Thermal Ablation refers to destruction of a tumor using extremes of temperature. This is typically performed by freezing (Cryoablation) or burning (Radiofrequency Ablation) the tumor. Ablation can be performed percutaneously (through the skin) or via surgical exposure (open or laparoscopic surgery).
Not all tumors are suitable for ablation and thus a discussion with a kidney cancer expert regarding all options is always best prior to selecting a treatment.
What are the benefits of thermal ablation?
Thermal ablation, particularly when performed percutaneously (or through the skin), is a minimally invasive option for the treatment of small renal masses. It is typically done by an interventional radiologist as an outpatient, same-day surgery and has a very favorable side effect profile (similar to a minimally invasive nephrectomy).
What is the downside to thermal ablation?
Not all tumors are amenable to thermal ablation. The freezing or burning is achieved through a needle or probe. Depending on a patient’s anatomy, it may be impossible to reach the mass without injuring an adjacent normal structure (like the intestine). Depending on where the tumor is in the kidney, it was also be challenging to reach the mass without injuring the vital blood supply or ureter (urinary drainage tube) of the kidney. Lastly, thermal ablation is not as efficacious as a kidney surgery and may require multiple treatments to achieve the same cure rate.
Is freezing (cryoablation) or burning (radiofrequency ablation) a better option?
Both of these procedures seem to have a similar success rates when performed by experienced centers. In general, at Johns Hopkins we prefer cryoablation as we find it easier to monitor the iceball and control the margins of tumor kill without harming normal, adjacent tissue.
We recommend all patients undergo a thorough consultation with a kidney cancer expert prior to committing to a thermal ablation procedure. It is important to see a surgeon in a center that offers all the options so that the optimal decision is made. You should not let the inexperience of a surgeon guide you to the wrong procedure.