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[Treatment of locally advanced renal tumors]
D Sánchez Zalabardo1, J A Millán Serrano, A De Pablo Cárdenas
1Servicio de Urología, Hospital Reina Sofía, Tudela, Navarra, España.
Introduction:
Locally advanced renal tumors show a high progression rate after surgery. Surgical treatment of renal tumors has some unique characteristics related to involvement of the adrenal gland, vena cava, or regional lymph nodes.
Objective:
To review the current treatment of locally advanced renal tumors.
Materials And Methods:
A review is made of both the different drugs used and the different therapeutic possibilities in these tumors.
Results:
Systemic treatment with angiogenesis inhibitors may improve the natural history of these patients. Systemic treatment may be administered before surgery or as an adjuvant to surgical treatment. Early studies showed a decrease in tumor mass when treatment is administered before surgery, but no prospective randomized studies providing adequate evidence for recommending neoadjuvant treatment are available.
Conclusions:
Availability of systemic treatment with angiogenesis inhibitors may open an important field in the treatment of these tumors in both the neoadjuvant setting and as adjuvants to surgery, but no sufficiently solid scientific evidence as to recommend their use is currently available. Randomized studies with sunitinib and sorafenib will probably suggest the adequate approach to be used when their final results are reported.
Insights
Systemic treatment with angiogenesis inhibitors shows promise for advanced renal tumors, potentially improving outcomes when used before or after surgery. However, more research is needed to confirm efficacy and guide clinical recommendations.
Area of Science:
- Oncology
- Nephrology
- Pharmacology
Background:
- Locally advanced renal tumors have a high post-surgical progression rate.
- Surgical challenges include adrenal gland, vena cava, or lymph node involvement.
Purpose of the Study:
- To review current treatments for locally advanced renal tumors.
- To evaluate systemic therapies, including angiogenesis inhibitors.
Main Methods:
- Literature review of drugs and therapeutic options.
- Analysis of systemic treatment in neoadjuvant and adjuvant settings.
Main Results:
- Angiogenesis inhibitors may alter disease progression.
- Neoadjuvant treatment showed tumor mass reduction in early studies.
- Lack of prospective randomized trials for neoadjuvant therapy.
Conclusions:
- Systemic angiogenesis inhibitors offer potential for neoadjuvant and adjuvant therapy.
- Insufficient evidence currently supports routine use.
- Ongoing randomized trials with sunitinib and sorafenib are anticipated to clarify optimal approaches.
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