Ablative Therapies for Localized Primary Renal Cell Carcinoma

Surgery with either partial or radical nephrectomy remains the standard of care for localized primary renal cellcarcinoma (RCC). However, most RCCs are detected in an older age group, and some may have multiple comorbiditiesthat preclude surgery. Thermal ablation (TA) with radiofrequency ablation (RFA), cryoablation (CA), or microwaveablation (MWA) is considered an alternative to extirpative surgical procedures for select patients with small renaltumors. There is more than 90% post-ablation local control in carefully selected patients with reported complicationrates of less than 10%. Most thermal ablation require only a single procedure. More recently, stereotactic ablativebody radiotherapy (SABR) has emerged as an attractive noninvasive treatment modality for elderly patients withcomorbidities and localized RCC. It has shown more than 90% local control rates for both small and relatively largertumors (> 4 cm). Modest post-SABR renal function decline has been observed. Despite most patients presenting withmild or moderate chronic kidney disease there is less than a 5% chance of progression to end-stage renal disease. Thisarticle aims to summarize the key evidence and ablative treatment’s optimal patient selection, efficacy, and toxicity.