“Partial nephrectomy for small renal masses is the standard treatment that should be offered to all patients for whom an intervention is indicated and who possess a tumor that is amenable to this approach.”— Antonio Finelli, MD (left), Paul Russo, MD, and colleagues
As reported in the Journal of Clinical Oncology by Antonio Finelli, MD, of Princess Margaret Cancer Center, Toronto, and colleagues, ASCO has released a clinical practice guideline on management of small renal masses.1
The guideline was derived from an expert panel literature search for and review of systematic reviews, meta-analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes investigated included recurrence-free survival, disease-specific survival, and overall survival. A total of 83 studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and formed the evidentiary basis for recommendations.
The expert panel was co-chaired by Dr. Finelli and Paul Russo, MD, of Memorial Sloan Kettering Cancer Center, New York. Nofisat Ismaila, MD, MSc, Clinical Guideline Specialist at ASCO, Alexandria, Virginia, is the corresponding author for the Journal of Clinical Oncology article.
The key guideline clinical questions and recommendations are summarized/reproduced below. The type of recommendation, evidence quality, and strength of recommendation are shown in brackets.
Nofisat Ismaila, MD, MSc
Clinical Question 1: For patients who were diagnosed with a small renal mass, when is renal tumor biopsy indicated? What is the contemporary accuracy and complication profile of renal tumor biopsy?
Clinical Question 2: In patients with a small renal mass, is there an age limit at which active surveillance is a better option than surgical resection or thermal ablation? Is there an anticipated life expectancy for which active surveillance is a better option than surgical intervention or thermal ablation? Are patients with significant and active medical comorbidities—that is, chronic kidney disease, congestive heart failure, coronary artery disease, and chronic obstructive pulmonary disease—better treated with active surveillance than surgical intervention or ablation?
Clinical Question 3: In patients with a small renal mass, what are the optimal indications for undergoing partial nephrectomy, radical nephrectomy, or thermal ablation? What is the impact of these procedures on renal function?
Disclosure: For full disclosures of the guideline authors, visit ascopubs.org.