Image guided energy-based ablation of T1 renal cell cancer: a ten-year single centre experience

Abstract Purpose Image-guided energy-based tumour ablation (IGTA) with radiofrequency ablation (RFA), microwave ablation (MWA) and cryotherapy are curative local therapies for T1 renal cell carcinoma (RCC). The aim of this study is to evaluate the oncological outcomes and survival after IGTA of T1 RCC in our unit over a 10-year period. Methods We retrospectively reviewed all patients with biopsy proven RCC who underwent IGTA of a T1 tumour between 1st March 2013 and 1st June 2023. Data collected included: patient demographics, tumour size and histology, pre and post procedure creatinine, ablation technique, complications, efficacy, disease free survival and overall survival (OS). Results Fifty IGTAs were performed on 46 RCC (mean diameter 2.6 cm) in 45 patients. Complications occurred in 8% of procedures ( n = 4/50). Median clinical follow- up was 27.5 months (range 3—88). There was no significant change in creatinine due to IGTA. Primary efficacy of ablation was 94% (43/46 tumours). MWA had a lower primary efficacy than RFA (82% (14/17) vs 100% (28/28) respectively, ( p = 0.02)). Larger median RCC diameter was associated with failed primary efficacy in the MWA group (3.8 cm vs 2.4 cm respectively, p = 0.035). OS was 97.4%, 88.5% and 88.5% at 1, 3 and 5 years respectively. Local tumour progression free survival was 100%, 95.2% and 95.2% at 1, 3 and 5 years respectively. Cancer specific survival at 5 years was 100%. Conclusions IGTA provides an effective durable treatment option for patients with T1 RCCs. Primary efficacy was greater with RFA than MWA, although this may be influenced by the learning of curve for MWA during the study period. Primary efficacy failure in the MWA group is associated with greater median RCC diameters. Graphical Abstract