SIO Requests Changes to NCCM Renal Mass Guidelines

The Society of Interventional Oncology (SIO) recently sent a letter to the National Comprehensive Cancer Network (NCCN) Kidney Cancer Guideline panel seeking changes to proposed guidelines for management of T1a renal masses. The NCCN guidelines are influential among both clinicians and payors, and the letter from SIO outlines 6 specific changes along with supporting data for the panel to consider. The letter was authored by Ronald S. Arellano MD, Thomas D. Atwell MD, and S. William Stavropoulos MD.

One of the suggested changes is including thermal ablation with surgical techniques instead of as third tier after active surveillance, supported by a 2016 Lancet  paper by Larcher and colleagues. Another change would state that both thermal ablation and surgery are very effective, with a small difference (5% or less) in treatment success. “The incidence of local recurrence following renal ablation is quite low, with historical worse outcomes following ablation of larger tumors using radiofrequency ablation. Using NCCN’s threshold of 3 cm, outcomes are much more favorable and approach that of partial nephrectomy,” the authors wrote. They added, “For small renal tumors, cancer specific survival is also similar amongst treatment strategies.”

Thermal ablation should also be mentioned in Principles of Surgery because in comparison with surgery, “thermal ablation is associated with superior perioperative outcomes, including shorter hospital stay, fewer adverse events, and decreased cost,” the letter stated.

An additional change recommends updating language to indicate that some patients are willing to accept a low or absent difference in rates of tumor control in exchange for the benefits of more minimally invasive surgical techniques. An article by Campbell and colleagues, published in the Journal of Urology, supported this update to the guidelines.

The full letter detailing all changes and supporting literature is available here (SIO log-in required).