephrectomy as well as it can be performed as an outpatient procedure and local recurrence of tumour can also be re-treated by RFA. RFA can be undertaken on patients unfit for partial nephrectomy or radical nephrectomy. A global Consensus meeting would be recommended to decide whether RFA should be considered as a first line alternative treatment of choice option for patients who may be on active surveillance or those who may require treatment of curative intent for well localized renal cell carcinomas of up to 3 cm size.