Of particular concern, the researchers noted, is that patients with pre-existing chronic kidney disease (CKD) had a nearly twofold increased likelihood of undergoing RN than NSM compared with patients without CKD. Even though NSM use increased over the study period, most CKD patients still received RN, the investigators found.
via Nephron-Sparing Treatments Underused in CKD Patients – Renal and Urology News.
This study looked at data from the 1998-2008 and found that most renal masses were being treated by removing the entire kidney, even in patients with kidney disease. I have been performing partial nephrectomies for renal masses that were less than 4cm since I was at Indiana in 1997. Over the last 5 years, I have performing partial nephrectomies for tumors as large as 9cm if the location would allow it.
UroToday – PET Imaging Identifies Aggressive Kidney Cancers that Require Surgery
“Antibody PET could end up changing the standard of care for patients with kidney cancer,” said the study’s senior author, Paul Russo, MD, a urologic cancer surgeon at MSKCC. “The excellent sensitivity and specificity of this tool supports the utility of G250 PET imaging in the work-up and management strategies for clinically localized renal masses and as an alternative to biopsy for distinguishing renal lesions.”
In the study, 25 patients scheduled to have surgery to remove a renal mass received intravenous 124I-cG250. PET images obtained prior to surgery were graded as positive or negative for antibody uptake. A pathologist unaware of PET scan results then classified resected tumor specimens as clear cell renal carcinoma or otherwise.
According to the authors, G250 PET may ultimately be used not only to determine the aggressiveness and extent of a patient’s disease prior to any surgical intervention, but also to measure the therapeutic effects of a particular treatment, and predict the likelihood of recurrence.
“The promising results of this trial have stimulated interest in a larger, prospective multi-center trial to confirm our findings, and ultimately greatly improve the clinical management of patients with kidney tumors,” said Dr. Divgi.
I would not agree that I would consider a negative PET with the new antibody to mean that I would not operate on a renal mass, but this is an important study,
I look forward to hearing about newer studies for PET and to see if treating lesions with cryosurgery or RF ablation may allow for a followup with this type of study.