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Cryoablation or radiofrequency ablation of the small renal mass†
Article first published online: 24 SEP 2008
Copyright © 2008 American Cancer Society
Volume 113, Issue 10, pages 2671–2680, 15 November 2008
How to Cite
Kunkle, D. A. and Uzzo, R. G. (2008), Cryoablation or radiofrequency ablation of the small renal mass. Cancer, 113: 2671–2680. doi: 10.1002/cncr.23896
See editorial on pages 2623–6, this issue.
- Issue published online: 3 NOV 2008
- Article first published online: 24 SEP 2008
- Manuscript Accepted: 9 JUN 2008
- Manuscript Revised: 8 MAY 2008
- Manuscript Received: 7 MAR 2008
- Fox Chase Cancer Center. Grant Number: P30 CA006927
- Kidney Cancer Keystone Program
- kidney neoplasms;
- radiofrequency ablation
The incidence of renal cell carcinoma is rising because of incidental detection of small renal masses (SRMs). Although surgical resection remains the standard of care, cryoablation and radiofrequency ablation (RFA) have emerged as minimally invasive treatment alternatives. The authors of this report performed a comparative meta-analysis evaluating cryoablation and RFA as primary treatment for SRMs.
A search of the MEDLINE database was performed reviewing the world literature for clinically localized renal masses treated by cryoablation or RFA.
Forty-seven studies representing 1375 kidney lesions treated by cryoablation or RFA were analyzed. No differences were detected between ablation modalities with regard to mean patient age (P = .17), tumor size (P = .12), or duration of follow-up (P = .53). Pretreatment biopsy was performed more often for cryoablated lesions (82.3%) than for RFA (62.2%; P < .0001). Unknown pathology occurred at a significantly higher rate for SRMs that underwent RFA (40.4%) versus cryoablation (24.5%; P < .0001). Repeat ablation was performed more often after RFA (8.5% vs 1.3%; P < .0001), and the rates of local tumor progression were significantly higher for RFA (12.9% vs 5.2%; P < .0001) compared with cryoablation. The higher incidence of local tumor progression was found to be correlated significantly with treatment by RFA on univariate analysis (P = .001) and on multivariate regression analysis (P = .003). Metastasis was reported less frequently for cryoablation (1.0%) versus RFA (2.5%; P = .06). Cryoablation usually was performed laparoscopically (65%), whereas 94% of lesions that were treated with RFA were approached percutaneously.
Ablation of SRMs is a viable strategy based on short-term oncologic outcomes. Although extended oncologic efficacy remains to be established for ablation modalities, the current data suggest that cryoablation results in fewer retreatments and improved local tumor control, and it may be associated with a lower risk of metastatic progression compared with RFA. Cancer 2008. © 2008 American Cancer Society.