ORLANDO, FL (UroToday) - The increased use of abdominal CT scans has given rise to the incidental small renal mass. Although surgical extirpation remains the standard of care for these small renal masses (SRMs), data from active surveillance of these renal masses is emerging. Kunkle and colleagues from Philadelphia, Pennsylvania evaluated the published literature in addition to their own series (the largest to date) regarding clinically localized sporadic renal masses managed by active surveillance.Clinical and growth rate data pertaining to lesions undergoing metastatic progression while under observation were then analyzed.

The authors found 470 renal tumors managed by active surveillance at 14 instituions. Mean tumor size for all observed lesions was 2.83 cm. Mean duration of surveillance was 33.7 months (study range: 26.9-47.6). Metastatic disease was detected in 7/470 (1.5%) lesions under active surveillance. For lesions which did not metastasize, the mean net increase in tumor diameter during observation was 0.77 cm (study range: 0.19-1.86) while the mean growth rate was 0.29 cm/year (study range:0.06-1.02). For those lesions which progressed to metastatic disease, mean net increase in maximal tumor diameter was 3.15 cm (range 1.8-6) while mean growth rate was 0.74 cm/year (range 0.20-1.33) from the time of diagnosis to detection of metastases.

No lesions progressed to metastatic renal cell carcinoma in the absence of interval radiographic growth. Mean time from tumor diagnosis to clinical metastases was 65.4 months (range 20-132).

The authors found that metastatic progression of renal masses managed by active surveillance is an infrequent event. All reported primary lesions which progressed to metastatic renal cell carcinoma during a period of surveillance demonstrated rapid interval radiographic growth prior to clinical detection of metastasis, which was a delayed event (mean 65.4 months).

Their results suggest that an initial period of close radiographic surveillance may identify lesions at higher risk for progression and that active surveillance with delayed intervention may be a viable strategy for selected patients unfit or unwilling to accept risks associated with immediate intervention.

Moderated by: Christopher G. Wood, MD, and Richard A. Memo, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday Contributing Editor Michael K. Louie, MD

UroToday - the only urology website with original content global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday

Copyright © 2008 - UroToday

Tag Cloud