Percutaneous ablation for localized renal tumors is an appropriate treatment option for patients unable to undergo surgery, according to investigators.

A team at Mayo Clinic in Rochester, Minnesota, led by R. Houston Thompson, MD, compared partial nephrectomy (PN) with percutaneous ablation in the treatment of 1422 patients with cT1 renal masses at their institution. Of the 1422 patients, 1055, 180, and 187 underwent PN, radiofrequency ablation (RFA), and cryoablation, respectively. Patients had a median follow-up duration of 9.4, 7.5, and 6.3 years, respectively.

The study found no significant difference between PN, RFA, and cryoablation with regard to local recurrence, metastases, and death from renal cell carcinoma (RCC), Dr Thompson and his colleagues reported in European Urology. The 5-year local recurrence-free survival rates for patients in PN, RFA, and cryoablation groups were 97.7%, 95.9%, and 95.9%, respectively. The 5-year metastasis-free survival rates were 98%, 93.9%, and 100%, respectively. The 5-year cancer-specific survival rates were 99%, 96%, and 100%, respectively.

“With mature follow-up at a single institution, percutaneous ablation appears to have acceptable results for cT1 tumors and is appropriate for patients with a contraindication for surgery,” the investigators concluded. “For cT1 patients, clinically relevant differences between PN and ablation are unlikely, and treatment choice should involve shared decision making.”

In a discussion of study limitations, the authors noted that there “is an obvious selection bias between patients treated with PN and those selected for ablation.” They pointed out that adverse oncologic outcomes were relatively rare in their study cohort, and “additional follow-up may provide improved power to identify statistically significant differences among the treatments.”

Reference

Andrews JR, Atwell T, Schmit G, et al. Oncologic outcomes following partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2019.

https://www.europeanurology.com/article/S0302-2838(19)30340-9/fulltext