The role of active surveillance of small renal masses

Volpe, Alessandro

doi:10.1016/j.ijsu.2016.06.007

Cited by 29 publications

(9 citation statements)

References 54 publications

(61 reference statements)

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“…We included 20 systematic reviews from 7098 references identified from our database search (fig 1). 7 8 9 28 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 These 20 systematic reviews included 240 primary studies and 627 073 patients. Fifteen systematic reviews provided data to quantify the prevalence of detecting incidentalomas7 8 9 28 30 31 32 33 34 35 36 37 38 39 45 (table 1), whereas 18 provided data to quantify the outcomes of incidentalomas7 8 9 28 30 31 32 33 34 35 38 39 40 41 42 43 44 45 (table 2) (13 provided both).…”

Section: Resultsmentioning

confidence: 99%

Prevalence and outcomes of incidental imaging findings: umbrella review

O’Sullivan

Muntinga

Grigg

et al. 2018

BMJ

224

175

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ObjectiveTo provide an overview of the evidence on prevalence and outcomes of incidental imaging findings. DeSiGNUmbrella review of systematic reviews. Data SOurceSSearches of MEDLINE, EMBASE up to August 2017; screening of references in included papers. eliGibility criteria Criteria included systematic reviews and meta-analyses of observational studies that gave a prevalence of incidental abnormalities ("incidentalomas"). An incidental imaging finding was defined as an imaging abnormality in a healthy, asymptomatic patient or an imaging abnormality in a symptomatic patient, where the abnormality was not apparently related to the patient's symptoms. Primary studies that measured the prevalence of incidentalomas in patients with a history of malignancy were also considered in sensitivity analyses. reSultS 20 systematic reviews (240 primary studies) were identified from 7098 references from the database search. Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas (13 provided both). The prevalence of incidentalomas varied substantially between imaging tests; it was less than 5% for chest computed tomography for incidental pulmonary embolism in patients with and without cancer and whole body positron emission tomography (PET) or PET/computed tomography (for patients with and without cancer). Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging (MRI), chest computed tomography (for incidentalomas of thorax, abdomen, spine, or heart), and computed tomography colonoscopy (for extracolonic incidentalomas). Intermediate rates occurred with MRI of the spine (22%) and brain (22%). The rate of malignancy in incidentalomas varied substantially between organs; the prevalence of malignancy was less than 5% in incidentalomas of the brain, parotid, and adrenal gland. Extra-colonic, prostatic, and colonic incidentalomas were malignant between 10% and 20% of the time, whereas renal, thyroid, and ovarian incidentalomas were malignant around a quarter of the time. Breast incidentalomas had the highest percentage of malignancy (42%, 95% confidence interval 31% to 54%). Many assessments had high between-study heterogeneity (15 of 20 metaanalyses with I 2 >50%).cONcluSiONS There is large variability across different imaging techniques both in the prevalence of incidentalomas and in the prevalence of malignancy for specific organs. This umbrella review will aid clinicians and patients weigh up the pros and cons of requesting imaging scans and will help with management decisions after an incidentaloma diagnosis. Our results can underpin the creation of guidelines to assist these decisions.

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Section: Resultsmentioning

confidence: 99%

Prevalence and outcomes of incidental imaging findings: umbrella review

O’Sullivan

Muntinga

Grigg

et al. 2018

BMJ

224

175

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“…Evidence for the effectiveness of AS for DCIS, RCC or CLL is accumulating, [ 5 – 9 ] yet this scoping review found a paucity of research on patient or provider views and experiences of PE in decision-making for AS compared with prostate cancer for which AS is a standard option. [ 3 , 4 ] Among patients with DCIS, there was no difference in concern or treatment preferences if the condition was referred to as “abnormal cells” or “cancer”.…”

