CUA 2018: Outcomes of Metastasectomy in Metastatic Renal Cell Carcinoma Patients: The Canadian Kidney Cancer Information System Experience

Halifax, Nova Scotia (UroToday.com) In common urological practices, it has been shown that over 25% of patients are diagnosed with metastasis at the time of renal cell carcinoma (RCC) diagnosis and up to 35% will eventually progress to metastasis after some time. There have been recent indications that state that surgical resection of these metastatic tumors can be integrated into the treatment plan with the possibility of slowed disease progression and increased survival. Sara Nazha, MD of McGill University determined to discover the efficacy of this treatment by conducting a multi-center retrospective study to assess the impact of metastasectomy in patients suffering from metastatic RCC (mRCC). 

CUA 2018: Development of a Patient Decision Aid for Complex, Localized Renal Masses

Halifax, Nova Scotia (UroToday.com) One particularly challenging aspect of quality patient care is the allowance of the patient to make their own informed decisions regarding their care. The problem therein lies in the gap in understanding between the patient and physician’s perception of risk stratification. In particular, in regard to kidney cancer, the decision between radical versus partial nephrectomy remains a debated decision in urology for localized renal masses. Therefore, Dr. Kristen McAlpine and her team of urologists at the University of Ottawa attempted to develop a decision aid for patients with localized renal masses deciding on a proper surgical approach. 

CUA 2018: Surveillance Post-Radio Frequency Ablation For Small Renal Masses: Recurrence and Follow-Up

Halifax, Nova Scotia (UroToday.com) Small renal masses (SRMs) are a particularly worrisome condition that affects patients at a high volume worldwide and have actually increased in prevalence due to increases quality of imaging technologies. These tumors, usually less than 4 cm in diameter, are particularly daunting due to the possibility of them being renal cell carcinoma (RCC) and becoming metastatic. Typically, partial nephrectomy is the gold standard for the treatment of SRMs. However, an increase of radio frequency ablation (RFA) has emerged as a less invasive alternative to surgery.

CUA 2018: Comparative Survival Following Initial Cytoreductive Nephrectomy versus Initial Targeted Therapy for Metastatic Renal Cell Carcinoma

Halifax, Nova Scotia (UroToday.com) Bimal Bhindi, MD presented a population level analysis assessing survival following upfront cytoreductive nephrectomy (CN) versus targeted therapy (TT) for patients with metastatic RCC. The optimal sequence of CN and TT for patients with mRCC remains to be established. The CARMENA study demonstrated that sunitinib was non-inferior to CN followed by sunitinib.1. Therefore, the authors aimed to compare overall survival (OS) between patients with mRCC receiving initial CN with or without subsequent TT versus initial TT with or without subsequent CN.

CUA 2018: Surveillance Post-Radio Frequency Ablation for Small Renal Masses: Recurrence and Follow-Up

Halifax, Nova Scotia (UroToday.com) The management of renal cell carcinoma (RCC) continues to evolve as we begin to develop a better understanding of its natural history. We now know that growth kinetics can vary significantly for renal masses, and those with slow growth kinetics can often be watched without losing the opportunity for cure. As such, there has been a shift from surgery (radical or partial nephrectomy for every renal mass) to more conservative options to help reduce morbidity, unnecessary treatment and to spare nephrons. Active surveillance for small renal masses has become more established and is now a front-line treatment option in many guidelines. Similarly, when masses are small but growing, an alternative to surgery is focal therapy – radiofrequency ablation (RFA) being one such energy source option. 

CUA 2018: Predictors of a Positive Genetic Test Result in Patients with a Suspected Hereditary Kidney Cancer Syndrome: Results from a Provincial Medical Genetics Unit

Halifax, Nova Scotia (UroToday.com) Andrea Kokorovitch, MD, presented a study attempting to assess risk factors associated with a positive genetic test in a real-life cohort of patients referred to medical genetics for evaluation of hereditary renal cell carcinoma (RCC).

CUA 2018: Development of a Patient Decision Aid for Complex, Localized Renal Masses

Halifax, Nova Scotia (UroToday.com) Management of renal cell carcinoma (RCC) has traditionally been a surgically managed disease, and while alternatives have risen for small renal masses (active surveillance, focal therapy), for larger cT1b+ renal masses, the standard of care is still extirpative management. Yet, the decision to proceed with either a nephron-sparing partial nephrectomy (nephron-sparing, albeit with more potential complications) or a laparoscopic radical nephrectomy (not nephron-sparing but usually with fewer complications due to the lack of reconstruction) can be a tough one. Sometimes it is determined by disease factors (ie complexity of the tumor, nephrometry score, etc) or physician factors (preference, comfort). However, sometimes both options are equal and the options are offered to the patient – but it is not an easy decision to make.
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