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Table 2. Percutaneous CA outcomes of stage T1b RCC

Study Atwell Andrews Hasegawa Hebbadj Gunn [88] Grange
et al.
et al. [85]
et al. [84]
et al. [86]
et al. [89]
et al. [87]
Tumor diameter mean (cm) 4.8 4.8 4.6 4.8 4.7 4.6
Sample size (Patients) 46 48 3 27 37 23
Biopsy (RCC) Yes No (Imaging) Yes Yes Yes Yes
Follow-up (months) 24 (Mean) NR 24.9 (Median) 20 (Mean) 26.4 (Mean) 13.9 (Mean)
Technical efficacy 98% NR 96% 88% 87% 86.3%
Secondary Technical efficacy NR NR 100% NR 91% 100%
Local recurrence 1/36 (2.8%) 3/48 (6%) 2/21 (9%) 3/26 (12%) 8/34 (23.5%) 2/23 (9%)
Metastatic disease 2/36 (6%) 2/35 (6%) 2/21 (9%) NR NR 1/23 (4%)
Major complications 8% NR 9% 11% 13% NR
Follow-Up Months 24 (Mean) NR 24.9 (Median) 20 (Mean) 26.4 (Mean) 13.9 (Mean)
(Mean/Median)

NR: Not reported; RCC: renal cell carcinoma.

well as modality of imaging, should be individualized based on the patient’s risk of recurrence or metastasis.
The AUA, NCCN, and EAU all recommend that the intensity of post-treatment follow-up and monitoring
be individualized based on the patient’s risk of recurrence [16-18] . This highlights the importance of obtaining
RTB prior to CA or at the time of CA to help determine the follow-up strategy. Although there is consensus
among guidelines that patients should have follow-up monitoring with imaging for at least 5 years following
treatment of RCC, there is less consensus on whether follow-up monitoring should be performed beyond 5
years. However, in a multinational and interdisciplinary Delphi consensus project, practitioners reached a
consensus that 10 years follow-up is preferred following focal therapy for RCC including CA. The Delphi
consensus initiative issued its follow-up proposal: the first scan be performed three months after therapy; in
the second year, the biannual imaging is performed; from the third year forward, annual imaging is
required. The first choice should be a 3-phase CT, and the second choice would be MRI using a
[93]
multiparametric technique .
Patients who have undergone an ablation procedure can still usually undergo salvage surgical extirpation
with PN or RN for residual unablated tumors or local recurrent tumors, but salvage surgery following
ablation is more challenging . Since many patients who undergo ablation were poor candidates for surgery
[94]
in the first place, it is not surprising that the majority of patients who have local tumor recurrence following
PCA undergo repeat PCA, similar to patients who have residual unablated tumors .
[72]

A LOOK TO THE FUTURE - POSSIBILITY OF COMBINATION THERAPIES AND ADJUNCTS
TO CRYOABLATION
Efforts have continued to develop techniques and technology that enhance the safety and effectiveness of
cryoablation. These efforts have included research focusing on optimizing parameters of cryoablation,
including temperature nadir, cryoprobe size and placement, ice ball margin, freeze-thaw cycle parameters,
and freeze-thaw cycle repetition. In addition to efforts to optimize cryoablation techniques and technology,
there has been recent interest in combining the use of cryotherapy with other treatments such as systemic
chemotherapy, systemic immunotherapy and transarterial embolization.

Sorafenib
Baust et al. studied the in vitro response of RCC to CA alone compared to combination therapy with
[95]
Sorafenib and CA. Pre-treatment with 10.61 μM sorafenib increased the reported minimum critical/lethal
temperature using a single or double freeze technique from -25 °C to -20 °C and from -20 °C to -15 °C,