Management of Residual or Recurrent Disease Following Thermal Ablation of Renal Cortical Tumors

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Justin Loloi
W. Bruce Shingleton
Stephen Y. Nakada
Ronald J. Zagoria
Jaime Landman
Benjamin R. Lee
Surena F. Matin
Kamran Ahrar
Raymond J. Leveillee
Jeffrey A. Cadeddu
Jay D. Raman


cryoablation, radiofrequency ablation, renal cell carcinoma, nephrectomy, recurrences


Management of residual or recurrent disease following thermal ablation of renal cortical tumors includes surveillance, repeat ablation, or surgical extirpation. We present a multicenter experience with regard to the management of this clinical scenario. Prospectively maintained databases were reviewed to identify 1265 patients who underwent cryoablation (CA) or radiofrequency ablation (RFA) for enhancing renal masses. Disease per-sistence or recurrence was classified into one of the three categories: (i) residual disease in ablation zone; (ii) recurrence in the ipsilateral renal unit; and (iii) metastatic/extra-renal disease. Seventy seven patients (6.1%) had radiographic evidence of disease persistence or recurrence at a median interval of 13.7 months (range, 1–65 months) post-ablation. Distribution of disease included 47 patients with residual disease in ablation zone, 29 with ipsilateral renal unit recurrences (all in ablation zone), and one with metastatic disease. Fourteen patients (18%) elected for surveillance, and the remaining underwent salvage ablation (n = 50), partial nephrectomy (n = 5), or radical nephrectomy (n = 8). Salvage ablation was successful in 38/50 (76%) patients, with 12 failures managed by observation (3), tertiary ablation (6), and radical nephrectomy (3). At a median follow-up of 28 months, the actuarial cancer-specific survival and overall survival in this select cohort of patients was 94.8 and 89.6%, respectively.

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1. Snyder ME, Bach A, Kattan MW, Raj GV, Reuter VE, Russo P. Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: Influence of sex. J Urol. 2006;176(6 Pt 1):2391–5; discussion 5–6. http://dx.doi. org/10.1016/j.juro.2006.08.013
2. Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA. The natural history of incidentally detected small renal masses. Cancer. 2004;100(4):738–45. http://dx.doi. org/10.1002/cncr.20025
3. Sanchez A, Feldman AS, Hakimi AA. Current manage-ment of small renal masses, including patient selection, renal tumor biopsy, active surveillance, and thermal ablation. J Clin Oncol. 2018;36(36):3591–600. JCO.2018.79.2341
4. Chenam A, Lau C. Management of small renal masses. Cancer Treat Res. 2018;175:105–26. http://dx.doi. org/10.1007/978-3-319-93339-9_5
5. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang  A, et al. Renal mass and localized renal cancer: AUA guideline. J Urol. 2017;198(3):520–9. juro.2017.04.100
6. Rivero JR, De La Cerda J, 3rd, Wang H, Liss MA, Farrell AM, Rodriguez R, et al. Partial nephrectomy versus thermal abla-tion for clinical stage T1 renal masses: Systematic review and meta-analysis of more than 3,900 patients. J Vasc Interv Radiol. 2018;29(1):18–29.
7. Best SL, Park SK, Youssef RF, Olweny EO, Tan YK, Trimmer C, et al. Long-term outcomes of renal tumor radio frequency ablation stratified by tumor diameter: Size matters. J Urol. 2012;187(4):1183–9.
8. Matin SF, Ahrar K, Cadeddu JA, Gervais DA, McGovern FJ, Zagoria RJ, et al. Residual and recurrent disease following renal energy ablative therapy: A multi-institutional study. J Urol. 2006;176(5):1973–7.
9. Breda A, Anterasian C, Belldegrun A. Management and out-comes of tumor recurrence after focal ablation renal therapy. J Endourol. 2010;24(5):749–52. end.2009.0658
10. Ferakis N, Bouropoulos C, Granitsas T, Mylona S, Poulias I. Long-term results after computed-tomography-guided per-cutaneous radiofrequency ablation for small renal tumors. J Endourol. 2010;24(12):1909–13. end.2009.0639
11. Okhunov Z, Chamberlin J, Moreira DM, George A, Babaian K, Shah P, et al. Salvage percutaneous cryoablation for locally recurrent renal-cell carcinoma after primary cryoablation. J Endourol. 2016;30(6):632–7. end.2016.0088
12. Weld KJ, Landman J. Comparison of cryoablation, radiofre-quency ablation and high-intensity focused ultrasound for treat-ing small renal tumours. BJU Int. 2005;96(9):1224–9. http://
13. Raman JD, Stern JM, Zeltser I, Kabbani W, Cadeddu JA. Absence of viable renal carcinoma in biopsies performed more than 1 year following radio frequency ablation confirms reliabil-ity of axial imaging. J Urol. 2008;179(6):2142–5. http://dx.doi. org/10.1016/j.juro.2008.01.119
14. Lum MA, Shah SB, Durack JC, Nikolovski I. Imaging of small renal masses before and after thermal ablation. Radiographics. 2019;39(7):2134–45.
15. Cotta BH, Meagher MF, Bradshaw A, Ryan ST, Rivera-Sanfeliz G, Derweesh IH. Percutaneous renal mass biopsy: Historical per-spective, current status, and future considerations. Expert Rev Anticancer Ther. 2019;19(4):301–8. 140.2019.1571915
16. Siva S, Louie AV, Warner A, Muacevic A, Gandhidasan S, Ponsky L, et al. Pooled analysis of stereotactic ablative radio-therapy for primary renal cell carcinoma: A report from the International Radiosurgery Oncology Consortium for Kidney (IROCK). Cancer. 2018;124(5):934–42. http://dx.doi. org/10.1002/cncr.31156