Renal Cell Carcinoma Treatment
ACTIVE SURVEILLANCE
A study on 89 patients older 80 years with T1 masses show 5yr cancer specific survival of 95.6%. Tumor grew 1.28cm a year in patients who had metastatic disease vs. 0.18cm a year without. (3) Studies suggest small renal masses (<4cm) have less than 2% chance of progression to metastatic disease. (4,5,6) CSS at 1-3 yrs is >95% for <2cm masses(5,9,10). Another analysis of over 14,000 patients with tumors ≤4 cm showed no significant difference in overall survival whether surgery occurred within 30 days or beyond 6 months. A sensitivity analysis showed the lack of difference extended to patients who had surgery beyond 12 months. (7) A large study of 2770 patients found 20-25% of T1a tumors are benign with about 20% high grade or locally invasive. The percentage of benign tumors decreased from 46.3% for those less than 1 cm to 6.3% for those 7 cm or greater. (8)
See renal cysts section for statistics on renal cysts.
NEOADJUVANT
Adjuvant radiotherapy, hormonal therapy and cytotoxic chemotherapy have demonstrated no measurable survival benefit (2)
SURGICAL RESECTION
See surgery.
LYMPHADENECTOMY
See Landmark Studies.
ADJUVANT
See locally advanced & metastatic.
METASTASIS TREATMENT:
See locally advanced & metastasic section. 5-10% of appropriately selected patients respond to IL-2 for treatment of mRCC. (1)
A study on 89 patients older 80 years with T1 masses show 5yr cancer specific survival of 95.6%. Tumor grew 1.28cm a year in patients who had metastatic disease vs. 0.18cm a year without. (3) Studies suggest small renal masses (<4cm) have less than 2% chance of progression to metastatic disease. (4,5,6) CSS at 1-3 yrs is >95% for <2cm masses(5,9,10). Another analysis of over 14,000 patients with tumors ≤4 cm showed no significant difference in overall survival whether surgery occurred within 30 days or beyond 6 months. A sensitivity analysis showed the lack of difference extended to patients who had surgery beyond 12 months. (7) A large study of 2770 patients found 20-25% of T1a tumors are benign with about 20% high grade or locally invasive. The percentage of benign tumors decreased from 46.3% for those less than 1 cm to 6.3% for those 7 cm or greater. (8)
See renal cysts section for statistics on renal cysts.
NEOADJUVANT
Adjuvant radiotherapy, hormonal therapy and cytotoxic chemotherapy have demonstrated no measurable survival benefit (2)
SURGICAL RESECTION
See surgery.
LYMPHADENECTOMY
See Landmark Studies.
ADJUVANT
See locally advanced & metastatic.
METASTASIS TREATMENT:
See locally advanced & metastasic section. 5-10% of appropriately selected patients respond to IL-2 for treatment of mRCC. (1)
- Allard, Christopher B., et al. "Contemporary trends in high-dose interleukin-2 use for metastatic renal cell carcinoma in the United States." Urologic Oncology: Seminars and Original Investigations. Vol. 33. No. 11. Elsevier, 2015.
- Smaldone, Marc C., et al. "Adjuvant and neoadjuvant therapies in high-risk renal cell carcinoma." Hematology/Oncology Clinics 25.4 (2011): 765-791.
- Celtik, Kenan E., et al. "Active surveillance for incidental renal mass in the octogenarian."World journal of urology 35.7 (2017): 1089-1094.
- Pierorazio, Phillip M., et al. "Five-year analysis of a multi-institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry." European urology 68.3 (2015): 408-415.
- Jewett, Michael AS, et al. "Active surveillance of small renal masses: progression patterns of early stage kidney cancer." European urology 60.1 (2011): 39-44.
- Smaldone, Marc C., et al. "Small renal masses progressing to metastases under active surveillance." Cancer 118.4 (2012): 997-1006.
- Tan, W. S., Trinh, Q.-D., Hayn, M., Marchese, M., Lipsitz, S., Nabi, J., … Chang, S. (2019). PD46-02 DELAYED NEPHRECTOMY HAS COMPARABLE LONG-TERM OVERALL SURVIVAL TO IMMEDIATE NEPHRECTOMY FOR CT1A RENAL CELL CARCINOMA: A RETROSPECTIVE COHORT STUDY. The Journal of Urology, 201.
- Frank, Igor, et al. "Solid renal tumors: an analysis of pathological features related to tumor size." The Journal of urology 170.6 (2003): 2217-2220.
- Kunkle, David A., Brian L. Egleston, and Robert G. Uzzo. "Excise, ablate or observe: the small renal mass dilemma—a meta-analysis and review." The Journal of urology 179.4 (2008): 1227-1234.
- Gordetsky, Jennifer, et al. "Active surveillance of small renal masses." Urology 123 (2019): 157-166.