Pre-surgical Treatment of Renal Cell Carcinoma

Abstract

With the development of a number of novel targeted systemic therapies for metastatic renal cell carcinoma (RCC), there has been renewed interest in the pre-surgical treatment of this disease. The rationale for administering systemic therapy prior to surgery in patients with locally advanced or metastatic RCC is threefold. First, systemic therapy may decrease tumor size and complexity, allowing for less invasive approaches to surgery. Second, by treating distant micrometastatic disease, systemic therapy can theoretically improve oncologic outcomes. Finally, pre-surgical systemic therapy in patients with metastatic RCC may help to identify those patients who are most likely to benefit from cytoreductive surgery. This chapter evaluates pre-surgical therapies including chemotherapy, radiation therapy, immunotherapy, angioembolization, and targeted molecular therapies. The evidence of benefit for pre-surgical therapy in different clinical contexts is discussed, and the ideal duration of therapy, toxicities, and associated adverse events are reviewed.