Treatment of Locally Advanced Renal Cell Carcinoma

Context: Locally advanced renal cell carcinoma (RCC) is associated with a poor prognosis despite radical surgery. The surgical approach can differ according to tumour size, location, and vascular involvement. The development of molecular targeted therapies aroused new interest in adjuvant and neoadjuvant strategies. Objective: The aim of this article was to review trends in surgical approaches for locally advanced RCC as well as to discuss the role of targeted therapies in an adjuvant and neoadjuvant setting. Evidence acquisition: A PubMed search performed in September 2011 was used to identify relevant literature regarding locally advanced RCC. Evidence synthesis: An aggressive surgical approach is essential in locally advanced RCC. Nevertheless, the necessity of simultaneous ipsilateral adrenalectomy and extended lymphadenectomy in RCC is put into question. The presence of a tumour thrombus in the inferior vena cava requires special surgical techniques for thrombus control. The role of adjuvant and neoadjuvant molecular targeted therapies is investigated in ongoing trials. Phase 3 results of an adjuvant tumour cell vaccine are promising. Conclusions: Radical surgical resection remains mandatory in locally advanced RCC. The role of adjuvant and neoadjuvant therapy in these patients remains unknown until the data from ongoing trials become available. (C) 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.