Since 2009, Brady urologist Phillip Pierorazio, M.D., has run the Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) Registry, following patients with small, localized kidney tumors (stage T1a, 4 cm or smaller), who choose either active surveillance or immediate surgery. DISSRM is one of the world’s largest active surveillance programs for patients with solid, small renal masses. The registry follows the outcomes of 350 patients on active surveillance and 300 patients who have received treatment.
“Most tumors on active surveillance grow slowly, about 1mm per year, and no patient in active surveillance has had a kidney cancer spread or has died of kidney cancer.”
Kidney cancer can be fatal if it escapes the kidney, but surgical cure rates for kidney-confined tumors are excellent – about 95 percent. And yet, says Pierorazio, “More than 30 percent of small kidney tumors are benign lesions, not cancer. Of the 70 percent left, most are low-grade, indolent tumors that aren’t ever going to cause a problem. That only leaves about 5 percent that are potentially aggressive.”
Many people, then, who have small renal masses can safely avoid surgery, and the DISSRM results are bearing this out. “Our data are finally starting to mature,” says Pierorazio. The study is designed to be fully mature when patients have been followed for five years. Allaf and Pierorazio: New standards reflect the Brady’s evidence-based, individualized approach.
So far, one quarter of patients have been followed for five years and the average follow-up is approaching three years. At a recent American Society for Clinical Oncology meeting, medical student Ridwan Alam presented the most up-todate outcomes from DISSRM. “Most tumors on active surveillance grow slowly,” states Alam, “about 1mm per year, and no patient in active surveillance has had a kidney cancer spread or has died of kidney cancer.”
Additional findings presented at the American Urological Association (AUA)’s Annual Meeting in Boston indicated that overall tumor size, and not necessarily growth rate, may be the best indicator that a patient should discontinue active surveillance and undergo treatment.
“Because of this program,” says Mohamad Allaf, M.D., Director of Kidney Cancer at the Brady, “active surveillance is gaining recognition around the world. This is reflected in the updated AUA Guidelines (see story) and the expanded role for active surveillance in the management of small renal masses – much of which can be attributed directly to data from DISSRM.”