• Surgical treatment (for early RCC)
• Palliative therapies or experimental protocols (for advanced RCC)
Curative treatments: Radical nephrectomy (removal of kidney, adrenal gland, perirenal fat, and Gerota's fascia) is standard treatment for localized RCC and provides a reasonable chance for cure. Results with open or laparoscopic procedures are comparable. Nephron-sparing surgery (partial nephrectomy) is possible and appropriate for many patients, even in patients with a normal contralateral kidney if the tumor is < 4 cm. Nonsurgical destruction of renal tumors via freezing (cryosurgery) or thermal energy (radiofrequency ablation) is being done in highly selected patients, but long-term data about efficacy and indications are not yet available.
For tumors involving the renal vein and vena cava, surgery may be curative if no nodal or distant metastases exist.
If both kidneys are affected, partial nephrectomy of one or both kidneys is usually preferable to bilateral radical nephrectomy if technically feasible.
Radiation therapy is no longer combined with nephrectomy.
Palliative treatments: Palliation can include nephrectomy, tumor embolization, and possibly external beam radiation therapy. Resection of metastases offers palliation and, if limited in number, prolongs life in some patients, particularly those with a long interval between initial treatment (nephrectomy) and development of metastases. Although metastatic RCC is traditionally characterized as radioresistant, radiation therapy can be palliative when metastatic in bone.
For some patients, drug therapy reduces tumor size and prolongs life. About 10 to 20% of patients respond to interferon alfa-2b or IL-2, although the response is long-lasting in < 5%. Three new targeted therapies have shown efficacy for advanced tumors: sunitinib and sorafenib (tyrosine kinase inhibitors) and temsirolimus, which inhibits the mammalian target of rapamycin (mTOR). Other treatments are experimental. They include stem cell transplantation, other interleukins, antiangiogenesis therapy (eg, bevacizumab,thalidomide), and vaccine therapy. Traditional chemotherapeutic drugs, alone or combined, and progestins are ineffective. Cytoreductive nephrectomy before systemic therapy, or as a delayed surgical procedure to remove the primary tumor after response in the metastases, is commonly performed in patients healthy enough to undergo it.
Last full review/revision December 2007 by David A. Swanson, MD
Content last modified December 2007
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