An 80-year-old patient with an incidental finding of a 2-cm renal mass: a model case report and analysis of treatment options
Authors:
Michal Fedorko 1,2; Mariana Plevová 1; Vlastimil Válek 2,3; Petr Filipenský 2,4; Štěpán Tuček 5
Authors‘ workplace:
Urologická klinika Fakultní nemocnice Brno
1; Lékařská fakulta Masarykovy univerzity Brno
2; Klinika radiologie a nukleární medicíny Fakultní nemocnice Brno
3; Urologické oddělení Fakultní nemocnice u sv. Anny, Brno
4; Interní hematologická a onkologická klinika Fakultní nemocnice Brno
5
Published in:
Ces Urol 2022; 26(1): 29-37
Category:
Review articles
Overview
The article presents a model case of an elderly patient with a small renal tumor and discusses possible treatment options. It follows the communication presented by specialists from various medical disciplines at the 6th year of „Komplexní novinky v onkourologii (KNOU21)“ conference. The specific finding, the possible biological nature of the lesion, the natural course of the disease, the meaning, benefit and risks of active or delayed treatment and the specifics of the geriatric population require a critical look at current general recommendations and individualization of treatment strategy. Multidisciplinary approach with the subsequent discussion of all considered treatment options with the patient is absolutely crucial.
Keywords:
surgery – Biopsy – Active surveillance – small renal masses – thermal ablation
Sources
1. Brierley J, Gospodarowitz M, Wittekind C, et al. Union for International Cancer Control (UICC). TNM Classification of Malignant Tumours. 8th ed. Oxford, UK: John Wiley & Sons, Inc. 2017; 241.
2. Tomaszewski JJ, Uzzo RG, Kutikov A, et al. Assessing the burden of complications after surgery for clinically localized kidney cancer by age and comorbidity status. Urology. 2014; 83(4): 843–849.
3. Ball MW, Bezerra SM, Gorin MA, et al. Grade heterogeneity in small renal masses: potential implications for renal mass biopsy. J Urol. 2015; 193(1): 36–40.
4. Thompson RH, Hill JR, Babayev Y, et al. Metastatic renal cell carcinoma risk according to tumor size. J Urol. 2009; 182(1): 41–45.
5. Patel HD, Kates M, Pierorazio PM, et al. Comorbidities and causes of death in the management of localized T1a kidney cancer. Int J Urol. 2014; 21(11): 1086–1092.
6. Ljungberg B, Albiges L, Bedke J, et al. EAU Guidelines on Renal Cell Carcinoma. In: EAU Guidelines. Edition presented at the EAU Annual Congress Milan 2021. Arnhem, The Netherlands: EAU Guidelines Office. 2021; 84.
7. Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009; 182(4): 1271–1279.
8. Hora M, Eret V, Stránský P, et al. Laparoskopická resekce tumorů ledviny. Ces Urol. 2015; 19(2): 103–105.
9. Študent V, Hartmann I, Vidlář A, Grepl M. Roboticky asistovaná resekce ledviny pro tumor. Ces Urol. 2016; 20(1): 13–15.
10. Korc‑Grodzicki B, Downey RJ, Shahrokni A et al. Surgical considerations in older adults with cancer. J Clin Oncol. 2014; 32(24): 2647–2653.
11. Sun M, Becker A, Tian Z, et al. Management of localized kidney cancer: calculating cancer‑specific mortality and competing risks of death for surgery and nonsurgical management. Eur Urol. 2014; 65(1): 235–241.
12. Tang DH, Nawlo J, Chipollini J, et al. Management of Renal Masses in an Octogenarian Cohort: Is There a Right Approach? Clin Genitourin Cancer. 2017; 15(6): 696–703.
13. Kim SP, Thompson RH, Boorjian SA, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta‑analysis. J Urol. 2012; 188(1): 51–57.
14. Shuch B, Hanley J, Lai J, et al. Overall survival advantage with partial nephrectomy: a bias of observational data? Cancer. 2013; 119(16): 2981–2989.
15. Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006; 7(9): 735–740.
16. Huang WC, Atoria CL, Bjurlin M, et al. Management of Small Kidney Cancers in the New Millennium: Contemporary Trends and Outcomes in a Population‑Based Cohort. JAMA Surg. 2015; 150(7): 664–672.
