Kidney Cancer

Focal Treatments in Kidney Tumors

Focal therapies are methods that are increasingly used in the treatment of kidney tumors. Focal treatments are recommended to be applied in patients who are not suitable for surgery in kidney tumors <4 cm, in the presence of tumors in both kidneys, in patients with one kidney, or in cases with a proven genetic cause (due to the possibility of developing more than one tumor at a different time). The main of these treatment modalities are radiofrequency ablation (RFA), cryoablation (CA), microwave thermotherapy (MDT), high-intensity focused ultrasound (HIFU) and irreversible electroporation (GDE).
  1. Radiofrequency Ablasting (RFA): The use of radiofrequency energy is directed to the tip of the probe by directing the continuous and high frequency electric current to the tip of the probe, providing a temperature of over 100 °C in the target tissue and causes cell death with the genetic structure of the target tumor cells, the cell wall structure and the damage in the microvessels. Studies comparing standard partial nephrectomy (PN) (only tumor removal operation) have shown no significant difference in cancer-free survival and overall survival at 5-year follow-up. The general opinion in the world about this method is that it is promising in short follow-up and it still needs long-term results.
  2. Cryoablation (CA): KA method causes cell death by hypothermic stress thanks to the sudden temperature drop in the tumor tissue. KA treatment can also be performed with open, percutaneous, laparoscopic methods under ultrasound, CT or MRI. KA is more preferred than other methods because the ablation in the targeted tissue can be actively controlled. In terms of oncological outcomes, 3-year recurrence-free survival rates for RF, KA, and PN were 93%, 100%, and 99%, respectively.
  3. Microwave Thermotherapy (MDT): It activates the water molecules in the targeted tumor tissue with the help of electromagnetic microwaves and causes tissue destruction by increasing the temperature. MDT can reach the required temperature faster and provide a wider ablation zone than conventional RFA methods. In a study in which patients were followed for 5 years, although MDT (67.3%) was more disadvantageous than PN (97.8%) in terms of overall survival, no difference was observed in cancer-free survival (97.1%; 97.8%).
  4. High-intensity focused ultrasound (HIFU): HIFU is based on the ablation of tumor tissue with high-intensity ultrasound waves through a transducer in kidney tumors. During HIFU, the temperature in the ablated area quickly reaches 8 0 C. The most important advantage of this method over other methods is that it is non-invasive. In other words, since it is a method performed outside the body, there are no risks such as bleeding and tumor transplantation.
  5. Irreversible electroporation (GDE): It is a non-thermal ablation method by passing an electric current in the tumor tissue. Changes in the cell membrane caused by the electric current cause the death of the tumor cell. The cellular components are destroyed while the basic tissue structure is preserved. Today, many studies are needed to create a secure GDE protocol.
Follow-up protocol after focal treatments Focal treatments are generally applied in <4 cm stage 1 kidney tumors today. Abdominal and kidney imaging with ultrasound and abdominal and thorax imaging with CT at 6 months, CT in the 1st year, USG in the 2nd year, and 3rd year. CT, USG at 4 years and finally CT imaging at 5 years are recommended.

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