For some patients, kidney cancer can be effectively treated without surgery, according to the Society of Interventional Radiology’s first-ever position statement on the role of percutaneous ablation in the treatment of renal cell carcinoma (RCC). The position statement was published with an accompanying quality improvement document, which establishes performance thresholds for patient safety for interventional radiology (IR) groups who wish to develop a renal ablation practice.
The position statement and quality improvement document, published in the February issue of SIR’s flagship Journal of Vascular and Interventional Radiology (JVIR), were written by a multidisciplinary group of experts, including interventional radiologists and urologists. They were endorsed by the Canadian Association for Interventional Radiology (CAIR) and the Society of Interventional Oncology (SIO).
The authors recommend thermal percutaneous ablation for kidney cancer patients with small renal tumors, calling it “a safe and effective treatment with less [sic] complications than nephrectomy [surgery] and acceptable long-term oncological and survival outcomes.” Unlike current existing guidelines, the position statement offers recommendations on the consideration of treatment over active surveillance and discusses the incorporation of ablation for appropriate patients with T1b disease.
“Interventional radiologists are critical members of the multidisciplinary team caring for patients with kidney cancer. They have an important role, not only in the diagnosis of cancer but in its definitive treatment,” says SIR president Laura Findeiss, (Grady Hospital and Emory University School of Medicine, Atlanta, USA). “An image-guided biopsy by an interventional radiologist can confirm a diagnosis of cancer, and the interventional radiologist can be a game-changer as a partner physician on the cancer care team, expanding access to the complete range of therapeutic options, tailored to the individual patient.”
Lead author of the quality improvement document Andrew Gunn (University of Alabama, Birmingham, USA) elaborates: “These documents should expand the interventional radiologist’s approach in recommending image-guided ablation for renal cancer. First, there is sufficient evidence to suggest that image-guided ablation has nearly equivalent oncologic outcomes to traditional surgery for tumours up to 4cm in size. Additionally, ablation has fewer complications and is less detrimental to renal function than surgery. Second, there is increasing evidence that ablation can be performed for curative intent in tumours up to 7cm. While surgery is still the preferred approach for tumours this size, many patients cannot or will not undergo traditional surgery. Therefore, interventional radiologists can now recommend ablation in this patient population with more confidence.”
The position statement’s authors deemed radiofrequency ablation, cryoablation, and microwave ablation “appropriate modalities”, noting that the “method of ablation should be left to the discretion of the operating physician.”
According to the statement, thermal percutaneous ablation may have a potential beneficial role to play in the treatment of high-risk patients with more advanced disease who are not candidates for surgery, but further research is necessary. Read the full position statement and quality improvement guidelines here.
Speaking to Interventional News, Gunn comments on the timeliness of these publications: “Image-guided renal ablation is a safe and efficacious procedure for many patients with renal cancer. Despite this, there is heterogeneity among medical organisations about who might be eligible for this procedure. For example, some organisations only recommend ablation for tumours <3cm in size, while others allow ablation as a viable option for tumors up to 4cm. Furthermore, there are increasing reports of safe and effective image-guided ablations for tumours up to 7cm, but this has yet to be addressed from a societal standpoint. Thus, it was an opportune time for the SIR to release an updated position statement and quality improvement guidelines.”
RCC is the most common type of kidney cancer and an estimated 73,820 new cases of kidney cancer will be diagnosed in the USA in 2019, resulting in 14,770 new deaths.