Page 11 - CUA KIDNEY CANCER HANDBOOK 2020
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Management of Locally Advanced
Kidney Cancer
Locally Advanced Kidney Cancer
Management Algorithm
Locally Advanced Kidney Cancer
Surgically resectable at diagnosis, Medically or surgically inoperable
medically fit
Manage according to guidance for
Proceed to surgery
advanced or metastatic kidney cancer
Potentially convertible to an operable
state? Refer for multidisciplinary team
evaluation
Management of Patients with Locally Advanced
Kidney Cancer who are Surgical Candidates
• Consensus Statement: There is no indication for neoadjuvant therapy prior
to planned surgical resection outside the context of a clinical trial.
– Patients should proceed directly to surgery
– There is currently insufficient evidence to support a general recommendation
for neoadjuvant therapy
• Consensus Statement: The use of adjuvant therapy following nephrectomy
in non-metastatic renal cell carcinoma patients is not currently
recommended outside the context of a clinical trial.
– To date, no clinical trial has demonstrated an overall survival (OS) advantage
with adjuvant targeted therapy in patients with RCC after curative resection
of the primary tumor
– Patients with high-risk tumors who are candidates for complete resection
should be encouraged to participate in clinical trials
– Although not currently offered, adjuvant therapy is an exciting field for
clinical trials
Practical Approaches to Managing Advanced Kidney Cancer 7
