Drug-eluting bead transarterial chemoembolization combined with cryoablation for renal cell carcinoma

Treatment approaches available to manage small renal masses (SRMs) include active surveillance, SRM ablation, partial nephrectomy (PN), or radical nephrectomy. Advances in local ablative technologies, together with the aging of the global patient population, have led to increased interest in the use of percutaneous ablation as an approach to managing localized renal cell carcinoma (RCC). Cryoablation is a widely used approach that demonstrates efficacy and a favorable safety profile in the treatment of early stage RCC. During renal cryoablation, the target zone can be readily ablated and the procedure can be performed under local anesthesia. However, in contrast to other ablative techniques such as microwave or radiofrequency ablation, cryoablation fails to induce substantial coagulation, which can result in severe bleeding in some cases. Drug-eluting bead transarterial chemoembolization (DEB-TACE) is a novel embolization technique for unresectable RCC cases that can facilitate embolization of tumor-feeding arteries, thereby restricting tumor access to a robust blood supply.

A 75-year-old man presented with a 3.4 cm tumor in the midpole of the right kidney that was diagnosed as RCC on histological examination. Because of comorbid chronic obstructive pulmonary disease, the patient could not undergo general anesthesia. The patient was successfully managed via tumor cryoablation following DEB-TACE.

The combination of DEB-TACE and cryoablation can result in significant short-term reductions in renal tumor size, improving patient quality of life, and prolonging survival owing to the complementary and synergistic effects of these two interventions.