News
Active surveillance carries substantial risks for RCC patients
Monday, 7 December 2009- The issue of whether to choose for active surveillance (AS) or aggressive treatment in patients with small renal tumours is fraught with uncertainties. However, active surveillance has its own substantial risks and is not suited for younger patients, according to Prof. Michael Stöckle (Homburg/Saar, Germany).
"Surveillance strategies in kidney cancer are attracting attention simply because most of the kidney tumours nowadays are diagnosed in early, asymptomatic stages and this is simply caused by the inflationary use of imaging techniques," noted Stöckle in his state-of-the-art lecture at the recently concluded 2nd European Multidisciplinary Meeting on Urological Cancers (EMUC) held in Barcelona Spain.
In his lecture titled "Are active surveillance strategies viable options in the treatment of renal cell cancers?" Stöckle said many published studies on active surveillance showed that small tumours remain indolent for some years without detriment to the patient’s health.
"We are confronted with overtreatment in the screening population," Stöckle commented as he noted that some of these kidney tumours would not have harmed the patient if left untreated.
He cited what he called a classic 2004 study from Michael Jewett’s group (Canada) titled "The Natural History of Incidentally Detected Small Renal Masses," (Cancer), which described the surveillance in 32 patients with small, asymptomatic tumours and where none of the patients had disease progression. Stöckle said that since none of the patients developed metastasis during the observation period, the logical conclusion is that surveillance could be a reasonable option for some of the patients.
However, he also underscored that although the prognosis for many small renal tumours in general is favourable, "…minority of these tumours, certainly more than 15%, will behave aggressively."
"Inadequate treatment for these tumours can be fatal for the patient. Small tumours do not exclude aggressive behaviour…so don’t play down small renal tumours as they can behave aggressively,” he added.
In his concluding remarks, Stöckle said surveillance may be an option but it is a strategy that is not suitable for all RCC patients.
"Active surveillance could be recommended only for the very old and the very multi-morbid patients for whom the risks of surgery and the risk of anaesthesia is more relevant than the risk of an untreated tumour," he said whilst noting that the age limit can also present a dilemma since one has to define what is 'old.'
"For younger people active surveillance is not a strategy especially if they are responsible for a family," he said adding that active treatment is an option for younger patients without cardiovascular risk factors and with a higher life expectancy. Moreover, the risk of tumour progression under observation is more relevant than the risk of surgery (no mortality, serious complications < 5%).
Reiterating the need for effective treatment, Stöckle said: "Kidney cancer is a very unpredictable disease and when counselling patients always keep in mind that under treatment bears more substantial risks for the patient than over treatment."
Source: State-of-the-art lecture, Michael Stöckle,"Are active surveillance strategies viable options in the treatment of renal cell cancers?" 2nd European Multidisciplinary Meeting on Urological Cancers, Barcelina, Spain, November 26-29, 2009.
