According to the results of a large study published in the journal European Urology, needle-guided tumor destruction procedures offer near equivalent lengths of local cancer control compared to surgery for patients with small kidney cancer tumors. “If validated, these data suggest that an update to clinical guidelines would be warranted,” explained R. Houston Thompson, M.D., a Mayo Clinic urologist and lead author of the study
Thompson notes that radical nephrectomy, the surgical removal of the entire kidney, has historically been the standard of care for management of kidney cancer. However, partial nephrectomy, which is the surgical removal of tumors from a kidney while sparing healthy tissue, has become increasingly more common because of its nephron-sparing benefits and similar cancer control. The nephron is the part of the kidney that filters out toxins from the blood.
… direct comparisons of outcomes among patients with kidney cancer … who have received one of these treatments … are missing…
“We undertook this study because direct comparisons of outcomes among patients with kidney cancer who have received partial nephrectomy or PN, radio frequency ablation or RFA, tumor destruction using intense heat, and cryoablation, the destruction using extreme cold, are lacking, especially from institutions that routinely perform all three of these procedures,” Thompson explains.
Trial design
The study included 1,803 patients. Among patients with tumors 4 cm or less, 1,057 patients received PN, 180 received RFA and 187 received cryoablation. Recurrence-free survival was similar among the three treatment groups, while metastases-free survival was significantly better for patients who received PN and cryoablation when compared with patients who received RFA. For the 379 patients with 4 cm tumors, lengths of recurrence-free and metastases-free survival were similar between PN and cryoablation. In that group, 326 underwent PN and 53 received cryoablation.
Inferior outcomes?
“Cryoablation and RFA have traditionally been thought to provide inferior outcomes compared with surgical removal. Our results of near equivalent success, if correct, should encourage further investigation of these treatment modalities among patients with early stage kidney cancer,” Thompson noted.
For more information:
Thompson RH, Atwell T, Schmit G, Lohse CM, Kurup AN, Weisbrod A, Psutka SP. Comparison of Partial Nephrectomy and Percutaneous Ablation for cT1 Renal Masses. Eur Urol. 2014 Aug 6. pii: S0302-2838(14)00673-3. doi: 10.1016/j.eururo.2014.07.021 [Article][PubMed]
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