The most common treatment for someone who is discovered to have early stage kidney cancer is surgery. The patient’s tumors and a part of their kidneys are removed through a procedure called a partial nephrectomy. However, a recent study published in the journal Radiology, has indicated that this is far from the best option for some patients. The surgery is prescribed so frequently because that is what has become commonplace but this new research has shown we need to take a more individualized approach to treatment in order to ensure that each patient is receiving the care they need.
Who Surgery May Not be Right For
Primarily, this study showed that those living with chronic kidney disease might not be the best candidates for a partial nephrectomy. Researchers used a computer simulation to determine which therapeutic option would result in the longest life expectancy for patients. They conducted 1 million simulations, and in all those examining chronic kidney disease specifically- active surveillance resulted in a longer life expectancy than surgery. In fact, this type of personalized approach was found to extend life expectancy by over two years compared to a partial nephrectomy.
“We need a better way of weighing the risks, so that more patients can be considered for non-surgical management.”
Other comorbidities such as heart disease may also make patients a poor candidate for surgery. Researchers have advocated that it’s time to start looking at patients as individuals as opposed to one diagnosis which has one go-to treatment.
Other Options
The researcher’s simulation showed that active surveillance may be a good option for chronic kidney disease patients. But what exactly does that entail?
Active surveillance of a patients tumors basically means monitoring them through periodic CT scans to document any changes in size. This is important because many tumors are actually either very slow-growing malignancies or benign.
Researchers believe this approach is underutilized because there aren’t clear guidelines for its use in the scientific community. They hope their computerized simulation will help inform researchers on when surveillance may be the right approach. Ultimately, they want to help medical providers prescribe the right treatment option for each individual patient as opposed to following a standard protocol, especially because this protocol has now been shown to be a poor choice for many patients with early-stage kidney cancer.
With that being said, for individuals who have normal renal function, the simulation showed that surgery still proved to be the best option, yielding the longest life expectancy.
More Information Provided by the Simulation
Researchers found additional information from their computer simulation which may also benefit patients.
First, the simulation suggests that the incorporation of tumor subtype data may improve the effectiveness of biopsies when working to determine whether a tumor is cancerous or benign.
Second, the model showed that MRIs may be utilized to better predict a type of kidney cancer which is slow-growing called papillary renal cell carcinoma. If these patients are then monitored through active surveillance, it may improve their overall prognosis.
Most importantly, the model indicated that there is a lack of conversation surrounding treatment options for individuals with small renal tumors. These researchers are not advocating for one type of treatment, and they certainly aren’t saying that active surveillance is the best option for all patients. What they are advocating for is a deeper discussion, which includes all of the options, and from there deciding on the best treatment approach for the individual patient in question.
The Benefits of Computer Models
Clinical trials are an important way to investigate novel therapies. However, they do have their downfalls. They are expensive and often take years to initiate. Additionally, clinical trials only represent the outcome of a specific treatment for a limited set of patients.
This is where computer models can come in handy. Computer simulations are able to provide researchers with supplemental data on potential interventions and disease states themselves. This information can help guide the scientific community by helping them understand what research should be completed next based on what may be the most beneficial to patients.
As shown in this study, even for diseases which have an effective treatment option, there is still a wide variability between patients. We need to continue to work for a more personalized approach to medicine. Hopefully, this research will help us get there faster for those living with early-stage kidney cancer, chronic kidney disease, and papillary renal cell carcinoma.
You can read more about this study and the impact it could have on treatment for kidney cancer here.
