Image-guided percutaneous ablative treatments for renal cell carcinoma

In recent decades, percutaneous ablation procedures have evolved into a recognized treatment option for renal cell carcinoma (RCC). Thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) are now incorporated in most treatment guidelines as a viable alternative, and in some cases, deemed equivalent to nephron-sparing surgery (NSS) or other surgical methods, especially for small renal masses (SRM) up to 4 cm. This review offers an overview of the most prevalent ablation techniques used to treat localized RCC. Additionally, it compares the oncological and clinical outcomes of these techniques with those of surgical options. Finally, it provides an assessment of the role that ablation treatment occupies in current guidelines. In conclusion, the use and incorporation of image-guided minimally invasive treatment options for RCC is on the rise. Existing data suggest that thermal ablation procedures (RFA, MWA, and CA) and partial nephrectomy yield comparable oncologic and clinical outcomes. Despite the data available, the recommendations for thermal ablations vary significantly across national and international guidelines. KEY POINTS: Question Despite growing evidence and integration in international guidelines, recommendations for ablative procedures in localized small renal cell cancer vary considerably. Findings Existing, mostly retrospective, data suggest that thermal ablation and partial nephrectomy yield comparable clinical results for small tumors. Clinical relevance Based on the current literature, thermal ablation of renal cell cancer up to 4 cm in size can be offered to patients as an alternative to surgery.