Interdisciplinary approach to the treatment of renal clear cell carcinoma

03/2017

MUDr. Darja Šustrová

Onkologická klinika 2. LF UK a FN v Motole, Praha

SUMMARY

Czech Republic has the highest incidence of kidney cancer in the world. Although the incidence of renal cell carcinoma has been increasing, the survival rate has improved substantially. Renal cancer consists of an heterogeneous group of tumors with distinct genetic and metabolic characteristics and histopathologic and clinical features. It has become more evident that a multidisciplinary team approach is necessary to provide optimal care to patients. This team includes medical oncologists, radiologists, urologist pathologists, radiation oncologists and surgeons. In the era of tyrosinkinase inhibitors therapy the role of cytoreductive nephrectomy should be discussed. There is a role of surgeon in the management of oligometastatic disease. Resection of oligometastatic disease can in selected patients prolong survival and delay the need to commence systemic treatment. When determining the prognosis of RCC, MSKCC criteria based on Motzer criteria are still used, although The MSKCC model was developed during the cytokine era, and was subsequently validated in the TKI population era by Heng, who confirmed four of the five MSKCC criteria (excluding elevated LDH) as independent predictors of poor prognosis, and added neutrophilia and thrombocytosis as additional risk factors, with a median survival rate of 43.2, 22.5 and 7.8 months in the favourable, intermediate and poor prognostic groups. Renal cell carcinoma can sometimes follow an indolent course, therefore a period of observation should be considered before starting treatment.

KEY WORDS

clear cell renal cell carcinoma, metastasis, bevacizumab, cytoreductive nefrectomy, hypertension