Initial Treatment for Renal Cell Carcinoma

Localized Disease Treatment Options

• The American College of Surgeons recommends partial nephrectomy for small renal tumors (T1, ≤7 cm) to preserve renal function while completely removing the tumor 1, 2
• The European Association of Urology recommends open radical nephrectomy with the goal of obtaining negative margins for larger or locally advanced tumors 3, 4

Metastatic Disease Management

• The National Comprehensive Cancer Network recommends cytoreductive nephrectomy for patients with good performance status, large primary tumors, and symptomatic primary lesions 3, 4
• The European Society for Medical Oncology recommends systemic therapy as initial treatment for patients with poor-risk features, clear cell histology, and high-volume distant metastases 1, 6

Systemic Therapy for Metastatic Disease

• The American Society of Clinical Oncology recommends sunitinib as a first-line option for good or intermediate risk patients with clear cell histology [Level I, A] [5]
• The European Association of Urology recommends pazopanib as a first-line option for good or intermediate risk patients with clear cell histology [Level II, B] [7]

Risk Stratification Importance

• The Memorial Sloan Kettering Cancer Center recommends using validated prognostic models, such as the MSKCC risk criteria, to guide treatment decisions 5
• The International Metastatic RCC Database Consortium recommends using the IMDC criteria to guide treatment decisions 2, 6

Special Considerations

• The Society of Surgical Oncology recommends surgical intervention to remove venous tumor thrombus for patients with T3 disease 5
• The European Society for Medical Oncology recommends metastasectomy for select patients with solitary or easily accessible pulmonary metastases, solitary resectable intra-abdominal metastases, or long disease-free interval after nephrectomy 3, 5