Percutaneous Ablation of Renal Cell Carcinoma (RCC)
- Incidence of renal cancer is 400’000 patients and mortality is 175’000 patients per year1
- 90% of tumours in the kidney are renal cell carcinoma (RCC)2
- Small tumours < 40 mm (T1a) account for 48-66% of all RCC2
- 12% of RCC are currently being ablated, 88% are treated with surgery
Indications for Ablation
- Not amenable to resection due to comorbidities
- Limited renal function reserve (solitary kidney, bilateral tumours).
- RCC stage T1a (limited to kidney and ≤ 40 mm)
- High-risk patients with RCC stage T1b (limited to kidney and ≤ 70 mm)
- Perform biopsy before ablation (10-33% of biopsies reveal benign tumours2)
- Cryoablation, MWA or RFA
- Use ABLATE algorithm:
- A, axial tumour diameter;
- B, bowel proximity;
- L, location within the kidney;
- A, adjacency to the ureter;
- T, touching renal sinus fat;
- E, endophytic or exophytic position.3
- European Society for Medical Oncology (ESMO): Ablation is an option in patients with small tumours and high surgical risk, compromised renal function or bilateral disease4
- National Comprehensive Cancer Network (NCCN): Ablation can be considered for patients with T1 renal lesions5
- American Society of Clinical Oncology (ASCO): Patients who are not indicated for surgery and where complete ablation can be achieved6
Quality Ablation of RCC with CAS-One IR - Reproducible and Standardized Treatments
- Comprehensive treatment planning and assessment of risk factors (ABLATE algorithm)
- Off-plane targeting enables treatment of lesions in difficult locations (kidney dome)
- CT-fusion based ablation control for reliable assessment of technical success
Stage T1a RCC
- Ablative treatments lead to significantly better renal cancer-specific survival than active surveillance8,9
- Lower overall survival for ablation compared to resection10,11
- No difference in cancer-specific survival (CSS) between ablation and resection8,10
- Ablation leads to lower complication rates and shorter hospital stays than resection9,11
- Partial nephrectomy (PN) and ablation are being increasingly used for T1b lesions
- Small retrospective studies show no significant difference in CSS between PN and ablation12,13
- Lower complication rates for ablation than PN12
- 17% of patients present metastasis at the time of diagnosis and 25% develop metastasis after treatment
- Surgical metastasectomy improves survival, ablation may be considered when resection is not feasible14
- No significant difference in CSS between cryoablation and MWA/RFA8
- Bray, F. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. Cancer J. Clin. 68, 394–424 (2018).
- Morris, C. S. et al. Society of Interventional Radiology Position Statement on the Role of Percutaneous Ablation in Renal Cell Carcinoma: Endorsed by the Canadian Association for Interventional Radiology and the Society of Interventional Oncology. J. Vasc. Interv. Radiol. 31, 189-194.e3 (2020).
- Schmit, G. D. et al. ABLATE: A Renal Ablation Planning Algorithm. Am. J. Roentgenol. 202, 894–903 (2014).
- Escudier, B. et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 30, 706–720 (2019).
- Motzer, R. J. et al. NCCN Guidelines Insights: Kidney Cancer, Version 2.2020. J. Natl. Compr. Cancer Netw. 17, 1278–1285 (2019).
- Finelli, A. et al. Management of small renal masses: American society of clinical oncology clinical practice guideline. Journal of Clinical Oncology vol. 35 668–680 (2017).
- Huang, W. C. et al. Management of small kidney cancers in the new millennium contemporary trends and outcomes in a population-based cohort. JAMA Surg. 150, 664–672 (2015).
- Uhlig, A. et al. Treatment for Localized T1a Clear Cell Renal Cell Carcinoma: Survival Benefit for Cryosurgery and Thermal Ablation Compared to Deferred Therapy. Cardiovasc. Intervent. Radiol. 41, 277–283 (2018).
- Larcher, A. et al. Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer: a competing risks analysis. BJU Int. 118, 541–546 (2016).
- Xing, M., Kokabi, N., Zhang, D., Ludwig, J. M. & Kim, H. S. 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 288, 81–90 (2018).
- Talenfeld, A. D. et al. Percutaneous Ablation Versus Partial and Radical Nephrectomy for T1a Renal Cancer: A Population-Based Analysis. Ann. Intern. Med. 169, 69–77 (2018).
- Caputo, P. A. et al. Cryoablation versus Partial Nephrectomy for Clinical T1b Renal Tumors: A Matched Group Comparative Analysis. Eur. Urol. 71, 111–117 (2017).
- Thompson, R. H. et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur. Urol. 67, 252–9 (2015).
- Zaid, H. B. et al. Outcomes Following Complete Surgical Metastasectomy for Patients with Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. J. Urol. 197, 44–49 (2017)