Possible Alternatives to Kidney Removal

Kidney cancer successfully treated with tumor removal and cryoablation

(RxWiki News) Looking for a less extreme alternative to surgical removal of the organ, a new study assessed the effectiveness of two alternative treatments for kidney cancer patients.

Led by a Mayo Clinic urologist, doctors studied outcomes for patients whose tumors — not the entire kidney — were either removed or treated with extreme heat and cold.

"Follow a kidney-healthy diet rich in fruits, veggies and fish."

R. Houston Thompson, MD, and colleagues studied the effectiveness of alternatives to radical nephrectomy — the removal of a cancerous kidney.

The study authors compared partial nephrectomy (PN), which is simply removing tumors, to two other treatment methods.

The first was radiofrequency ablation (RFA), which destroys cancer with intense heat. The second was cryoablation, which destroys tumors using extreme cold.

The authors found that survival rates without a repeat bout of cancer were similar for all three treatments.

However, patients who received PN and cryoablation had less spreading of cancer from the kidney to other organs than RFA patients.

“Cryoablation and RFA have traditionally been thought to provide inferior outcomes compared with surgical removal,” Dr. Thompson said in a press statement. “Our results of near equivalent success, if correct, should encourage further investigation of these treatment modalities among patients with early stage kidney cancer."

In an interview with dailyRx News, Alexander Kutikov, MD, academic urologic surgical oncologist at Fox Chase Cancer Center in Philadelphia, explained one limitation of this study.

"Patients in thermal ablation group were followed for a much shorter time than patients who underwent surgery. For instance, patients who underwent cryotherapy and did not have a recurrence were followed for a median of only approximately 1.5 years, while follow up data was available at a median of 5 years for those who underwent surgery. In other words, surgery cleared a much higher bar in this study, making meaningful comparisons between the groups difficult," Dr. Kutikov said.

"What this study tells us is that the thermal ablation (i.e., cryotherapy or RFA) option is a safe alternative for patients for whom surgery is not ideal; however, it is premature to state that these treatments are equivalent to surgery," he said.

The study included 1,424 patients with kidney tumors. Of that group, 1,057 were treated with PN, 180 with RFA and 187 with cryoablation.

In the PN group, 36 patients had their cancer recur. The RFA group had five recurrences, and the cryoablation group had three.

The cancer spread to other organs in 16 patients treated with PN and four treated with RFA. No patients with cryoablation had cancer spread.

“If validated, these data suggest that an update to clinical guidelines would be warranted,” Dr. Thompson said.

"Decisions regarding treatment must be individualized," said Dr. Kutikov. "Patient's age, overall health, surgical risks, tumor characteristics such as size and anatomic complexity, status of renal function in addition to many other factors must all be integrated into nuanced decision-making. Given the complexity of the decision regarding treatment of a renal mass, patients should seek high volume centers that offer all treatment modalities in order to get an objective and balanced opinion about treatment options."

The study was published online Sept. 12 in European Urology.

The authors disclosed no funding sources or conflicts of interest.

Review Date: 
September 11, 2014