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Innere Medizin 1. September 2008

Treatment options in localised and metastatic renal cell carcinoma

Renal cell cancer (RCC) accounts for 2% of all malignancies. RCC shows a rising incidence and overall mortality is the highest among all urologic malignancies. In localised disease, radical cancer surgery remains the only potential curative treatment option. Indications for nephron-sparing surgery include renal tumours 4 cm or less in diameter and patients with solitary kidneys or bilateral synchronous RCC. Nephron-sparing surgery is also recommended in patients with conditions that might lead to impaired kidney function later on. In metastatic RCC (mRCC), cytoreductive surgery followed by the immunotherapy has proven to be a mainstay in patients with a good performance status. Chemotherapy has no role in the treatment of mRCC. Pharmacological treatment of mRCC has significantly changed in the last months due to the approval of targeted therapies such as sunitinib, sorafenib, bevacizumab or temsirolimus, which have largely replaced immunotherapy. Immunological therapy has been the standard of care in the treatment of mRCC in the last decade. Sequencing therapy and combination of different treatment modalities may further increase therapeutic options in the future. The purpose of the following short review is to summarize the contemporary treatment options in localised and metastatic RCC.

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