Surveillance may be a better option for older patients with kidney cancer
According to a news release of the American Society of Clinical Oncology (ASCO), ‘watch and wait’ strategy is preferable to surgery in elderly patients with kidney cancer. This alternative seems to be safer than surgery in elderly patients who, because of their poor health, cannot tolerate general anesthesia and surgery.
The researchers arrived at these conclusions after analyzing approximately 8,000 patients older than 66 years who were diagnosed with small renal tumors, that is tumours with a diameter less than 1.5 inches. It was found that of these patients, 70% had undergone either segmental resection or entire kidney removal, while the other 30% were followed by investigations such as magnetic resonance imaging, computed tomography or ultrasound. “Physicians can comfortably tell an elderly patient, especially a patient that is not healthy enough to tolerate general anesthesia and surgery, that the likelihood of dying of kidney cancer is low and that kidney surgery is unlikely to extend their lives,” said study lead author Dr. William Huang, an assistant professor of urologic oncology at NYU Medical Center.
What is interesting is that after 5 years of follow-up, 25% of patients died from all causes and only 3% of renal cancer. Moreover, mortality rate of patients who undergone surgery was the same as mortality rate of those unoperated who underwent surveillance. It was also seen that patients who were monitored had a lower rate of death from any cause and a lower risk of having heart problems or stroke. However, Huang mentioned that some patients prefer to be operated. He added that if a patient’s health status allows surgery, he may opt for it because it can prolong life expectancy.
Another finding of researchers at NYU Medical Center was that the number of patients diagnosed with kidney cancer who underwent surveillance increased from 25% to 37% in the period 2000-2007. This shows that doctors began to become aware that small renal tumors, even though cancerous, are not necessarily life-threatening, and that the best option is surveillance. Dr. Manish Vira, director of the fellowship program in urologic oncology at North Shore LIJ’s Arthur Smith Institute for Urology, pointed out that small renal tumors are slowly growing and that the risk is low especially in elderly patients. He also mentioned that although the risk of dying from kidney cancer is small, it is not yet zero, as demonstrated by the 3% of patients who died of kidney tumor. Vira added that an investigation would be interesting to see if these patients have certain risk factors. This would allow researchers to discover specific treatment for elderly patients with small renal tumors.