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SEER Inquiry System - Report
Produced: 12/21/2025 5:37 PM
Question 20240040
Inquiry Details
References:
2024 SEER Manual, 163-166. First Course of Therapy
Question:
First course treatment--Kidney: How should the different treatment fields be coded if surgery is planned but cancelled due to patient noncompliance, then the tumor is treated with ablation, and eventually surgery is given due to residual disease? See Discussion.
Discussion:
Patient was diagnosed in July 2022 with biopsy confirmed left kidney renal cell carcinoma. Initially, partial nephrectomy was planned for February 2023 but canceled at the last moment due to the patient’s “history of narcotic use.” The details of that cancellation were otherwise unclear. It appears the treatment plan was changed due to patient non-compliance.
Patient then had cryoablation of the tumor in May of 2023. Subsequent imaging in October found residual tumor, but no disease progression was noted. Again, additional ablation was offered but patient decided on surgical treatment which did not occur until December 2023.
Is the cryoablation second course due to a change of plan if there is no disease progression, recurrence, or treatment failure?
If the cryoablation is first course treatment, then would the partial resection also be first course treatment because it was documented as the treatment plan?
Answer:
The treatment with cryoablation is second course. Once the initial treatment plan is changed, everything after the change is no longer first course of treatment. If the cryoablation was not mentioned as part of the original treatment plan, it is second course.
