Non-Surgical Ablative Treatments for Small Renal Tumours Less Than 4 cm

Introduction and objectivesNon-Surgical Ablative Treatments of renal tumors represent an attractive alternative approach for small lesions (<4 cm) in selected patients. Aim of this study is to extensively assess the evidences and indications of this conservative approach and to provide notion of technical aspects.MethodsA comprehensive evaluation of available published data included analysis of published full-length papers that were identified with Medline and Cancerlit from January 1999 to January 2006. Official proceedings of internationally known scientific societies held in the same time period were also assessed.ResultsCryoablation, radiofrequency and HIFU ablation represent the current available non-surgical ablative treatments for renal cell carcinoma (RCC). Indications for this conservative approach are widening and include RCC in a solitary or transplant kidney, synchronous bilateral primary tumors, RCC local recurrence in absence of metastatic disease, and RCC in patients with von Hippel-Lyndau. Cryoblation has been more extensively studied. It is based on cells freezing and consequently disruption of cell membranes and proteins. Multiple lesions can be treated and the procedures can be repeated. Radiofrequency ablation, as well as cryoablation, can be delivered via an open, laparoscopic or percutaneous approach. It delivers a monopole alternative current and it is associated with optimal 5-year follow-up in patients with RCC volume less than 3 cm. Morbidity rate of these approaches was up to 14%. Limited data are available for HIFU ablation.ConclusionsNon surgical ablative approach seems to represent an attractive alternative treatment for small RCC (<4 cm) in selected patients, due to the immense improvement in imaging techniques, the ability to be delivered to specific targeted lesions and the opportunity to be repeated. However, future well-designed studies are needed to formally assess and confirm the long term oncological results of these approaches.