Thermal ablation is being increasingly used for the treatment of clinical stage T1a renal cell carcinoma. However, it is not uncommon to hear mixed messages regarding this issue. Hence, it is necessary for every urologist to understand the basics of thermal ablation and its clinical outcome based on the latest literature to help guide their patients through treatment options. Patient selection criteria are also analysed. Among thermal ablation techniques, cryotherapy and radiofrequency are the most commonly performed ablative procedures. The superiority of one technique over the other is difficult to demonstrate in the absence of a randomised controlled trial. Local recurrence seems more likely after radiofrequency ablation than after cryotherapy, with the latter achieving better local control. When compared to partial nephrectomy, higher local recurrence rates are described with the thermal ablation techniques. However, the small difference at five year follow-up and the better tolerability profile of thermal ablation procedures in elderly and/or comorbid patients explain the rationale for their use in selected cases. Follow-up is mandatory in these patients to diagnose recurrence or persistence of the disease, to monitor renal function and to detect complications. Of note, redo-techniques and surgical approach, though challenging, remain possible salvage procedures after primary failure.

(BELG J MED ONCOL 2016;10(3):85–91)