Integration of Surgery and Systemic Therapy in the Treatment of Locally Advanced and Metastatic Renal Cell Carcinoma

摘要

Prior to 2006, the integration of surgery and systemic therapy in the management of locally advanced and metastatic renal cell carcinoma was fairly straightforward. In the locally advanced setting, there was no known effective adjuvant therapy available, such that aggressive surgical resection followed by risk-stratified surveillance was the standard of care. In the metastatic setting, level one evidence-in the context of immunotherapy with interferon-promoted upfront cytore-ductive nephrectomy in properly selected patients, followed by the adjuvant administration of immunotherapy. This practice was based on two randomized studies comparing immunotherapy with and without prior cytoreductive nephrectomy, which showed prolonged survival for operated patients and the realization that the primary tumor rarely, if ever, responded to systemic immunotherapy.