title: Focal therapy for kidney cancer: a systematic review.
abstract: OBJECTIVE
  Surgical excision remains the standard of care for treatment of localized small renal masses (SRMs). Laparoscopic and percutaneous minimally invasive ablative technologies are being increasingly employed in current urologic practice. We review recent literature regarding focal ablative treatments of SRMs.
  
  
  RESULTS
  Most cryoablations are performed using a laparoscopic approach, whereas radiofrequency ablation (RFA) of the SRM is more commonly administered percutaneously. Pretreatment biopsy is performed more often for lesions treated by cryoablation than RFA with a significantly higher rate of indeterminate or unknown pathology for SRMs undergoing RFA versus cryoablation (P < 0.0001). Currently available data suggest that cryoablation results in lower retreatments (P < 0.0001), less local tumor progressions (P < 0.0001) and may be associated with a decreased risk of metastatic progression compared with RFA. It is unclear whether these differences are a function of the technologies or their application. Given the excellent results reported for active surveillance of the SRM in selected patients, the extent to which focal ablation alters the natural history of SRMs has not yet been established.
  
  
  CONCLUSIONS
  Currently, data on the ability of interventions for SRMs to affect the natural history of these masses are lacking. Prospective randomized evaluations of available clinical approaches to SRMs are needed.
authors.affiliation: Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
authors.forename: David A
authors.initials: DA
authors.lastname: Kunkle
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D017115:Catheter Ablation; D003452:Cryosurgery; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D011159:Population Surveillance