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Renal Cell Carcinoma

Renal Cell Carcinoma. Locally Advanced Group 5 Dr. Dana Livne Segev Dr. Alon Mashiach Dr. Shilo Rosenberg Dr. Ronny Ohlgisser. Staging of RCC. Locally advanced. Cristopher G.Wood, Cancer 2009. Prognostic Factors:. A natomic:. >7 cm. ???. Histologic. Above 3 (Fuhrman grade).

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Renal Cell Carcinoma

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  1. Renal Cell Carcinoma Locally Advanced Group 5 Dr. Dana Livne Segev Dr. Alon Mashiach Dr. Shilo Rosenberg Dr. Ronny Ohlgisser

  2. Staging of RCC

  3. Locally advanced Cristopher G.Wood, Cancer 2009

  4. Prognostic Factors: Anatomic: >7 cm ???

  5. Histologic Above 3 (Fuhrman grade)

  6. Clinical

  7. Molecular

  8. Neoadjuvant - Adv Select for surgery responding patients Downstaging (tumor shrinkage) Eliminates morbidity and mortality in those that wouldn’t benefit anyway Screen for patients with borderline PS

  9. Neoadjuvant – disadv. May add morbidity/mortality to surgery May decondition good surgical candidates No proven benefit Unclear timing of surgery

  10. Medication

  11. Adjuvant Trials in RCC in the TKI’s EraRationale Poor prognosis for selected groups after nephrectomy No proven adjuvant treatment Efficacy of TKI’s in advanced disease

  12. Embolization Rationale: Reduction of tumor burden Aids resection of localized RCC Paliation of symptoms in mRCC

  13. Today, no studies have shown survival benefit for embolization in mRCC No advantage for presurgical embolization in loclaized RCC Minimally invasive procedure may be carried out in previously inoperatable patients The only indication today is paliation for symptomatic patients with localized or mRCC

  14. Lap vs. Open Lap Not contraindicated Surgeon experience and dept. policy Size, location, penetration to intravascular vessels

  15. The predictive value in locally advanced RCC for intravascular penetration is in most reports: PPV – 96% NPV – 92%

  16. RPLND In clinically negative L.N -unnecessary Positive – improve survival When technically feasible For corrected therapy RENAL CELL CARCINOMA WITH RETROPERITONEAL LYMPH NODES: ROLE OF LYMPH NODE DISSECTION, ALLAN J. PANTUCK, AMNON ZISMAN, FREDRICK DOREY, DEBBY H. CHAO, KEN-RYU HAN, JONATHAN SAID, BARBARA J. GITLITZ, ROBERT A. FIGLIN AND ARIE S. BELLDEGRUN, Journal of Urology, 2003

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