Kidney cancer. Principles and practice. Second edition. Primo N. Lara, Jr. Eric Jonasch (Editors). Springer International Publishing (2015)
Cytoreductive nephrectomy (CN) continues to be an integral part in the contemporary multidisciplinary treatment paradigm for patients with metastatic renal cell carcinoma (mRCC). Unlike many other cancers, removal of the primary tumor in mRCC has been shown to significantly increase overall survival (OS) when combined with postoperative cytokine therapy [1–3]. This was based on two randomized trials with a combined median increase in OS of 5.8 months. Since the FDA approval of the first systemic targeted therapy in 2005, CN has remained prevalent despite controversies regarding the optimal integration of surgery into the contemporary systemic targeted therapy paradigm. Two large phase III randomized trials are underway to assess the role and timing of CN in patients receiving the tyrosine kinase inhibitor, sunitinib malate [4, 5]. While awaiting the results of these trials, it is imperative for the treating physicians to understand the risks associated with CN and optimal patient selection for surgery. This chapter will highlight the historical evolution of CN in the treatment of metastatic RCC, review the data regarding optimal patient selection, highlight the risks of CN, and explore future methods on how to better integrate surgery into the treatment of patients with metastatic RCC.
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