Review of the efficacy and safety of radiofrequency ablation for the treatment of small renal masses.
BACKGROUND
Small renal masses are increasingly being discovered incidentally on imaging performed for another reason. The standard of care for these masses involves excision by open or laparoscopic techniques. Recently, ablative techniques such as radiofrequency ablation (RFA) and cryoablation have taken a more prominent role in the treatment algorithm for these masses. We sought to evaluate the efficacy and safety of radiofrequency ablation in the treatment of renal tumours.


METHODS
We conducted a review of the literature. There was no language restriction. We obtained studies from the following sources: the Cochrane Library, PubMed, EMBASE, LILACS and Current Controlled Trials.


RESULTS
We identified no clinical trials in the literature. Thus we described the results from case series and retrospective studies with a reasonable sample size (number of reported patients in each study > 65). Most patients undergoing RFA had T1a disease with a mean tumour size of about 3 cm. Radiofrequency ablation was usually performed percutaneously with image guidance. Reported follow-up was short and ranged from 1 to 30 months. Most series used radiographic response as a surrogate for cancer control. The rates of local recurrence of the tumour were as high as 13.0% (average 8.5%) and were slightly higher than those associated with cryoablation and partial nephrectomy. Complications included hemorrhage, ureteral strictures and loss of a renal unit.


CONCLUSIONS
Our review demonstrates that RFA is a suitable and promising therapy in patients with small renal tumours who are considered to be poor candidates for more involved surgery. However, clinical trials with long-term data are needed to establish the oncological efficacy.
Post-doctoral Urology Fellow, St. Joseph's Healthcare, McMaster University, Hamilton, Ont.
Regina El
RE
Dib
Naji J
NJ
Touma
Anil
A
Kapoor