The American Society of Clinical Oncology (ASCO) published new recommendations for the management of patients with clinically localized small renal masses (SRMs) in the Journal of Clinical Oncology.1 The recommendations aim to provide guidance for oncologists, urologists, and nephrologists, as well as mid-level providers, nurses, and patients.

The evidence-based guideline was developed by a multidisciplinary expert panel using data from 83 studies, which included 63 primary studies and 20 systematic reviews.

SRM is defined by the guideline as a contrast-enhancing tumor of a diameter of 4 cm or less, which is typically found incidentally. Commonly, SRMs are stage T1a renal cell carcinoma, but they can be lymphoma, sarcoma, metastasis, or benign cortical tumors.

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The guideline indicates that all patients with an SRM should be considered for a biopsy, particularly if the results may change management decisions.

The recommended standard treatment is partial nephrectomy for patients who are eligible for surgery. For tumors that are not amenable to partial nephrectomy, a full nephrectomy should be performed. Percutaneous thermal ablation is recommended as another option for patients in whom the tumor can be fully ablated. For patients with substantial comorbidities or limited life expectancy, the guideline recommends active surveillance.

For patients with chronic kidney disease, or who develop chronic kidney disease after SRM treatment, the guideline recommends that a referral to a nephrologist should be considered.

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Additional recommendations highlight the importance of the clinician-patient relationship with strong communication. ASCO recommends that clinicians should ensure that patients are educated and informed about their disease, and provide or recommend sources of information. All test results should be promptly discussed with the patient and caregiver, and the benefits of clinical trials should be explained.


  1. 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 Jan 17. doi: 10.1200/JCO.2016.69.9645 [Epub ahead of print]