Less radical procedures control kidney cancer similarly to surgery
Needle-guided tumor destruction procedures offer near equivalent lengths of local cancer control compared with surgery for patients with small kidney cancer tumors, according to the results of a large study.
“If validated, these data suggest that an update to clinical guidelines would be warranted,” said the study's lead author, R. Houston Thompson, MD, a Mayo Clinic urologist in Rochester, Minnesota. The study was published in European Urology (2014;65:372-377).
Thompson said that radical nephrectomy (surgical removal of the entire kidney) has historically been the standard of care for management of kidney cancer. However, partial nephrectomy (resection of tumors from a kidney while sparing healthy tissue) has become increasingly more common because of its nephron-sparing benefits and similar cancer control. The nephron is the part of the kidney that filters out toxins from the blood.
“We undertook this study because direct comparisons of outcomes among patients with kidney cancer who have received partial nephrectomy (PN); radiofrequency ablation (RFA), tumor destruction using intense heat; and cryoablation, tumor destruction using extreme cold, are lacking, especially from institutions that routinely perform all three of these procedures,” Thompson said.
Researchers studied a total of 1,803 patients. Among patients with tumors 4 cm or less, 1,057 patients underwent PN, 180 underwent RFA, and 187 underwent cryoablation. Recurrence-free survival was similar among the three treatment groups, whereas metastases-free survival was significantly better for patients who underwent PN and cryoablation compared with patients who underwent RFA.
For the 379 patients with tumors 4-7 cm, lengths of recurrence-free and metastases-free survival were similar between PN and cryoablation. In that group, 326 underwent PN and 53 underwent cryoablation.
“Cryoablation and RFA have traditionally been thought to provide inferior outcomes compared with surgical removal. Our results of near equivalent success, if correct, should encourage further investigation of these treatment modalities among patients with early stage kidney cancer,” Thompson said.