PURPOSE: Renal tumor size influences the efficacy of radio frequency ablation 
but identification of confident size cutoffs has been limited by small numbers 
and short followup. We evaluated tumor size related outcomes after radio 
frequency ablation for patients with adequate (greater than 3 years) followup.
MATERIALS AND METHODS: We identified 159 tumors treated with radio frequency 
ablation as primary treatment. Disease-free survival was defined as the time 
from definitive treatment to local recurrence, detection of metastasis or the 
most recent imaging showing no evidence of disease. Patients were evaluated with 
contrast enhancing imaging preoperatively, and at 6 weeks, 6 months and at least 
annually thereafter.
RESULTS: Median tumor size was 2.4 cm (range 0.9 to 5.4) with a median followup 
of 54 months (range 1.5 to 120). Renal cell carcinoma was confirmed in 72% of 
the 150 tumors that had pre-ablation biopsy (94%). The 3 and 5-year disease-free 
survival was comparable at 92% and 91% overall, and was dependent on tumor size, 
being 96% and 95% for tumors smaller than 3.0 cm and 79% and 79%, respectively, 
for tumors 3 cm or larger (p=0.001). Most failures (14 of 18) were local, either 
incomplete ablations or local recurrences. This is an intent to treat analysis 
and, therefore, includes patients ultimately found to have benign tumors, 
although outcomes were comparable in patients with cancer.
CONCLUSIONS: Radio frequency ablation treatment success of the small renal mass 
is strongly correlated with tumor size. Radio frequency ablation provides 
excellent and durable outcomes, particularly in tumors smaller than 3 cm. Of 
tumors 3 cm or larger, approximately 20% will recur such that alternative 
treatment techniques should be considered. However, most treatment failures are 
local and are often successfully treated with another ablation session.