scholarly journals Growth rates and outcomes of observed large renal masses

2018 ◽  
Vol 13 (8) ◽  
Author(s):  
Naji J. Touma ◽  
Gregory W. Hosier ◽  
Michael A. Di Lena ◽  
Robert J. Leslie ◽  
Louisa Ho ◽  
...  
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Growth Rates ◽  
Study Entry ◽  
Maximal Dimension ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Kaplan Meier ◽  
History Of ◽  
Metastatic Risk

Introduction: The natural history of small renal masses has been well defined, leading to the recommendation of active surveillance in some patients with limited life expectancy. However, this information is less clear for large renal masses (LRM), leading to ambiguity for management in the older, comorbid patient. The objective of this study was to define the natural history, including the growth rate and metastatic risk, of LRM in order to better counsel patients regarding active surveillance.Methods: This was a retrospective review of patients with solid renal masses >4 cm that had repeated imaging identified from an institutional imaging database. Patient comorbidities and outcomes were obtained through retrospective chart analysis. Outcomes assessed included tumour growth and metastatic rates, as well as cancer-specific (CSS) and overall survival (OS) usimg Kaplan-Meier methodology.Results: We identified 69 patients between 2005 and 2016 who met the inclusion criteria. Mean age at study entry was 75.5 years; mean tumour maximal dimension at study entry was 5.6 cm. CSS was 83% and OS 63% for patients presenting without metastasis, with a mean followup of 57.5 months. The mean growth rate of those that developed metastasis during followup (n=15) was 0.98 cm/year (95% confidence interval [CI] 0.33‒1.63) as compared to those that did not develop metastasis (n=46), with a growth rate of 0.67 cm/year (95% CI 0.34‒1) (non-significant). Seven patients had evidence of metastasis at the baseline imaging of their LRM and had subsequent growth rate of 1.47 cm/year (95% CI 0.37‒2.57) (non-significant).Conclusions: Compared to small renal masses, LRM are associated with higher metastasis rates and lower CSS and more rapid growth rates. Selection criteria for recommending observation of LRM in older, comorbid patients should be more conservative than for small renal masses.

scholarly journals The natural history of incidentally detected small renal masses

Cancer ◽  
2004 ◽  
Vol 100 (4) ◽  
pp. 738-745 ◽  
Author(s):  
Alessandro Volpe ◽  
Tony Panzarella ◽  
Ricardo A. Rendon ◽  
Masoom A. Haider ◽  
Filippos I. Kondylis ◽  
...  
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of

The Natural History of Incidental Meningiomas

Neurosurgery ◽  
2003 ◽  
Vol 53 (1) ◽  
pp. 62-71 ◽  
Author(s):  
Makoto Nakamura ◽  
Florian Roser ◽  
Julia Michel ◽  
Cornelius Jacobs ◽  
Madjid Samii
Keyword(s):  
Growth Rate ◽  
Natural History ◽  
Tumor Growth ◽  
Growth Rates ◽  
Tumor Size ◽  
Annual Growth ◽  
Tumor Doubling Time ◽  
History Of ◽  
Doubling Times ◽  
Initial Tumor Size

Abstract OBJECTIVE Little information about the natural history of incidental meningiomas exists in the literature. The aim of this study was to determine the natural history of asymptomatic meningiomas by comparing different methods of growth rate calculation to establish a strategy for dealing with these tumors. METHODS In 47 asymptomatic patients, hospital charts, follow-up records, and imaging studies were reviewed. Of these patients, 6 underwent surgery. Tumor growth rates were determined by calculating the absolute and relative growth rates and the tumor volume doubling times. RESULTS In 41 patients with conservative management, the average tumor size was 9 cm3, and the majority (66%) of growth rates were less than 1 cm3/yr. The absolute growth rate ranged from 0.03 to 2.62 cm3/yr (mean, 0.796 cm3/yr). Relative annual growth rates ranged from 0.48 to 72.8% (mean, 14.6%). The tumor doubling time ranged from 1.27 to 143.5 years (mean, 21.6 yr). A moderate correlation between the age and growth rates was found. In young patients, annual growth rates tended to be higher and tumor doubling times shorter. There was no clear correlation between the initial tumor size and tumor doubling time. The mean annual growth rate of meningiomas with calcification was lower than in tumors without calcification. Also, tumors with hypointense or isointense T2 signals on magnetic resonance imaging had a lower growth rate. In the group of six patients with surgical excision, tumor growth rates were higher and tumor doubling times shorter than in the nonsurgical group. CONCLUSION The majority of incidental meningiomas show minimal growth; thus, they may be observed without surgical intervention unless specific symptoms appear. Tumor growth is associated with patient age. The initial tumor size is not considered a predictive factor for tumor growth. Radiological features, such as calcification or T2 signal intensity, may provide useful information to predict the growth potential of meningiomas.

