Why cryoablation (freezing) is better in kidney cancer?​​​​​​​​​​

Percutaneous cryoablation is one of the most commonly used treatment modalities in renal cancers. Cryoablation is ideal for the treatment of kidney tumors in many respects;

 

1. Today, a large proportion of RCCs are detected incidentally in examinations such as ultrasound, tomography, or MRI, before the tumor has not yet grown to give symptoms. The majority of these tumors are stage 1 tumors smaller than 7 cm in diameter, limited to kidney, and non-metastatic. The vast majority of these tumors are suitable for cryoablation.

 

2. Most of the RCCs detected incidentally occur in individuals over the age of 50-60 with comorbid conditions such as heart-lung disorders or kidney problems that can make surgery dangerous. In such individuals, cryoablation, which is performed only with local anesthesia and does not require  hospitalization, is a very attractive option.

 

3. Long-term (5-10 years) results of renal cryoablation have been published in recent years. According to these results, cryoablation is equally successful with partial nephrectomy, but has less side effects, provides better renal function and higher patient satisfaction.

 

4. In some patients, surgery may be too dangerous; for example if RCC develops in the single kidney, or in both kidneys, or if there are multiple RCCs in the same kidney, surgery may be very challenging and too risky. In such patients, cryoablation should be considered the first option. 

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5. Cryoablation is a REPEATABLE treatment and this is its one of the biggest advantages. Unlike surgery and radiotherapy, the second or third cryoablations do not put the patient in any increased danger. 

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Which patients are eligible?

The ideal patients for cryoablation are RCC cases smaller than 5 cm and not metastasized. Apart from these, in some patient groups, partial nephrectomy is high risk and cryoablation should be preferred. These include patients with impaired renal function, those with heart and lung problems, those with a kidney already removed, those with RCC in both kidneys, and more than one RCC in the same kidney. Although the most suitable tumors for cryoablation are those less than 5 cm in size and not metastasized, metastatic renal cancers and tumors upto 8 cm have been successfully treated in some centers including ours.

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Cryoablation for RCC in a single kidney

In some patients, one of the kidneys may have already removed surgically for many reasons such as tumor, stone atrophy etc. and in the remaining single kidney, a cancer may develop. In such cases, surgical removal of the tumor (partial nephrectomy) may be technically impossible or too dangerous. In such patients, cryoablation may be a perfect alternative as it can kill the tumor by preserving the renal function. 

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Cryoablation for RCC in a transplanted kidney

Kidney transplantation is the treatment of choice in patients with end stage renal insufficiency. Although rare, renal cancer may developed in the transplanted kidney. In such cancers surgery is more dangerous and difficult as the kidney is not original and the patients may be receiving immune supressive drugs. In such patients, cryoablation is generally the best option as it is minimally invasive, effective and able to preserve kidney function better than surgery. Even if the tumor recurs in the future, cryoablation may also be repeated as safely and effectively as the first one. 

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Cryoablation in large cancers

Although cryoablation is most effective in renal cancers  less than 5cm in size, larger tumors upto 8-10cm can successfully be treated by using multiple needles and multiple ablations. In large tumors, the recurrence rate is slightly increased. If recurrence occurs however, cryoablation can be repeated as many times as necessary. 

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Cryoablation in stage 4 kidney cancer

In stage 4 RCC, the tumor has spread to distant organs such as bones and lungs. In this stage, only chemotherapy and immunotherapy are given to the patient and surgery is not recommended. Although not well-known, cryoablation and microwave ablation may be a good local treatment option in such patients. With these techniques, both the primary kidney tumor and its metastases in the lungs and bones may be successfully ablated. Additionally, as immunotherapy with immune checkpoint inhibitors is beneficial, intratumoral immunotherapy may be performed after percutaneous ablations to enhance tumor-specific immunity against tumor cells.  

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  Video: Cryoablation: freezing kills kidney tumors  

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