Thousands of patients each year are diagnosed with small kidney tumours that may never cause harm, yet many undergo invasive surgery to remove them. This research tackles a critical gap: doctors lack reliable evidence on whether active monitoring or immediate surgery is best, and patients have little say in the decision. The project runs three linked studies. One compares cryoablation—freezing the tumour—against surgical removal, testing whether it preserves kidney function just as well. Another tests whether a biopsy or a specialised scan (sestamibi) can identify benign tumours, sparing patients unnecessary operations. A third evaluates a shared decision-making programme that helps patients weigh options and feel more satisfied with their choice. If successful, this could transform kidney cancer care. Fewer people would undergo needless surgery for harmless growths. Those who do need treatment would have better-preserved kidney function, reducing long-term complications like chronic kidney disease. Patients would also gain confidence in their treatment decisions, improving quality of life. The results are expected to feed directly into clinical guidelines, changing how the NHS manages early-stage kidney tumours.
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Research question: Can the management of early-stage kidney tumours be transformed by improving treatment choice, diagnosis and patient involvement in shared decision making? Background: The increased use of cross-sectional imaging, has contributed to increased incidental diagnosis of small kidney tumours ( Aims and Objectives: 1. Provide evidence for the use of CRO compared to RPN. 2. Determine if biopsy and/or sestamibi can reduce patients with benign tumours from having unnecessary surgery. 3. Assess whether a novel SDM programme reduces treatment decision conflicts and increases decision-making satisfaction. 4. Develop a personalised treatment effects model to support patients and clinicians when choosing between management strategies. Methods: Deliver a multi-centre randomized controlled trial comparing CRO to RPN. Funding (£7.7 million) secured from collaboration with industry (Boston Scientific Limited). This study will assess whether CRO is non-inferior in terms of oncological control and superior in renal function preservation to RPN. (multi-NEST study) Perform a multi-centre RCT comparing biopsy and/or sestamibi directed management to standard of care, to determine whether unnecessary surgery and harm can be reduced. (multi-MIBI/Bx study) Compare patient treatment decision conflicts and decision-making satisfaction between patients randomized to receive a novel SDM program and standard of care. Use existing clinical data linked to NHS digital to develop a personalized treatment effects model and ascertain whether the model increases the prediction accuracy of treatment outcome to enhance SDM. Timelines for delivery: Year 1: Multi-NEST and SDM study recruitment commenced, protocol for multi-MIBI/Bx finalized, data extraction for treatment effects model Year 2: development of treatment effects model, commence multi-MIBI/Bx Year 3: recruitment completed for multi-NEST/SDM and started for multi MIBI/Bx Year 4: SDM report/published, testing phase of treatment effects model Year 5: interim analysis published for multi-NEST(2year follow up), publish multi MIBI/Bx and treatment effects model. Post- RP: Final results of multi-NEST published (5year follow up). Anticipated impact This research would see that patients diagnosed with kidney tumours have more choice in treatment options, have access to diagnostic tools to avoid unnecessary surgery and also have greater treatment satisfaction from being more involved in SDM. Dissemination The protocols and results will be published in peer-reviewed open-access journals, presented at national and international clinical conferences and included in clinical practice guidelines. The results will be communicated to patient/public community through Kidney Cancer UK, social media and patient advocacy meetings.
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