Society of Interventional Radiology Position Statement on the Role of Percutaneous Ablation in Renal Cell Carcinoma: Endorsed by the Canadian Association for Interventional Radiology and the Society of Interventional Oncology.
Morris, C. S., M. O. Baerlocher, S. R. Dariushnia, E. D. McLoney, N. Abi-Jaoudeh, K. Nelson, M. Cura, A. K. Abdel Aal, J. W. Mitchell, S. Madassery, S. Partovi, T. D. McClure, A. L. Tam and S. Patel (2020). “Society of Interventional Radiology Position Statement on the Role of Percutaneous Ablation in Renal Cell Carcinoma: Endorsed by the Canadian Association for Interventional Radiology and the Society of Interventional Oncology.” J Vasc Interv Radiol 31(2): 189-194.e183.
In accordance with multidisciplinary and society guidelines, Society of Interventional Radiology (SIR) considers thermal PA to be an acceptable treatment option for stage T1a renal cell carcinoma (RCC) neoplasms (≤4 cm in diameter) in carefully selected patients and can be offered over active surveillance. Perccutaneous ablation (PA) may also have a potential beneficial role to play in the treatment of T1b tumors as well as oligometastatic RCC. However, future research in this area is warranted before strong recommendations can be made. SIR also recommends further investigation directly comparing ablation modalities, as well as comparing PA to surgical therapies with RCTs or other prospective study designs with adherence to standardized reporting of trials. RECOMMENDATIONS: 1. In patients with small renal tumors (stage T1a), percutaneous thermal ablation is a safe and effective treatment with fewer complications than nephrectomy and acceptable long-term oncological and survival outcomes. (Level of Evidence: C; Strength of Recommendation: Moderate). 2. In selected patients with suspected T1a RCC, percutaneous thermal ablation should be offered over active surveillance. (Level of Evidence: C; Strength of Recommendation: Moderate). 3. Percutaneous biopsy of small renal masses is recommended before or during PA, whenever possible. (Level of Evidence C; Strength of Recommendation: Moderate). 4. In high-risk patients with T1b RCC who are not surgical candidates, percutaneous thermal ablation may be an appropriate treatment option; however, further research in this area is required. (Level of Evidence D; Strength of Recommendation: Weak). 5. PA of oligometastatic RCC may be appropriate in patients with surgically resectable primary RCC who are not candidates for metastasectomy. (Level of Evidence D; Strength of Recommendation: Weak). 6. Radiofrequency ablation, cryoablation, and MW ablation are all appropriate modalities for thermal ablation, and method of ablation should be left to the discretion of the operating physician. (Level of Evidence: D; Strength of Recommendation: Weak). (Excerpt from text, p. 192-193; no abstract available.)
