title: Prolonged natural progression from localized to symptomatic renal cell carcinoma.
abstract: Surgical excision is the gold standard therapy for clinically localized renal masses.  Nevertheless, prognostication of the natural history of untreated renal cell carcinoma (RCC) remains a clinical challenge.  While active surveillance (AS) has emerged as a viable treatment option in select patients with localized tumors and significant competing mortality risks, long term follow up data to assess the risk of disease progression are limited.  We present a case of a localized, clinical stage T2 renal mass progressing to regional and systemic disease over 6 years, demonstrating that kinetics of disease progression may be prolonged and are yet to be fully understood.
authors.affiliation: Department of Surgucal Oncology, Division of Urological Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Sterious
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Plimack
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Daniel
authors.initials: D
authors.lastname: Canter
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D018450:Disease Progression; D016503:Drug Delivery Systems / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D018570:Risk Assessment; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: C401859:temsirolimus; D020123:Sirolimus