Energy ablative techniques in renal cell carcinoma

Cross-sectional imaging has led to a significant increase in the incidence of small renal masses, particularly in the older population. Given the heterogeneous nature of these tumors and the lack of molecular markers to predict disease progression, early intervention or close observation may be warranted. Partial nephrectomy is the treatment of choice for small renal cell carcinomas. Minimally invasive nephron-sparing ablation therapies have yielded satisfactory oncologic outcomes for selected patients who may not be suitable surgical candidates. Radiofrequency ablation and cryoablation are most commonly used technologies for ablation of small renal cell carcinomas. This chapter reviews the range of ablation technologies that are currently being used experimentally and clinically. The clinical approaches to radiofrequency ablation and cryoablation of small renal cell carcinomas are outlined, and the merits, limitations, and controversies surrounding these two ablation modalities are discussed. Validation of ablation therapy with long-term follow-up data is required, however, before its role is solidified in the management of renal cell carcinomas.