THE NATURAL HISTORY OF SMALL RENAL MASSES

2000 ◽  
pp. 1143-1147 ◽  
Author(s):  
RICARDO A. RENDON ◽  
NIR STANIETZKY ◽  
TONY PANZARELLA ◽  
MICHAEL ROBINETTE ◽  
LAWRENCE H. KLOTZ ◽  
...  
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of

scholarly journals The Role of Surveillance in the Management of Small Renal Masses

2007 ◽  
Vol 7 ◽  
pp. 860-868 ◽  
Author(s):  
Alessandro Volpe
Keyword(s):  
Natural History ◽  
Active Treatment ◽  
Initial Period ◽  
Renal Tumors ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Cross Sectional ◽  
Slow Growth Rate ◽  
History Of

Incidentally detected, small renal masses (SRMs) have been increasing significantly in recent years due to the widespread use of improved cross-sectional imaging. A significant number of incidental SRMs are diagnosed in elderly patients who are more likely to undergo imaging for other medical issues. The natural history of SRMs has not been historically well understood because most masses are surgically removed soon after diagnosis.Several reports of surveillance of SRMs have been published in the last few years. When followed conservatively with serial imaging, SRMs have variable growth rates with an average of 0.28 cm/year, according to a recent meta-analysis. Larger series with longer follow-up are needed, but a significant number of small tumors seem to have an indolent behavior with a slow growth rate and a limited tendency to progress. The standard of care for enhancing SRMs is surgery. Up to one-third of surgically removed, <4-cm tumors are histologically benign. The outcomes of current surgical treatment of histologically confirmed, <4-cm, renal cell carcinomas are excellent, but this has not led to a decrease in mortality. Based on these considerations and on the available data on the natural history of SRMs, it seems reasonable to consider that we may be overtreating these lesions. This is especially true for elderly or unfit patients who have a decreased life expectancy. In these selected patients and in patients who refuse active treatment, it seems reasonable to propose an initial period of active surveillance for incidental SRMs, with delayed intervention for those tumors that will exhibit fast growth during follow-up. Percutaneous needle biopsies of renal tumors can be safely performed with the use of modern techniques and have the potential to characterize SRMs at histologically diagnosis, thereby allowing a better selection of the conservative or active treatment that is best suited for each individual patient.

Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

scholarly journals 509: The Natural History of Small Renal Masses: A Prospective Multi-Center Canadian Trial

2007 ◽  
Vol 177 (4S) ◽  
pp. 169-170 ◽  
Author(s):  
Kamal Mattar ◽  
Julian Azuero ◽  
Ricardo Rendon ◽  
Christopher Morash ◽  
D. Robert Siemens ◽  
...  
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of

Management of Small Renal Masses

2018 ◽  
Author(s):  
Keith A Lawson ◽  
Antonio Finelli
Keyword(s):  
Natural History ◽  
Renal Mass ◽  
The Body ◽  
Renal Tumors ◽  
Small Renal Mass ◽  
Small Renal Masses ◽  
Tumor Biopsy ◽  
Renal Masses ◽  
History Of

The rise in incidentally discovered enhancing solid renal tumors has spurred the development of new approaches to managing this unique clinical entity known as the small renal mass (SRM). These approaches are grounded on a better understanding of the natural history of SRM, with the goal to reduce the morbidity associated with their management and avoid overtreatment. In this chapter, we review the body of evidence pertaining to the classification and clinical management of SRMs with respect to diagnosis, treatment, and follow-up. In addition, we discuss the controversies and active areas of development for this rapidly evolving field that strides towards a precision medicine paradigm.  This review contains 6 figures, 6 tables and 63 references Keywords: Small renal mass, renal cell carcinoma, radical nephrectomy, renal tumor biopsy, active surveillance, natural history, oncocytoma, robotic surgery, partial nephrectomy

The natural history of incidentally detected small renal masses

Cancer ◽  
2004 ◽  
Vol 101 (3) ◽  
pp. 650-650 ◽  
Author(s):  
Andrew Renshaw
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of

THE NATURAL HISTORY OF SMALL RENAL MASSES

2000 ◽  
Vol 164 (4) ◽  
pp. 1143-1147 ◽  
Author(s):  
RICARDO A. RENDON ◽  
NIR STANIETZKY ◽  
TONY PANZARELLA ◽  
MICHAEL ROBINETTE ◽  
LAWRENCE H. KLOTZ ◽  
...  
Keyword(s):  
Natural History ◽  
Small Renal Masses ◽  
Renal Masses ◽  
History Of
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