title: T1a as the sole selection criterion for RFA of renal masses: randomized controlled trials versus surgery should not be postponed.
abstract: OBJECTIVE
  To evaluate the long-term effects of radiofrequency ablation (RFA) of renal masses (RM) and compare them with surgery.
  
  
  METHODS
  A total of 203 RM (193 malignant; mean size 30 mm) in 137 patients (95 male subjects; average age 64 years) underwent RFA. Complications and technique effectiveness were evaluated. Overall survival, cancer-specific survival, and disease-free survival were calculated (mean follow-up time 39 months). Predictors for complications, technique effectiveness, and survival were investigated.
  
  
  RESULTS
  Seventeen (8.4 %) adverse events were recorded (2 % major complications). Exophytic development and smaller size were protective against adverse events. Complete ablation was obtained in 87 % RM (93 % ≤3 cm, 89 % ≤4 cm). T1a threshold was a positive predictor for complete ablation and central location a negative one. Three- and 5-year overall survival were 84 and 75 %; cancer-specific survival 96 and 91 %; and disease-free survival 80 and 75 %. Considering only the 79 patients with newly diagnosed renal cell carcinoma, T1a disease stage resulted a positive predictor for both overall survival (87 and 83 % at 3 and 5 years) and cancer-specific survival (100 % at 5 years).
  
  
  CONCLUSIONS
  RFA of noncentral small RM is safe and effective, and it provides favorable long-term oncological outcomes. Selection criteria for RFA can also include T1a renal cell carcinoma in patients without surgical contraindications, even though randomized controlled trials are needed to establish the best treatment.
authors: Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy, andrea.veltri@unito.it.
authors: Andrea
authors: A
authors: Veltri
authors: Carlo
authors: C
authors: Gazzera
authors: Marco
authors: M
authors: Busso
authors: Federica
authors: F
authors: Solitro
authors: Giorgina B
authors: GB
authors: Piccoli
authors: Bruno
authors: B
authors: Andreetto
authors: Irene
authors: I
authors: Garetto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003287:Contrast Media