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Surveillance versus ablation for incidentally diagnosed small renal tumours: The SURAB feasibility RCT

Lookup NU author(s): Professor Naeem Soomro, Jan Lecouturier, Dr Deborah Stocken, Dr Jing Shen, Dr Ann Marie Hynes, Dr Holly Fisher, David Rix

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This is the final published version of an article that has been published in its final definitive form by NIHR Journals Library, 2017.

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Abstract

© Queen’s Printer and Controller of HMSO 2017 Background: There is uncertainty around the appropriate management of small renal tumours. Treatments include partial nephrectomy, ablation and active surveillance. Objectives: To explore the feasibility of a randomised trial of ablation versus active surveillance. Design: Two-stage feasibility study: stage 1 – clinician survey and co-design work; and stage 2 – randomised feasibility study with qualitative and economic components. Methods: Stage 1 – survey of radiologists and urologists, and development of patient information materials. Stage 2 – patients identified across eight UK centres with small renal tumours (< 4 cm) were randomised (1: 1 ratio) to ablation or active surveillance in an unblinded manner. Randomisation was carried out by a central computer system. The primary objective was to determine willingness to participate and to randomise a target of 60 patients. The qualitative and economic data were collected separately. Results: The trial was conducted across eight centres, with a site-specific period of recruitment ranging from 3 to 11 months. Of the 154 patients screened, 36 were eligible and were provided with study details. Seven agreed to be randomised and one patient was found ineligible following biopsy results. Six patients (17% of those eligible) were randomised: three patients received ablation and no serious adverse events were recorded. The 3- and 6-month data were collected for four (67%) and three (50%) out of the six patients, respectively. The qualitative substudy identified factors directly impacting on the recruitment of this trial. These included patient and clinician preferences, organisational factors (variation in clinical pathway) and standard treatment not included. The health economic questionnaire was designed and piloted; however, the sample size of recruited patients was insufficient to draw a conclusion on the feasibility of the health economics. Conclusions: The trial did not meet the criteria for progression and the recruitment rate was lower than hypothesised, demonstrating that a full trial is presently not possible. The qualitative study identified factors that led to variation in recruitment across the sites. Implementation of organisational and operational measures can increase recruitment in any future trial. There was insufficient information to conduct a full economic analysis.


Publication metadata

Author(s): Soomro N, Lecouturier J, Stocken DD, Shen J, Hynes AM, Ainsworth HF, Breen D, Oades G, Rix D, Aitchison M

Publication type: Article

Publication status: Published

Journal: Health Technology Assessment

Year: 2017

Volume: 21

Issue: 81

Pages: 1-68

Print publication date: 01/12/2017

Acceptance date: 02/04/2016

ISSN (print): 1366-5278

ISSN (electronic): 2046-4924

Publisher: NIHR Journals Library

URL: https://doi.org/10.3310/hta21810

DOI: 10.3310/hta21810


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