Consideration in the management of renal cell carcinoma during the COVID-19 Pandemic

Abstract

Introduction: Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice. Objectives We propose a risk-based approach for patients with RCC, to be used during this unprecedented viral infection time. Materials and Methods: After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance. Results: Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a ((≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice. Conclusion:In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.

Cancer management during the COVID-19 pandemic: Choosing between the devil and the deep blue sea

“…Shortage of staff was also a contributor to the delay in cancer diagnosis and management, with the mobilization of healthcare providers and physicians to reinforce frontline pandemic care ( Wang and Zhang, 2020 ), along with the isolation of infected or exposed staff members and their unavailability for several days ( de C. Zequi and Abreu, 2020 ).…”

“…Several articles have provided insight into how practitioners should approach this difficult dilemma accordingly to each cancer histology. Suggestions and guidelines are available for head and neck, sino-nasal, spinal, breast, upper tract urothelial, cervical, penile, testicular, pancreatic, kidney, gastric, colorectal, skin, adrenal, liver, prostate, ovarian, endometrial, bladder and endocrine cancer ( Cohen et al, 2020 ; Baumann et al, 2020 ; Werner et al, 2020 ; Tarantola et al, 2013 ; Catanese et al, 2020 ; Vecchione et al, 2020 ; Turri-Zanoni et al, 2020 ; de C. Zequi and Abreu, 2020 ; Gravas et al, 2020 ; O’Leary et al, 2020 ; Casco et al, 2020 ; Katims et al, 2020 ; Berjano et al, 2020 ; Kapuria et al, 2020 ; P. March 25 and 2020, 2021 ; Tachibana et al, 2020 ; Loveday et al, 2020 ; Jones et al, 2020 ; Villani et al, 2020 ; Fligor et al, 2020 ; Sanchez et al, 2020 ; Wallis et al, 2020 ; Topf et al, 2020 ; Matsuo et al, 2020 ; Colombo et al, 2020 ; Campi et al, 2020 ; Raghavan et al, 2020 ).…”

Informed consent and a risk‐based approach to oncologic surgery in a cancer center during the COVID‐19 pandemic

“…Surprisingly, in the searched literature, we found only a few papers on the use of IC regarding trials of drugs for COVID-19, or about its use in general surgeries, intubation, and mechanical respiration, [25][26][27][32][33][34]39 and there were few on studies proposing IC documents focused on oncologic surgery during these exceptional times. 19,40 Motivated by this situation, physicians and institutional legal teams developed a comprehensive IC, which can be applied by all the oncological surgeons at our center. We took care to prepare a wide list of problems, both expected and unexpected, which could affect patients as well as health professionals.…”

“…Good communication and understanding are mandatory, and all decisions must be jointly taken by physicians, patients, and family members, and registered in medical charts. 19,[40][41][42] This new model IC dedicated to the surgical treatment of cancer patients during the COVID-19 pandemic and the new multidisciplinary comprehensive algorithm are tools that can improve safety for patients, health professionals, and institutions.…”

“…It can vary from immediate surgery to safely delayed surgery, or the use of efficacious alternative nonsurgical options during the COVID-19 threat [15][16][17][18][19][20][21][22][28][29][30][31][32][34]39,40…”