New Frontiers in Renal Cell Cancer

Abstract

The treatment of renal cell cancer (RCC) is rapidly evolving. During the last decade, an important trend towards minimally invasive treatment options has led to significant developments and procedures formerly considered experimental now being widely used for localised RCC. Laparoscopy has become an integral part of surgical treatments in many urologic departments worldwide and is no longer confined to centres of excellence alone. Laparoscopic or retroperitoneoscopic radical nephrectomy is an established procedure considered standard of care in Europe [1]. Laparoscopic partial nephrectomy requires advanced surgical experience but is gaining increasing acceptance in the urologic community [2]. For selected cases, thermal ablation techniques such as cryoablation and radiofrequency ablation are valuable therapeutic alternatives offering even less invasiveness and promising intermediate-term oncologic outcomes [3,4]. The systemic treatment of metastatic RCC has long been a significant problem for urologists and medical oncologists due to the lack of response to conventional therapeuticstrategies andpoorsurvival in the majority of patients. However, the clinical course of RCC varies considerably and a subset of patients may survive>5 yr.This emphasises the need to understand the genetics and molecular pathology of this disease to predict response to treatment and prognosis in individual patients. Recent important advances have been made in this field and research is ongoing to define biologic markers for RCC [5–7]. Although exciting immunologic approaches have been discovered and pursued for systemic