Dr Homi Zargar

ANZUP 2017 – Dr Homi Zargar

Dr Homi Zargar discusses some of the controversies in kidney cancer management

Talking Urology podcast transcript

ANZUP 2017 Interviews – Joseph Ischia and Homi Zagar

Joseph Ischia: I’m talking to Homi Zagar. He was one of the panel members on the MDT masterclass for the management of kidney cancer. It was a fantastic hour of discussing some really— a lot of the complexities of the kidney cancers that we see every day at our practice and throughout at the end, there was a little bullet point on some of the summaries and take home points. We’re going to cover these today Homi, so I want you to give me your answer. So what is the role of biopsy in the kidney mass?

Homi Zagar: Thank you Joseph. The biopsy is a useful strategy in certain group of patients. It’s not for everybody, but it certainly has are role in certain group of patients depending on patient characteristic, tumor characteristics, the indication for treatment, so I don’t think everyone should be biopsied but it certainly has a role.

Joseph: And the treatment of the small renal mass, it’s something we see that comes up every week in our x-ray MDMs, what do you recommend?

Homi: Again, I would go with my previous answer, again depends on the patient, on your setting, on your availability of treatments. Given in older patients, it’s reasonable to do the biopsy and survei them, if they’re younger, probably surgery is the best option. Again, no treatment fits all and all of these details needs to be kept in mind before proceeding to any treatment strategy.

Joseph: Say, you’ve got a 35-year-old lady with a 1.5 cm small renal mass, is this something you’re going to watch for 60 years or is that not a—

Homi: Increase use of imaging we’ve seen more of this incidental findings in a generally fit patient in capable hands, that sort of person could be treated with definitive therapy, usually it’s surgery, usually with partial nephrectomy. If you got a benign tumor, well, you’ve got your answer. If you’ve got a malignant tumor, that patient is most likely cured and then you can move on. I think, again, breaking the details, looking at the patient characteristic, you can have a definite answer for certain scenarios but you should consider all of the options when you’re meeting such patients.

Joseph: You had some great comments regarding the partial nephrectomy. So, say, you do a partial nephrectomy with clear margins, when do you do your first imaging and what?

Homi: As I mentioned, generally, I would do no change in my strategy. I would do the next imaging generally a year down the line unless there is a certain characteristic of the tumor that I would be worried about but generally follow up about one year with CT.

Joseph: And with a positive margin?

Homi: I would do exactly the same.

Joseph: And now, I reckon one of the most controversial topics for us at the moment is the treatment of the primary in the presence of metastatic disease. What do you think is the latest state of play regarding that?

Homi: Things have evolved with modern therapy and again, it comes down to the patient characteristic. In a fit person, you would give him all the options. Generally, try to get it off the primary with proceeding with definitive therapy, and then depending on where your oligometastatic disease is, what’s the burden. If you have multiple centers or a singular region then you can try to tailor your treatment with either surgery or focused radiotherapy. With more bulky disease, with metastases, usually systemic therapy has a greater role but really we don’t have the answers.

Joseph: Thank you Homi

Homi: . My pleasure Joseph absolutely.

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