Interventional Radiology Society of Australasia Quality Care Guidelines for Renal Tumour Ablation in Australia and New Zealand.

Abstract

Image-guided thermal ablation (radiofrequency, cryo- and microwave ablation) is a safe and effective primary treatment for small renal mass and localised renal cell carcinoma ≤ 4 cm (T1a) with long-term cancer-specific survival rates equivalent to surgical resection (Level A). Image-guided thermal ablation can be considered as a treatment option for localised renal cell carcinoma > 4 cm (T1b) (Level B). Image-guided thermal ablation is a nephron-sparing treatment option, particularly for renal cell carcinoma in the solitary or syndromic kidney (Level B). Patients referred for consideration of image-guided thermal ablation of a small renal mass or RCC should be consulted pre-operatively by an Interventional Radiologist (IR) including comprehensive clinical evaluation and assessment of suitability (Level C). Pre-operative work-up should include medical history, physical examination, evaluation of functional status, comorbidities, assessment of coagulation status and renal function, and review of relevant imaging (Level B). Renal mass biopsy is recommended either prior to or at the time of image-guided thermal ablation (Level B). Tumour embolisation prior to thermal ablation is not routinely recommended (Level B). Renal tumour ablation should be performed with general anaesthetic or deep sedation, under cross-sectional imaging, and achieve an ablation zone margin of 5-10 mm. Adjunctive techniques should be used if the tumour is close to thermally sensitive structures (Level C). The treating interventional radiologist is a primary clinician responsible for care during a patient's admission for renal tumour ablation, including management of complications (Level C). Follow up after renal tumour ablation should include clinical consultation, renal function assessment, and cross-sectional imaging within 6 months, followed by regular cross-sectional imaging for 5 years (Level C). Renal tumour ablation is a cost-effective and preferred treatment for T1a renal cell carcinoma to maximise health benefits per dollar (Level B). Interventional Radiologists are the medical specialist group with suitable training and expertise to perform image-guided renal tumour ablation in Australia and New Zealand (Level C).