**4. Investigational and experimental treatments**

#### **4.1. Laser interstitial thermal therapy (LITT)**

This treatment modality is currently being evaluated for treatment of solid tumours including brain, pancreatic, breast, thyroid and prostate cancer. LITT utilizes image guided low voltage laser probes to deliver heat and destroy target tissue. Optical fibres are inserted directly to the target tissue. Laser light delivers heat that is converted to heat. The emitted light energy from laser fibres is absorbed and converted to heat. This would result in thermal destruction of the cancer cells [26]. Neodymium: yttrium-aluminium-garnet (Nd:YAG) laser has been used to treat small renal tumours. All reports are based on small number of treated patients with short follow up [27, 28]. LITT remains an experimental treatment.

**Author details**

\* and Amr Emara2

1 Frimley Park Hospital, Frimley, UK

\*Address all correspondence to: manar.malki@nhs.net

2 Basingstoke and North Hampshire Hospital, Basingstoke, UK

[1] Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, et al. editors. SEER Cancer Statistics Review, 1975-2005. Bethesda, MD: National Cancer Institute;

Focal Therapy in Kidney Cancer

219

http://dx.doi.org/10.5772/intechopen.85819

[2] Hollingsworth JM, Miller DC, Daignault S, et al. Rising incidence of small renal masses: A need to reassess treatment effect. Journal of the National Cancer Institute. 2006;**98**:1331

[3] Butler BP, Novick AC, Miller DP, et al. Management of small unilateral renal cell carci-

[4] Gratzke C, Seitz M, Bayrle F, et al. Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in

[5] D'Armiento M, Damiano R, Feleppa B, et al. Elective conservative surgery for renal carcinoma versus radical nephrectomy: A prospective study. British Journal of Urology.

[6] Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. European Urology.

[7] White WM, Kaouk J. Ablative therapy for renal tumours. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, editors. Campbell's Urology. 10th ed. Philadephia, PA: WB Saunders

[8] Campbell S, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA

[9] Ljungberg B, Albiges L, Bensalah K, et al. EAU Guidelines on Renal Cell Carcinoma. 2018. Available from: https://uroweb.org/wp-content/uploads/EAU-RCC-Guidelines-

[10] A feasibility study for a multicentre randomised controlled trial to compare Surgery (partial nephrectomy) with needle ablation techniques (radiofrequency ablation/

nomas: Radical versus nephronsparing surgery. Urology. 1995;**45**:34

patients with renal cell carcinoma. BJU International. 2009;**104**:470

guideline. The Journal of Urology. 2017;**198**(3):520-529

Manar Malki1

**References**

2008

1997;**79**:15

2011;**59**:543

Co; 2012

2018-large-text.pdf

#### **4.2. Extracorporeal high-intensity focused ultrasonography (HIFU)**

The therapeutic use of the ultrasound to treat cancer was established in the 1970s. The mechanism of HIFU involves mechanical and thermal effects. Some of the acoustic wave is converted to heat once absorbed by the tissue. The thermal phenomenon causes cell death by coagulation necrosis once tissue temperature exceeded the 65°C. The mechanical effect causes micro-streaming, cavitation and radiation force [29].

HIFU offers completely trackless non-invasive ablative technology. Treatment session can be lengthy. Several studies reported incomplete treatment when renal tumours were excised following HIFU treatment. Skin burns were reported up to 10% of the patients. Respiratory movement and acoustic interference could impede on delivering treatment accurately. Other limitations to HIFU treatment include limited focal zone depth and inability to monitor treatment progression in real life [30–32]. Recent studies investigated the role of magnetic resonance-guided high intensity focused ultrasound. The results are promising, however it remains experimental [33, 34].

Laparoscopic HIFU has recently evolved to overcome the challenges related to respiratory movements, targeting tumours and acoustic interference.

HIFU is considered to be experimental treatment. It could be considered in some selected cases.
