SIR Today
Impact of multiple ablations on long-term oncologic outcomes
Presentation: Sunday, April 12 at 3 p.m. during the IO-Kidney Ablation session.
D.W. Cool, S. Albuqasim, R. Ladak, F. Lo, G. Watts, L. Cardarelli-Leite, S. Pautler, J. Izawa, J. Chin, A. Mujoomdar
New research indicates that successful renal cell carcinoma (RCC) ablation has no negative impact on long-term oncologic outcomes, enabling IRs to better plan and manage treatment.
“Impact of Multiple Ablations vs. Single Ablation Procedures for Treatment T1a Renal Cell Carcinoma (RCC): Evaluation of Adverse Event Rates and Long-Term Oncologic Outcomes” one of the SIR 2026 Featured Abstracts, sought to determine whether successful RCC ablation in a single procedure (primary technical success) or multiple procedures (secondary technical success) impacts adverse event rates or oncologic outcomes.
“At our center, the number of renal ablations we perform each year continues to grow, as we are seeing and treating younger and healthier patients who are choosing ablation over surgery for their small RCCs,” said lead author Derek W. Cool, MD, PhD. “As we expand the population that considers ablation as their therapeutic option, it is important to better understand potential consequences that incomplete ablation and multiple ablation procedures might have on our patients’ outcomes.”
According to Dr. Cool, he and his colleagues found very limited information on this topic within the renal ablation literature, which motivated them to pursue their research.
To determine whether patients who required multiple renal ablation procedures to successfully treat an RCC tumor had worse clinical outcomes than patients who were successfully treated with a single renal ablation procedure, researchers completed a retrospective study of all percutaneous ablation procedures performed at a single center from 2004-2022.
They reviewed outcomes of 269 patients and found that while 92% of patients had successful elimination of their RCC in a single ablation procedure, 8% required two or more ablations to achieve complete tumor response.
“We were pleased to find that patients who required more than one ablation did not have higher overall rates of complications or RCC disease recurrence,” Dr. Cool said.
According to Dr. Cool, knowing that performing more than one ablation to treat an RCC tumor does not negatively impact the long-term cancer outcomes or adverse event rates provides IRs with the power to plan their treatment approach in a way that best benefits the patient and the renal ablation program.
“For example, a more conservative initial ablation margin might be planned in patients who have impaired renal function or have a tumor located adjacent to critical internal renal structures—such as the collecting system,” he said. “Physicians may be more comfortable with a conservative approach, knowing that a second ablation can be performed if required and won’t impact their final outcome.”
Unlike surgery, a repeat ablation does not result in a harder procedure, nor does it appear to have a higher risk of an adverse event; therefore, a staged approach to RCC ablation can be considered.
“This fact is also important when comparing ablation to traditional surgery, in the sense that multiple ablations does indicate treatment failure, and it does not have the same impact as requiring a repeat surgery due to incomplete RCC resection with partial nephrectomy.”
According to Dr. Cool, the team plans to continue exploring the factors that impact ablation success and RCC recurrence.
“Among other things, we are developing tools using artificial intelligence to automatically identify the zone of ablation from CT and calculate the achieved ablation margin within the kidney,” he said. “We hope that this tool could be used to determine the optimal ablation margin needed for RCC to minimize the risk of local disease recurrence.”
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