Focal therapy in the management of small renal masses

Purpose of review Focal therapy has gained attention in the treatment of small renal masses. However its use is encased by scarce data on long-term outcomes and low evidence regarding perioperative complications. Our purpose is to review the emerging data in the past 18 months. Recent findings Population US-based studies show steady increase in the use of thermal ablation. Clinical series and comprehensive reviews support safety and mid/long-term efficacy. Comparative studies and meta-analysis outlined oncological inferiority against partial nephrectomy in local tumor control. There are profound demographic and tumor differences between patients treated by one or another. Complication rate is lower after ablation but the lack of standard reporting weakens conclusions on this point. Generalizable cost-benefit studies are yet missed. Clinical and basic research aims to diminish radiological associated burden, improving lesion targeting and developing new energy-based technologies. Summary Data confirm acceptable outcomes of focal therapy in the small renal masses treatment. Although these are inferior in terms of local control compared with partial nephrectomy, patients and tumor characteristics differ between treatments. Current data remain of low evidence but for some meta-analysis. Preliminary reports suggest the possibility to decrease radiation burden and bipolar radiofrequency and photodynamic therapy as focus of future interest