The Role of Focal Approach as Alternative to Nephron- Sparing Surgery in the Treatment of Stage I Cancer in Renal Graft: Results of a Systematic Review
Alessandro POSA1,Valentina LANCELLOTTA2,Filippo PAOLETTI3,Alessandro TANZILLI1,Anna ACAMPORA4,Barbara Alicja JERECZEK-FOSSA6,Maria Antonietta GAMBACORTA2,Jacopo ROMAGNOLI8,Rosario Francesco GRASSO9,Andrea VELTRI10,György KOVACS2,Vincenzo VALENTINI2,Riccardo MANFREDI1,Roberto IEZZI1,Luca TAGLIAFERRI2
1Department of Diagnostic Imaging, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radiation Oncology and Hematology, U.O.C. of Diagnostic and General Interventional Radiology, Rome-Italy
2Department of Diagnostic Imaging, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radiation Oncology and Hematology, U.O.C. of Radiation Oncology Therapy, Rome-Italy
3Sacred Heart Catholic University, Institute of Radiology, Rome-Italy
4Department of Epidemiology of the Regional Health Service of Lazio, UOC Epidemiology of the State of Health of the Population, Rome-Italy
5Catholic University of the Sacred Heart, Institute of Public Health, Section of Hygiene, Rome-Italy
6Department of Oncology and Hemato-oncology, University of Milan, Milan-Italy
7Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan-Italy
8Renal Transplant Unit, University Hospital A. Gemelli IRCCS, Rome-Italy
9Unit of Diagnostic Imaging, Università Campus Bio-Medico of Rome, Rome-Italy
10Institute of Radiology, University of Turin, Turin-Italy
In patients with kidney graft neoplasms, the treatment of choice is still represented by surgical approach, mainly based on partial nephrectomy/nephron sparing surgery (NSS). In this oncologic setting, focal treatments (FT) are becoming more and more useful to avoid the risk of dialysis, considering graft viability of utmost importance. There is still little evidence on which is the best FT option in kidney graft neoplasms and on its therapeutic indications. We performed a systematic review to assess the role of FT such as thermal ablation, interventional radiotherapy, electrochemotherapy, and stereotactic body radiotherapy, as alternative to NSS in the treatment of Stage I kidney cancer. We searched PubMed, Scopus, and Web of Science for articles published between 2010 and 2020 focusing on kidney transplant recipients with kidney graft neoplasm who had undergone FT. The review is framed by the population, intervention, control, and outcomes criteria. The studies underlined safety and efficacy of FT, with low morbidity and good graft survival, but none of them provided a direct comparison with graft nephrectomy or NSS. There is still no clear evidence that FTs, and percutaneous ones in particular, are indicated as a standard treatment in kidney graft neoplasms as opposed to total or partial graft nephrectomy. Keywords : Focal treatment; graft rejection; nephron sparing surgery; renal transplant patients