Renal Cancer Clinical Resource Area - Treatment

National Comprehensive Cancer Network
Used in everyday practice in community oncology for treatment decisions. Peer reviewed evidenced based guidelines.

Surgery is the only known effective therapy for localized renal carcinoma. Recently there have been significant advances in surgical techniques such as laparoscopic and partial nephrectomy.

• Tumors greater than 4 cms
• Includes the removal of Gerota's fascia, kidney and adrenal gland
• Can be accessed via an anterior transperitoneal approach, flank approach or thoracoabdominal approach
• Laparoscopic technique is becoming widely used due to decreased recovery time and comparable long-term outcomes.
• Approach depends on location and size of tumor, and body type of person
• Role in metatstatic disease:
• Palliative purposes to alleviate symptoms or abnormalities (ie, pain, hemorrhage, malaise, hypercalcemia or erythrocytosis)
• In combination with adjuvant systemic therapy

• Tumors less than 4 cms
• Bilateral tumors
• Laparoscopic technique is becoming widely used due to decreased recovery time and comparable long-term outcomes

• Cryotherapy or radiofrequency ablation
• Decrease morbidity vs. surgical resection
• Small (<4cm) exophytic tumors not near collecting system

• Surgical resection for a solitary metastasis will not likely rend cure but may increase survival

Chemotherapy
Not found to be effective in renal carcinoma

• Used for palliative symptom management
• Renal carcinoma is a radioresistent disease

Immunotherapy
Unfortunately, the potential for cure in those with metastatic disease is only seen in a small proportion of patients. Both of these agents have multiple toxicities and limited efficacy.

• IL-2 (response rate 15-20%)
• High morbidity and mortality with high dose regimens
• Interferon ( response rate 10-20%)

Targeted Therapies
Antiangiogenesis agents are some of the newer therapies targeting renal carcinoma. These agents work in renal carcicnoma due to two factors: vascular tumor consisting of largely capillaries and blood sinuses surrounded by tumor cells and overabundance of vascular endothelial growth factor (VEGF).

Sorafenib (Nexavar^®) and Sunitinib (Sutent^®) have been included in treatment guidelines for relapse or stage IV medical or surgically unresectable disease.