Multimodal treatment of advanced renal cancer in 2017

in the last decades, the treatment of renal cell carcinoma has become more complex due to the introduction of novel systemic agents and the improvement of the loco-regional therapies that prolong survival maintaining a good quality of life. Areas covered: in this review, we summarize the currently available local and systemic treatment options, their indications and their hypothetical role in the management of advanced renal cell carcinoma, highlighting the need of multimodality treatment paradigms within interdisciplinary decision-making. Expert commentary: in early disease, radical or partial nephrectomy remains the standard of care, but innovative ablation techniques, including radiofrequency ablation, microwave ablation, cryoablation and so on, may represent an alternative option of treatment for small renal lesions in unfit patients who cannot undergo surgery. In metastatic setting, it is imperative a multidisciplinary team approach to select patients for a cytoreductive nephrectomy, metastasectomy, and/or systemic treatment, aiming to the optimization of the treatment strategy.