In Review | Interventional Radiology Programme | Oncology | Renal Tumours
Precision Ablation: Cryotherapy vs Radiofrequency for Renal Masses, Three Years ON
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This article is a summary and review of a recent study published in the Brazilian Journal of Urology. It does not constitute original research, nor is it intended to replace or replicate the original study. Unless otherwise referenced, all information presented remains the intellectual property of the original authors. For full details and context, readers are encouraged to access the original publication and consult the complete disclaimer information.
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Small renal masses (SRMs) are increasingly diagnosed incidentally, often in older or comorbid patients for whom surgery may not be the best option.
In this context, percutaneous thermal ablation (PTA) techniques have emerged as valuable alternatives to surgery, offering nephron-sparing treatment with lower procedural risk.
Among these, cryotherapy (CRYO) and radiofrequency ablation (RFA) are the most widely used. Both approaches use image guidance—typically computed tomography or ultrasound—to target the tumour precisely. CRYO induces cell death through extreme cold, creating an "ice ball" visible on imaging, while RFA uses thermal energy to achieve tumour necrosis.
These modalities are particularly attractive for patients unsuitable for partial nephrectomy (PN), offering reduced hospital stays, fewer complications, and better preservation of renal function. The current American Urological Association (AUA) guidelines support cryotherapy (CRYO) and radiofrequency ablation (RFA) as treatment options for small renal masses (SRMs) measuring less than 3 cm.
However, the European Association of Urology (EAU) remains more conservative, recommending PTA primarily for frail or comorbid patients due to limited prospective data. Much of the existing evidence is drawn from small, retrospective, single-centre studies.
To address these limitations, researchers Cabonara & Ditonno et al. sought to compare long-term oncologic outcomes of CRYO and RFA in a large, international, multicenter cohort
Let's take a Closer Look
The researchers collected data from seven academic institutions across the U.S. and Europe for patients treated between 2004 and 2020.
The study cohort consisted of adult patients diagnosed with a single, solid clinical T1 (cT1) renal mass, as confirmed by imaging, who underwent percutaneous ablation using either cryotherapy (CRYO) or radiofrequency ablation (RFA). Patients were excluded if they had multifocal or metastatic disease, lacked essential follow-up data, or did not have post-procedural imaging to verify successful ablation.
A total of 643 patients met the eligibility criteria and were included in the final analysis. Among them, 492 (71%) underwent cryoablation, while 151 (29%) received radiofrequency ablation.
Baseline clinical characteristics—including age, body mass index (BMI), ASA score, tumour size, clinical T stage, and RENAL nephrometry score—were broadly comparable between the two treatment groups.
There were, however, some notable differences. The RFA group had a lower baseline estimated glomerular filtration rate (eGFR) compared to the CRYO group (62.5 vs. 67.0 mL/min) and a higher prevalence of chronic kidney disease (CKD) stage III or greater (34.4% in the RFA group vs. 23.9% in the CRYO group).
Histological confirmation of malignancy was obtained preoperatively in 77.8% of patients, with clear cell renal cell carcinoma (ccRCC) being the most frequently identified subtype, accounting for 29.6% of cases.
The median duration of post-procedural follow-up was 43 months for patients treated with cryoablation and 37 months for those treated with radiofrequency ablation.
Results: Efficacy, Safety, and Outcomes
The researchers recorded that both treatments demonstrated high technical success, with image-confirmed ablation achieved in 95.8% of the entire cohort, 96.5% for CRYO and 93.4% for RFA, a difference that was not statistically significant (p=0.09)
Intraoperative complications occurred more frequently during CRYO procedures (3.3% vs. 0%, p = 0.02), although postoperative complication rates remained low and similar between the groups.
Specifically, overall postoperative complications were observed in 10.4% of CRYO patients and 6% of those treated with RFA (p = 0.1), while major complications were rare in both groups (CRYO: 0.8% vs RFA: 1.3%, p = 0.06).
Patients with benign pathology or missing oncologic follow-up were excluded from further analysis, leaving 536 patients for the cancer-specific outcomes (CRYO: 417; RFA: 119). Local recurrence was observed in 17.9% of cases overall, with rates of 15.6% for CRYO and 22.7% for RFA
Despite this numerical difference, 5-year local recurrence-free survival (RFS) rates were statistically similar: 85.7% for CRYO and 84.9% for RFA (p = 0.2).Distant metastases developed in 4.5% of patients, with a median onset at 23 months.
Five-year overall survival (OS) rates were likewise comparable: 89% for CRYO versus 87.4% for RFA (p = 0.8), with median follow-up times of 43 and 37 months, respectively.
Despite this numerical difference, 5-year local recurrence-free survival (RFS) rates were statistically similar: 85.7% for CRYO and 84.9% for RFA (p = 0.2).
Finally, the trifecta outcome—defined as the absence of recurrence, preservation of renal function, and no major complications—was achieved in 76.3% of cases, with no significant difference between groups. However, the multivariable analysis identified higher BMI and RENAL nephelometry scores ≥7 as independent predictors of trifecta failure.
New Perspectives
This study stands out as one of the few to compare mid- to long-term outcomes of cryotherapy (CRYO) and radiofrequency ablation (RFA) for small renal masses in a large, multicentre cohort.
The researchers found no significant differences in oncological outcomes between the two modalities, with comparable rates of technical success, local recurrence-free survival, metastasis-free survival, and overall survival at five years. These results align with previously published single-centre data and reinforce the role of percutaneous thermal ablation (PTA) as an effective nephron-sparing option.
Patient- and tumour-related factors, such as BMI, tumour location, and complexity, did not differ significantly between groups, thereby strengthening the comparability of outcomes. While intraoperative complications were slightly higher with CRYO, the overall complication rates for both techniques were low and in line with existing studies.
These findings may highlight a procedural advantage of the percutaneous approach over laparoscopic techniques, which have been associated with higher complication rates. The use of trifecta outcomes as a composite measure—combining oncological control, renal function preservation, and low complication rates—adds a novel dimension to PTA evaluation.
Overall, the study provides valuable evidence supporting the long-term safety and efficacy of CRYO and RFA, particularly in patients who are not ideal surgical candidates for partial nephrectomy.
What the Panel Says
Dr Gareth Bydawell
This study builds on recent trials comparing surgery and ablation for T1a renal tumours, which have shown comparable outcomes. One limitation worth noting is the exclusion of microwave ablation (MWA), a widely used percutaneous technique that has largely replaced radiofrequency ablation (RFA) in many centres worldwide
Dr Dale Creamer
With precise and targeted treatments for kidney lesions tailored to achieve a disease-free post-ablation margin, the use of both CRYO and RFA has transformed the management of early-stage disease. This is a crucial therapeutic option that oncologists can offer their patients to significantly enhance outcomes.
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Original Study
Carbonara U, Ditonno F, Beksac AT, Derweesh I., et al. Percutaneous Cryotherapy and Radiofrequency Ablation of Renal Masses: Multicenter Comparative Analysis with Minimum 3-Year Follow-up. Int Braz J Urol. 2025 Mar-Apr;51(2):e20240565. doi: 10.1590/S1677-5538.IBJU.2024.0565. PMID: 39913094; PMCID: PMC11884627
Category: Interventional Radiology
Cross Reference: Oncology, Nephrology
Keywords: renal tumours, nephrology,
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