Ablation is gaining traction. I think we’ll see the broader incorporation of ablation into the management of renal masses. Certainly, percutaneous thermal ablation should be considered in cases where complete ablation can be achieved.

— Thomas Atwell, MD

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In a separate talk at the 2017 Genitourinary Cancers Symposium, Thomas Atwell, MD, a radiologist at the Mayo Clinic, Rochester, Minnesota, who performs ablation, discussed his experience with cryoablation for small renal tumors. “Early in our practice, we used both radiofrequency ablation and cryoablation. We recognized the strengths and weaknesses of these procedures, so we can triage patients. We have a success rate that approaches 98% when we triage accordingly,” Dr. ­Atwell revealed.

He pointed out that cryoablation may be suitable for the treatment of large central tumors. Also, cryoablation may be suitable for the treatment of more aggressive tumors, and “it can overcome the thermal sink effects of radiofrequency ablation,” added Dr. Atwell. Scoring systems such as RENAL and PADUA have limited utility in determining the complexity of an ablation case, he noted.

Pros and Cons

“Ablation is gaining traction,” declared Dr. Volpe. “The pros include minimal pain after the procedure and relatively minimal impact on physical well-being and social functioning.” However, he acknowledged that it can be difficult to achieve definitive surgical and pathologic margins in the middle of ablation, which is a disadvantage compared with partial nephrectomy.

“Percutaneous thermal ablation should be considered in cases where ablation can be achieved. Collaboration among specialists is key,” Dr. ­Atwell stated, paraphrasing the recently published ASCO guidelines. ■

Disclosure: Dr. Atwell reported no potential conflicts of interest.