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Minerva Medica 2013 June;104(3):237-59


language: English

Management of localized and locally advanced renal tumors. A contemporary review of current treatment options

Brookman-May S. 1, Langenhuijsen J. F. 2, Volpe A. 3, Minervini A. 4, Joniau S. 5, Salagierski M. 6, Roscigno M. 7, Akdogan B. 8, Vandromme A. 9, Rodriguez-Faba O. 10, Marszalek M. 11

1 Department of Urology Ludwig‑Maximilians‑University CampusGrosshadern, Munich, Germany; 2 Department of Urology Radboud University Nijmegen Nijmegen, The Netherlands; 3 Department of Urology University of Eastern Piedmont Ospedale Maggiore della Carità, Novara, Italy; 4 Department of Urology University of Florence, Florence, Italy; 5 Department of Urology University Hospitals Leuven, Leuven, Belgium; 6 Department of Urology Medical University of Łódź, Łódź, Poland; 7 Department of Urology AO Papa Giovanni XXIII, Bergamo, Italy; 8 Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey; 9 Department of Urology, Klinikum Braunschweig Braunschweig, Germany; 10 Uro‑oncology Unit, FundacioPuigvert Barcelona, Spain; 11 Department of Urology and Andrology Donauspital, Vienna, Austria; 12 Department of Urology Graz Medical University, Graz, Austria


About 70% of patients with renal cell carcinoma present with localized or locally advanced disease at primary diagnosis. Whereas these patients are potentially curable by surgical treatment alone, a further 20% to 30% of patients are diagnosed with primary metastatic disease. Although over the past years medical treatment for metastatic patients has nearly completely changed from immunotherapy to effective treatment with targeted agents, metastatic disease still represents a disease status which is not curable. Also in patients with metastatic disease, surgical treatment of the primary tumor plays an important role, since local tumor related complications can be avoided or minimized by surgery. Furthermore, also improvement of overall survival has been proven for surgery in metastatic patients when combined with cytokine treatment. Hence, surgical combined with systemic treatment as a multi-modal, adjuvant, and neo-adjuvant treatment is also required in patients with advanced or metastatic disease. A growing number of elderly and comorbid patients are currently diagnosed with small renal masses, which has led to increased attention paid to alternative ablative treatment modalities as well as active surveillance strategies, which are applied in order to avoid unnecessary overtreatment in these patients. Since surgical treatment also might enhance the risk of chronic kidney disease with consecutive cardiac disorders as well as reduced overall survival, ablative techniques and active surveillance are increasingly applied. In this review article we focus on current surgical and none-surgical treatment options for the management of patients with localized, locally advanced, and metastatic renal cell carcinoma.

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