Chan Vinson Wai-Shun, Ng Helen Hoi-Lam, Abdulrauf Khalil, Zaman Hira, Ahmed Aisha, Zhong Jim, Wah Tze Min
Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK.
Medicina (Kaunas). 2025 Feb 28;61(3):438. doi: 10.3390/medicina61030438.
Percutaneous image-guided ablation (IGA) has emerged as an established alternative to surgical management for small renal masses. This comprehensive review examines traditional and emerging indications, energy sources, techniques, and future developments in IGA for renal cancer treatment. Traditionally, IGA has been indicated for frail or comorbid patients, those with solitary kidneys or chronic kidney disease, and those with histologically proven renal cell carcinomas less than 4 cm in size. Recent evidence supports expanding these indications to include T1b or T2 tumours and hereditary or recurrent renal cell carcinomas. The use of IGA combined with pre-ablation transarterial embolisation is discussed herein. This review then explores traditional energy sources including radiofrequency ablation, cryoablation, and microwave ablation, highlighting their respective advantages and limitations. Emerging technologies such as irreversible electroporation and histotripsy, as promising alternatives, are then presented, highlighting their advantage of being able to treat tumours near critical structures. Future research priorities highlight the need to establish high-quality evidence through innovative trial designs, as well as taking patient-reported outcome measures into account. Health economic considerations are key to ensuring that ablation therapies are cost-effective. The integration of artificial intelligence and radiomics shows vast potential for improving patient selection and treatment outcomes. Additionally, the immunomodulatory effects of ablative therapies suggest possible synergistic benefits when combined with immunotherapy which also require exploration in future research. Technological advancement and research developments will continue to broaden the role of IGA in clinical practice.
经皮影像引导下消融术（IGA）已成为小肾肿瘤手术治疗的既定替代方案。本综述全面探讨了IGA在肾癌治疗中的传统和新出现的适应证、能量来源、技术及未来发展。传统上，IGA适用于体弱或合并症患者、单肾患者或慢性肾病患者，以及组织学证实的直径小于4 cm的肾细胞癌患者。最近的证据支持将这些适应证扩大到包括T1b或T2肿瘤以及遗传性或复发性肾细胞癌。本文讨论了IGA联合消融前经动脉栓塞术的应用。本综述接着探讨了传统能量来源，包括射频消融、冷冻消融和微波消融，突出了它们各自的优点和局限性。然后介绍了不可逆电穿孔和组织超声破碎术等新兴技术，它们作为有前景的替代方法，突出了能够治疗关键结构附近肿瘤的优势。未来的研究重点强调需要通过创新试验设计建立高质量证据，同时考虑患者报告的结局指标。卫生经济学考虑是确保消融治疗具有成本效益的关键。人工智能和放射组学的整合在改善患者选择和治疗结局方面显示出巨大潜力。此外，消融治疗的免疫调节作用表明与免疫治疗联合时可能具有协同效益，这也需要在未来研究中探索。技术进步和研究发展将继续拓宽IGA在临床实践中的作用。
