Abstract
ABSTRACTIntroduction:Recently the COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. Renal cell cancer (RCC) patients configure a heterogenous populations: some of them present indolent cases which can safely have postponed their treatments, others present aggressive tumors, deserving immediate care. These scenarios must be properly identified before a tailored therapeutic choice.ObjectivesWe propose a risk- based approach for patients with RCC, to be used during this unprecedented viral infection time.Materials and Methods:After a literature review focused in COVID-19 and current RCC treatments, we suggest therapeutic strategies of RCC in two sections: surgical approach and systemic therapy, in all stages of this malignance.Results:Patients with cT1a tumors (and complex cysts, Bosniak III/IV), must be put under active surveillance and delayed intervention. cT1b-T2a/b cases must be managed by partial or radical nephrectomy, some selected T1b-T2a (≤7cm) cases can have the surgery postponed by 60-90 days). Locally advanced tumors (≥cT3 and or N+) must be promptly resected. As possible, minimally invasive surgery and early hospital discharge are encouraged. Upfront cytoreduction, is not recommendable for low risk oligometastatic patients, which must start systemic treatment or even could be put under surveillance and delayed therapy. Intermediate and poor risk metastatic patients must start target therapy and/or immunotherapy (few good responders intermediate cases can have postponed cytoreduction). The recommendation about hereditary RCC syndromes are lacking, thus we recommend its usual care. Local or loco regional recurrence must have individualized approaches. For all cases, we suggest the application of a specific informed consent and a shared therapeutic choice.Conclusion:In the pandemic COVID -19 times, a tailored risk-based approach must be used for a safe management of RCC, aiming to not compromise the oncological outcomes of the patients.
Highlights
The COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed
Based on reports from first countries affected by this infection, health authorities, and medical societies, in these times, the main efforts and health infrastructures must be prioritized in favor of COVID-19 battle, reserving in advance, hospital health care facilities, personal protection equipment, and human resources that must be dedicated for pandemic cases
We reviewed the recent literature in English, Spanish and Portuguese Languages, searching by the mesh terms: COVID-19, coronavirus and renal cell carcinoma, kidney cancer, renal cancer, surgery, nephrectomy, ablation, active surveillance, systemic therapy, immunotherapy, target therapy, adjuvant, neoadjuvant
Summary
The COVID-19 pandemic became the main global priority; main efforts and health infrastructures have been prioritized in favor of COVID-19 battle and the treatment of benign diseases has been postponed. The incidence, mortality and prevalence of RCC in Latin America and Caribe corresponds respectively to 7,9% (31,983 cases); 8.2% [14,288] and 7,6% (77682 cases) of World total rates [1] RCC incidence is increasing, and its main risks factors are competing with the higher risks groups for COVID 19 infection and complications: age >60 years, arterial hypertension, diabetes, obesity, smoking [2] During this pandemic time, many patients diagnosed with RCC, if immediately treated by inpatient procedures (as surgery) are under risk of developing this viral infection and its life-threatening complications [3]. It is essential to indicate prompt surgical or systemic treatment for patients presenting with advanced life-threatening tumors despite of actual virus risks
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