Section: Discussionmentioning

confidence: 99%

“…AS avoids or postpones definitive cancer treatment until there is evidence from periodic observation or testing that a patient is at risk of or has disease progression [ 2 ]. AS is considered a management option for patients with prostate cancer [ 3 , 4 ], and research is accumulating to establish the clinical effectiveness of AS for renal cell carcinoma (RCC) [ 5 , 6 ], ductal carcinoma in situ (DCIS) of the breast [ 7 ], follicular lymphoma [ 8 ] and chronic lymphocytic leukemia (CLL) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Patient and provider experiences with active surveillance: A scoping review

et al. 2018

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ObjectiveActive surveillance (AS) represents a fundamental shift in managing select cancer patients that initiates treatment only upon disease progression to avoid overtreatment. Given uncertain outcomes, patient engagement could support decision-making about AS. Little is known about how to optimize patient engagement for AS decision-making. This scoping review aimed to characterize research on patient and provider communication about AS, and associated determinants and outcomes.MethodsMEDLINE, EMBASE, CINAHL, and The Cochrane Library were searched from 2006 to October 2016. English language studies that evaluated cancer patient or provider AS views, experiences or behavioural interventions were eligible. Screening and data extraction were done in duplicate. Summary statistics were used to describe study characteristics and findings.ResultsA total of 2,078 studies were identified, 1,587 were unique, and 1,243 were excluded based on titles/abstracts. Among 344 full-text articles, 73 studies were eligible: 2 ductal carcinoma in situ (DCIS), 4 chronic lymphocytic leukemia (CLL), 6 renal cell carcinoma (RCC) and 61 prostate cancer. The most influential determinant of initiating AS was physician recommendation. Others included higher socioeconomic status, smaller tumor size, comorbid disease, older age, and preference to avoid adverse treatment effects. AS patients desired more information about AS and reassurance about future treatment options, involvement in decision-making and assessment of illness uncertainty and supportive care needs during follow-up. Only three studies of prostate cancer evaluated interventions to improve AS communication or experience.ConclusionsThis study revealed a paucity of research on AS communication for DCIS, RCC and CLL, but generated insight on how to optimize AS discussions in the context of routine care or clinical trials from research on AS for prostate cancer. Further research is needed on AS for patients with DCIS, RCC and CLL, and to evaluate interventions aimed at patients and/or providers to improve AS communication, experience and associated outcomes.

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“…Post-treatment care and contrast-enhanced imaging examinations are performed at intervals of 1, 6 and 12 months after the initial procedure and once each year thereafter [ 6 , 17 ]. Some elderly patients with small renal tumors are actively monitored without any surgical or interventional treatment [ 18 , 19 ]. They are often urologically asymptomatic and other diseases are much more serious and important for their life expectancy.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous radiofrequency and microwave ablation in the treatment of renal tumors - 10 years of experience.

Dvorák

Hoffmann

Broďák

et al. 2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionThe standard radical treatment of renal cell carcinoma is surgical resection, but it is not suitable for patients with serious medical comorbidities and solitary kidney tumors. Minimally invasive ablation techniques could be an appropriate therapeutic alternative.AimTo retrospectively evaluate the technical success, mid-term and long-term efficacy and safety of radiofrequency and microwave ablation in patients with small renal tumors.Material and methodsOver the course of 10 years, 91 ablation procedures in 64 patients for 68 tumors, of size 12–60 mm, were performed using only conscious sedation. These ablations were done under the guidance of computed tomography. We treated 41 males and 23 females with solitary kidney tumors (14 cases) and tumors in non-surgical candidates (54 cases).ResultsIn 50 (73.5%) tumors single treatment was successful; in 13 (19.1%) cases a second procedure was used successfully, and in the 5 largest tumors (sizes 45–60 mm, 7.4%) a third treatment was necessary. Within the follow-up 10 (15.6%) patients died, but none due to metastatic renal cell carcinoma. Only 1 serious complication was observed – retroperitoneal and psoatic hematoma. Early recurrence occurred in 18 (26.5%) tumors. Late recurrence was detected in 5 (7.4%) cases. In all cases complete local control of the renal tumors was reached.ConclusionsPercutaneous ablation is a very effective treatment for patients with small renal tumors of the T1a group with a minimal complication rate.

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The role of active surveillance of small renal masses

Abstract: Most SRMs are benign tumors or RCCs with a relatively indolent clinical behaviour. AS can be offered to patients with SRMs and decreased life expectancy. Prospective series of AS of histologically confirmed RCCs are needed to confirm the long term safety of this conservative approach.

Cited by 29 publications

References 54 publications

Prevalence and outcomes of incidental imaging findings: umbrella review

Prevalence and outcomes of incidental imaging findings: umbrella review

Patient and provider experiences with active surveillance: A scoping review

Percutaneous radiofrequency and microwave ablation in the treatment of renal tumors - 10 years of experience.

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