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The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation

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Abstract

Introduction

Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients.

Objective

To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma.

Methods

A PubMed wide the literature search of was conducted.

Results

International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available.

Conclusion

Ablative techniques pose a valid treatment option in selected patients.

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Conflict of interest

Dr. Arie Belldegrun is a member of the Board of Directors and an equity holder of SonaCare Medical, LLC, a manufacturer of HIFU medical devices.

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Authors and Affiliations

  1. Department of Urology, University Medicine Greifswald, Greifswald, Germany

    Nils Kroeger, Uwe Zimmermann & Martin Burchardt

  2. Department of Urology, Medical University of Vienna, Vienna, Austria

    Tobias Klatte

  3. Department of Urology, Institute of Urologic Oncology, David Geffen School of Medicine at the University of California Los Angeles, 924 Westwood Boulevard, Suite 1050, Los Angeles, CA, 90095-7384, USA

    Tobias Klatte, Nils Kroeger, Arie S. Belldegrun & Allan J. Pantuck

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  1. Tobias Klatte
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  2. Nils Kroeger
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  5. Arie S. Belldegrun
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  6. Allan J. Pantuck
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Correspondence to Allan J. Pantuck.

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T. Klatte and N. Kroeger have contributed equally to this work.

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Klatte, T., Kroeger, N., Zimmermann, U. et al. The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation. World J Urol 32, 597–605 (2014). https://doi.org/10.1007/s00345-014-1284-7

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