Renal Tumour ablation

Thermal ablation refers to the heating or cooling of tumour tissue to cause necrosis (cell death). It is a well-established, safe and effective treatment option for tumours in many parts of the body, including the kidney, liver, and lung.

Renal Cell Carcinoma (RCC) refers to the most common type of malignant (cancerous) tumour of the kidney. Risk factors include smoking, obesity, hypertension, chronic kidney disease, male gender (2:1 ratio compared to female), and genetic syndromes such as Von Hippel-Lindau. Renal Cell Carcinoma (RCC) is commonly identified incidentally on imaging tests such as CT, MRI or ultrasound, however symptoms may include haematuria (blood in the urine), flank pain, and unexpected weight loss. Tumours detected early are commonly small and confined to the kidney, whereas those detected later may be larger and spread to other parts of the body. The appropriate treatment options and comparative effectiveness depend largely on the stage of the tumour.

Renal Cell Carcinoma (RCC) may be effectively treated with thermal ablation by an Interventional Radiologist (IR). Percutaneous renal tumour ablation is performed under ultrasound and/or CT imaging guidance, with placement of a needle into the tumour, and ablation treatment delivered to the tumour. This causes the tumour cells to undergo necrosis (cell death), rendering the tumour inactive.

Suitability for the treatment will depend on a number of factors including the tumour size and location.

Small Localised RCC Tumour (Stage T1a, ≤4 cm)

Thermal ablation has a recurrence-free survival rate of over 95% at 2 years and 80% at 5 years for T1a tumours, which is similar to nephrectomy (surgical removal). Thermal ablation may be offered as a first-line treatment for T1a tumours, particularly in cases when surgery may be inappropriate due to prior nephrectomy, multiple tumours, advanced age, and significant other medical issues. There is a risk (approximately 10%) of residual or recurrent tumour that can typically be retreated effectively with further thermal ablation.

Larger Localised RCC Tumour (Stage T1b, 4–7 cm)
Thermal ablation is not as effective compared to nephrectomy (surgical removal) for tumours of this size, and ablation would typically only be offered as a treatment if surgery was not suitable due to factors such as prior nephrectomy, multiple tumours, advanced age, and significant other medical issues.

Locally Advanced (T2) or Metastatic RCC Tumours

Thermal ablation is generally not suitable for ablation treatments. Treatment may involve surgical removal and/or chemotherapy/immunotherapy. This would be managed by a urologist or medical oncologist.

1. A specialist interventional radiologist will first consult and examine you in the outpatient clinic to assess your suitability for renal tumour ablation. If you are not suitable for ablation, your Interventional Radiologist (IR) will discuss this with you and arrange referral to another specialist as appropriate.
2. Renal tumour ablation is general performed under sedation or general anaesthetic with a specialist anaesthetist
3. You will typically be positioned prone (lying on your stomach) in a CT procedure room
4. A needle is passed through the back and into the kidney tumour. The needle is then connected to an ablation generator that delivers heat energy to the tumour over a period of 10 to 45 min.
5. You will be required to rest in bed for approximately 2 hours post-operatively, which is to minimise bruising.
6. Most patients experience some pain, typically a mild-moderate dull ache, after the procedure, which is treated with pain medications. You may also pass some blood in the urine (haematuria).
7. The procedure is typically performed with an overnight hospital stay and most patients are able to go home the next day, returning to usual activities within 1 or 2 weeks
8. After going home, you will need to undergo follow up scans, blood tests and consultation with Interventional Radiology at 3 months, 6 months, 12 months, then yearly for up to 5 years. This is to ensure that the tumour has been completely treated and does not have any residual component or recurrence, or to plan further treatment as required.

The overall risk of complications is low (<5%), lower than to surgical removal (nephrectomy), but these can include:

• Bleeding
• Bowel injury
• Infection
• Urine leakage (damage to urine system)

Interventional Radiologists (IRs) are uniquely specialty trained in both the advanced imaging assessment and grading of renal tumours and image-guided "pin-hole" procedures including biopsy and ablation. Interventional Radiologists (IRs) are broadly experienced in ablation procedures as they undergo comprehensive dedicated training in Radiofrequency Ablation (RFA), Cryoablation, and Microwave Ablation (MWA) of tumours throughout the body, including the kidney, liver, lung and thyroid.

It is important that all main main treatment options appropriate for your renal tumour are considered before proceeding with ablation, including surgical removal (nephrectomy). After consultation with our interventional radiologist, your case may be discussed with or you may be referred to consult with a urologist if you haven't previously seen one.

If you would like to consult with an Interventional Radiologist about renal tumour ablation, please send a referral for consultation, including the following

• CT and other imaging results
• Blood tests including coagulation and renal function
• Records of consultations with other doctors and specialists

Public eligible patients can undergo the treatment with no out-of-pocket expense in the public system.