The American Society of Clinical Oncology (ASCO) released new recommendations for managing patients with clinically localized small renal masses (SRMs), published in the Journal of Clinical Oncology.
ASCO’s purpose in developing this guideline was to provide evidence-based recommendations for practicing physicians, oncologists, urologists, nephrologists, and other health care providers concerning the management of clinically localized SRMs. A multidisciplinary expert panel that convened via teleconference, webinar, and e-mail analyzed data from 83 studies, including 63 primary studies and 20 systemic reviews, involving SRMs over a 15-year period (2000 to 2015). The panel specifically evaluated the following outcomes in these studies: recurrence-free survival, disease-specific survival, and overall survival.
The panel arrived at 6 specific recommendations regarding treatment options and general management for patients with clinically localized SRMs. The guidelines recommend:
- All patients with an SRM should be considered for a biopsy, especially when the results could change management decisions
- Active surveillance should be an initial management option for patients with significant comorbidities and limited life expectancy;
- Patients who possess a tumor for which intervention is necessary should undergo partial nephrectomy as the standard treatment;
- Percutaneous thermal ablation should be a viable option for patients who possess tumors;
- Radical nephrectomy for SRMs should be reserved for patients with a tumor of significant complexity that cannot be amended by partial nephrectomy; and
- Referral to a nephrologist should be considered if chronic kidney disease develops after treatment.
Further recommendations emphasized the importance of strong communication in clinician-patient relationships. The guideline recommends that clinicians should ensure that patients are educated and informed as much as possible about their disease and provide them with sources for more information. All test results should be discussed with the patient and caregiver. Benefits of clinical trials should be explained in depth before choosing a course of treatment.
By implementing this guideline, authors write the health care providers will be doing their part for further advancement in a “rapidly evolving field of urologic oncology.”