Active Surveillance

The gold standard treatment is partial nephrectomy, though a proportion of patients are not good surgical candidates due to age and/or comorbidities.5 For these patients, active surveillance may be an ideal treatment strategy and is now recommended as an option by ASCO.

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“Active surveillance is a relatively new concept (within the past 10 years) that is akin to active surveillance employed for prostate cancer and testicular cancer,” Marc C. Smaldone, MD, MSHP, an assistant professor of urologic oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania, told Cancer Therapy Advisor. At the general session, Dr Smaldone will discuss active surveillance as a primary treatment strategy for SRMs.

For SRMs, active surveillance consists of serial imaging to establish the tumor’s growth kinetics, according to Dr Smaldone, and is “most appropriate for small tumors (smaller than 3 cm) with stable growth kinetics in patients who are poor candidates for surgical intervention due to competing risks to mortality.”

The rationale behind active surveillance is that partial nephrectomy is associated with risk of complications, while 20% to 30% of SRMs are found to be histologically benign and over 50% demonstrate an indolent growth pattern.5 Several studies found that during active surveillance, the mean growth rate per year is 0.12 to 0.31 cm, and only 1% to 2% of SRMs progress to metastatic disease.6,7 Long-term follow-up is needed, however, to confirm the low metastatic rates of SRMs, Dr Smaldone said.

In a 5-year analysis of the DISSRM [Delayed Intervention and Surveillance for Small Renal Masses; Identifier: NCT02346435] registry, cancer-specific survival was 99% and 100% for primary intervention and active surveillance, respectively.8

Dr Smaldone noted that “emerging imaging modalities can better identify histologic subtype for malignant lesions or determine benign histology,” enabling improved patient selection for active surveillance vs partial nephrectomy.