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'Watch and Wait' Approach Often Best for Older Patients With Kidney Cancer
Date:2/12/2013

so found that the percentage of patients with small kidney tumors who were managed with surveillance increased between 25 percent to 37 percent from 2000 to 2007. This suggests that doctors are becoming more aware that small kidney tumors may not pose a threat, even if they are cancerous, the study authors said.

Two experts working with kidney cancer patients agreed that a "watch and wait" approach may be suitable for some patients.

The study "reaffirms the growing understanding that small [kidney] masses are relatively slow growing and generally pose only a small risk especially in the elderly population," said Dr. Manish Vira, director of the fellowship program in urologic oncology at North Shore LIJ's Arthur Smith Institute for Urology, in Lake Success, N.Y.

However, he noted that "although the risk is small, it is not zero as demonstrated by the finding that 3 percent [of the patients in the study] died of kidney cancer."

"It would interesting to look at these patients to determine if there are specific risk factors that predict more aggressive behavior of these small masses," Vira said. "This would allow physicians to target treatment for those patients with small [kidney] masses who are at higher risk."

Dr. Matthew Galsky is director of genitourinary medical oncology at the Tisch Cancer Institute at Mount Sinai School of Medicine, in New York City. He said prior studies "have shown that small kidney tumors that are not removed grow relatively slowly (approximately 0.3-0.4 centimeters per year) and in one series, only 1 percent of such tumors spread to other places in the body."

Galsky said the new study did have some limitations -- it was retrospective, looking over past data rather than the "gold standard" prospective form of trial -- and the methods of surveillance (such as scans) for the patients who did not get surgery was not made clear.

Nevertheless, he said, the findings, "should allow clinicians and patien
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