17. Shah PH, Alom MA, Leibovich BC, et al. The Temporal Association of Robotic Surgical Diffusion with Overtreatment of the Small Renal Mass. J Urol. 2018; 200(5): 981–988.
18. Matějková M, Kočárek J. Rizika a komplikace robotické resekce ledviny u pacientů starších 65 let. Geriatr Gerontol 2019; 8(2): 59–63.
19. Poletajew S, Zapała P, Kopczyński B, et al. Surgical treatment for renal masses in the elderly: analysis of oncological, surgical and functional outcomes. Int Braz J Urol. 2019; 45(3): 531–540.
20. Thompson RH, Atwell T, Schmit G, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015; 67(2): 252–259.
21. Johnson BA, Sorokin I, Cadeddu JA. Ten‑Year Outcomes of Renal Tumor Radio Frequency Ablation. J Urol. 2019; 201(2): 251–258.
22. Kunkle DA, Uzzo RG. Cryoablation or radiofrequency ablation of the small renal mass: a meta‑analysis. Cancer. 2008; 113(10): 2671–2680.
23. Zhou W, Herwald SE, McCarthy C, Uppot RN, Arellano RS. Radiofrequency Ablation, Cryoablation, and Microwave Ablation for T1a Renal Cell Carcinoma: A Comparative Evaluation of Therapeutic and Renal Function Outcomes. J Vasc Interv Radiol. 2019; 30(7): 1035–1042.
24. Ahrar K, Matin S, Wood CG, et al. Percutaneous radiofrequency ablation of renal tumors: technique, complications, and outcomes. J Vasc Interv Radiol. 2005; 16(5): 679–688.
25. Pierorazio PM, Hyams ES, Mullins JK, Allaf ME. Active surveillance for small renal masses. Rev Urol. 2012; 14(1–2): 13–9.
26. Ray S, Cheaib JG, Pierorazio PM. Active Surveillance for Small Renal Masses. Rev Urol. 2020; 22(1): 9–16.
27. Mir MC, Capitanio U, Bertolo R, et al. Role of Active Surveillance for Localized Small Renal Masses. Eur Urol Oncol. 2018; 1(3): 177–187.
28. Smaldone MC, Kutikov A, Egleston BL, et al. Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis. Cancer. 2012; 118(4): 997–1006.
29. Pierorazio PM, Johnson MH, Ball MW, et al. Five‑year analysis of a multi‑institutional prospective clinical trial of delayed intervention and surveillance for small renal masses: the DISSRM registry. Eur Urol. 2015; 68(3): 408–415.
30. Sebastià C, Corominas D, Musquera M, et al. Active surveillance of small renal masses. Insights Imaging. 2020; 11(1): 63.
31. Rebez G, Pavan N, Mir MC. Available active surveillance follow‑up protocols for small renal mass: a systematic review. World J Urol. 2021; 39(8): 2875–2882.
32. Finelli A, Ismaila N, Bro B, et al. Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017; 35(6): 668–680.
33. Crispen PL, Viterbo R, Fox EB, et al. Delayed intervention of sporadic renal masses undergoing active surveillance. Cancer. 2008; 112(5): 1051–1057.
34. Finelli A, Cheung DC, Al‑Matar A, et al. Small Renal Mass Surveillance: Histology‑specific Growth Rates in a Biopsy‑characterized Cohort. Eur Urol. 2020; 78(3): 460–467.
35. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994; 47(11): 1245–1251.
36. Kutikov A, Egleston BL, Canter D, et al. Competing risks of death in patients with localized renal cell carcinoma: a comorbidity based model. J Urol. 2012; 188(6): 2077–2083.
37. Sammon JD, Pucheril D, Abdollah F, et al. Preventable mortality after common urological surgery: failing to rescue? BJU Int. 2015; 115(4): 666–674.
38. Ferraris VA, Bolanos M, Martin JT, Mahan A, Saha SP. Identification of patients with postoperative complications who are at risk for failure to rescue. JAMA Surg. 2014; 149(11): 1103–1108.
39. American College of Surgeons National Surgical Quality Improvement Program. Surgical Risk Calculator [online]. © 2007–2022 [cit. 2022-01-10]. Dostupné z: http://www.riskcalculator.facs.org/RiskCalculator/.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2022 Issue 1
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