Management of small renal masses: American Society of Clinical Oncology Clinical Practice Guideline Journal Article

Authors: Finelli, A.; Ismaila, N.; Bro, B.; Durack, J.; Eggener, S.; Evans, A.; Gill, I.; Graham, D.; Huang, W.; Jewett, M. A. S.; Latcha, S.; Lowrance, W.; Rosner, M.; Shayegan, B.; Thompson, R. H.; Uzzo, R.; Russo, P.
Article Title: Management of small renal masses: American Society of Clinical Oncology Clinical Practice Guideline
Abstract: To provide recommendations for the management options for patients with small renal masses (SRMs). Methods By using a literature search and prospectively defined study selection, we sought systematic reviews, meta-Analyses, randomized clinical trials, prospective comparative observational studies, and retrospective studies published from 2000 through 2015. Outcomes included recurrence-free survival, disease-specific survival, and overall survival. Results Eighty-Three studies, including 20 systematic reviews and 63 primary studies, met the eligibility criteria and form the evidentiary basis for the guideline recommendations. Recommendations On the basis of tumor-specific findings and competing risks ofmortality, all patients with anSRMshould be considered for a biopsy when the results may alter management. Active surveillance should be an initial management option for patients who have significant comorbidities and limited life expectancy. Partial nephrectomy (PN) for SRMs 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. Percutaneous thermal ablation should be considered an option if complete ablation can reliably be achieved. Radical nephrectomy for SRMs should only be reserved for patients who possess a tumor of significant complexity that is not amenable to PN or for whomPN may result in unacceptablemorbidity even when performed at centers with expertise. Referral to a nephrologist should be considered if chronic kidney disease (estimated glomerular filtration rate , 45 mL/min/1.73 m2) or progressive chronic kidney disease occurs after treatment, especially if associated with proteinuria. ©2017 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 35
Issue: 6
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2017-02-20
Start Page: 668
End Page: 680
Language: English
DOI: 10.1200/jco.2016.69.9645
PROVIDER: scopus
PUBMED: 28095147
Notes: Review -- Export Date: 3 April 2017 -- Source: Scopus
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MSK Authors
  1. Paul Russo
    443 Russo
  2. Sheron Latcha
    12 Latcha
  3. Jeremy Charles Durack
    82 Durack