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Nonsurgical treatment may be as effective as radical nephrectomy for early renal cancer

Older patients with early renal cancer treated with percutaneous ablation had similar 5-year overall and cancer specific survival rates to those treated with radical nephrectomy and also had five times fewer complications, according to findings published in Annals of Internal Medicine.

“Stage T1a renal cell carcinoma (tumors < 4 cm) is usually curable. Nephron-sparing partial nephrectomy has replaced radical nephrectomy as the standard of care for these tumors,” Adam D. Talenfeld, MD, MS, from Weill Cornell Medicine, and colleagues wrote. “Radical nephrectomy remains the first alternative treatment option, whereas percutaneous ablation, a newer, nonsurgical treatment, is recommended less strongly because of the relative paucity of comparative [percutaneous ablation] data.”

Talenfeld and colleagues analyzed cancer registry data to compare the renal cell carcinoma-specific and overall survival and 30- and 365-day postintervention complications of percutaneous ablation, partial nephrectomy and radical nephrectomy. The researchers followed 4,310 patients aged 66 years or older who received treatment for T1a renal cell carcinoma for a median of 52 months. A total of 456 patients received percutaneous ablation, while 1,748 received partial nephrectomy and 2,106 received radical nephrectomy.

Results from the study showed that patients who received percutaneous ablation had a similar 5-year renal cell carcinoma-specific survival rate to those who received partial nephrectomy (95% vs. 98%). Five-year renal cell carcinoma-specific survival rates were also similar among patients who received percutaneous ablation and radical nephrectomy (96% vs. 95%).

The 5-year overall survival rate was shorter among patients who received percutaneous ablation than those who received partial nephrectomy (77% vs. 86%) and was similar between those who received percutaneous ablation and those who received radical nephrectomy (74% vs. 75%).

Rates of renal insufficiency 31 to 365 days after treatment was highest in the radical nephrectomy group (18%), followed by the percutaneous ablation (11%) and partial nephrectomy (9%) groups. The rate of nonurologic complications within 30 days after treatment was 30% in the radical nephrectomy, 29% for the partial nephrectomy group and 6% for the percutaneous ablation group.

Intraoperative conversion to radical nephrectomy occurred in 10% of patients receiving partial nephrectomy. Additional percutaneous ablation was received by 7% of patients in the percutaneous ablation group.

“Our findings suggest that, allowing for infrequent retreatment, appropriately selected older patients with stage T1a renal cancer may expect oncologic outcomes from [percutaneous ablation] similar to those of [radical nephrectomy], with fewer complications and less chronic renal insufficiency,” Talenfeld and colleagues concluded. “Although our conclusions about the comparability of oncologic outcomes for [percutaneous ablation] versus [partial nephrectomy] are less certain, our findings suggest that patients who receive ablation might have fewer complications.

“This large, population-based, comparative analysis of [percutaneous ablation] outcomes strengthen the findings of recent institutional studies and raises the level of evidence in support of [percutaneous ablation] for well-selected older patients with small renal tumors,” they added. – by Alaina Tedesco

Disclosure: Talenfeld reports receiving grants from the Association of University Radiologists GE Radiology Research Academic Fellowship and the Society of Interventional Radiology Foundation. Please see study for all other authors’ relevant financial disclosures.