The European Association of Urology (EAU) Renal Cell Carcinoma (RCC) Guideline Panel performed a protocol-driven systematic review (SR) on thermal ablation (TA) compared with partial nephrectomy (PN) for T1N0M0 renal masses, in order to provide evidence to support its recommendations. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and only comparative studies published between 2000 and 2019 were included. Twenty-six nonrandomised comparative studies were included, recruiting a total of 167 80 patients. Risk of bias (RoB) assessment revealed high or uncertain RoB across all studies, with the vast majority being retrospective, observational studies with poorly matched controls and short follow-up. Limited data showed TA to be safe, but its long-term oncological effectiveness compared with PN remains uncertain. A quality assessment of pre-existing SRs (n=11) on the topic, using AMSTAR, revealed that all SRs had low confidence rating, with all but two SRs being rated critically low. In conclusion, the current data are inadequate to make any strong and clear conclusions regarding the clinical effectiveness of TA for treating T1N0M0 renal masses compared with PN. Therefore, TA may be cautiously considered an alternative to PN for T1N0M0 renal masses, but patients must be counselled carefully regarding the prevailing uncertainties. We recommend specific steps to improve the evidence base based on robust primary and secondary studies. PATIENT SUMMARY: In this report, we looked at the literature to determine the effectiveness of thermoablation (TA) in the treatment of small kidney tumours compared with surgical removal. We found that TA could cautiously be offered as an option due to many remaining uncertainties regarding its effectiveness.

Department of Cancer Medicine Institut Gustave Roussy Villejuif France

Department of Nephrology and Hypertension Patient Advocate International Kidney Cancer Coalition University Medical Center Utrecht Utrecht The Netherlands

Department of Surgical and Perioperative Sciences Urology and Andrology Umeå University Umeå Sweden

Department of Urology and Urologic Oncology Hannover Medical School Hannover Germany

Department of Urology Cabueñes Hospital Gijón Spain

Department of Urology Chaim Sheba Medical Center Tel Hashomer Ramat Gan Israel

Department of Urology Coimbra University Hospital Coimbra Portugal

Department of Urology Elbe Kliniken Stade Stade Germany

Department of Urology Faculty Hospital and Faculty of Medicine in Pilsen Charles University Prague Prague Czech Republic

Department of Urology Ludwig Maximilians University Munich Germany

Department of Urology Royal Free Hospital London UK

Department of Urology Skåne University Hospital Malmö Sweden

Department of Urology Sunderby Hospital Sunderby Sweden

Department of Urology University Hospital Schleswig Holstein Lübeck Germany

Department of Urology University of Rennes Rennes France

Division of Urology Maggiore della Carita Hospital University of Eastern Piedmont Novara Italy

The Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science London UK; Department of Urology The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

The Royal Free NHS Trust and Barts Cancer Institute Queen Mary University of London London UK; Academic Urology Unit University of Aberdeen Aberdeen UK

Eur Urol Oncol. 2020 Aug;3(4):453-454. doi: 10.1016/j.euo.2020.06.002. PubMed

Citace poskytuje Crossref.org

Stereotactic Body Radiotherapy (SBRT) for the Treatment of Primary Localized Renal Cell Carcinoma: A Systematic Review and Meta-Analysis