As reported in the Journal of Clinical Oncology by Antonio Finelli, MD, of Princess Margaret Cancer Centre, Toronto, and colleagues, ASCO has released a clinical practice guideline on management of small renal masses.
The guideline was derived from an expert panel literature search for and assessment 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, disease-specific, 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 the recommendations. The expert panel was co-chaired by Dr. Finelli and Paul Russo, MD, of Memorial Sloan Kettering Cancer Center.
The key guideline clinical questions and recommendations are summarized/reproduced here. The type of recommendation, evidence quality, and strength of recommendation are shown in brackets.
Key Recommendations
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?
Qualifying statement: absolute indication: high risk for anesthesia and intervention or life expectancy < 5 years; relative indication: significant risk of end-stage renal disease if treated, small renal mass (< 1 cm), or life expectancy < 10 years
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?
Nofisat Ismaila, MD, of ASCO, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.