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Cryoablation Versus Radiofrequency Ablation for the Treatment of Small Renal Masses
David A Kunkle*, Brian L Egleston*, Robert G Uzzo
Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, PA
Introduction: The incidence of renal cell carcinoma (RCC) is rising due primarily to incidental detection of small renal masses (SRMs). While surgical resection remains the standard of care for enhancing renal lesions, ablative technologies have emerged as minimally-invasive treatment alternatives. Cryoablation and radiofrequency ablation (RFA) have been performed in selected patients via percutaneous, laparoscopic, and open approaches. In order to define the current data for ablation, we performed a meta-analysis evaluating cryoablation vs RFA as primary treatment for SRMs.
Methods: A MEDLINE search was performed reviewing the world literature for treatment of renal masses by cryoablation or RFA. Only studies examining clinically localized sporadic renal masses which provided information pertaining to disease recurrence/progression were included.
Results: 40 studies representing 1103 kidney lesions treated by cryoablation or RFA were analyzed (Table). While rates of local recurrence were significantly higher for RFA versus cryoablation(P<0.0001), there was no statistical difference in metastatic progression(P=0.26).
Conclusions: We demonstrate that ablation of SRMs is a viable strategy based on short- and intermediate-term oncologic outcomes. While extended oncologic efficacy remains to be established for ablation, our data suggests that cryoablation may result in significantly lower rates of local tumor recurrence compared to RFA.
Cryoablation versus RFA for treatment of enhancing renal masses. | Cryoablation | Radiofrequency Ablation | P Value | | No. Series / Institutions | 19 / 19 | 21 / 21 | - | | No. Lesions | 496 | 607 | - | | Mean Age, years | 65.7 | 67.2 | 0.21 | | Mean Tumor size, cm | 2.56 | 2.69 | 0.18 | | Mean Follow-up, months | 18.3 | 16.4 | 0.61 | | Rate of Unknown or Indeterminate Pathology | 17.7% | 42.8% | <0.0001 | | Rate of Malignancy (known pathology) | 75.8% | 88.3% | <0.0001 | | Incidence of Local Recurrence | 4.6% | 11.7% | <0.0001 | | Metastatic Progression | 1.2% | 2.3% | 0.26 |
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