2% to 3% of all adult malignant neoplasms
Most lethal of the common urologic
cancers.
12 new cases per 100000 population
male-to-female predominance of 3 : 2
sixth and seventh decades of life
Majority sporadic- 2%to 3 % familial
traditionally thought to arise primarily
from the proximal convoluted tubules,
and this is probably true for the clear
cell and papillary variants.
chromophobe and collecting duct RCC,
are derived from the more distal
components of the nephron
Most RCCs are round to ovoid and circumscribed by a pseudocapsule of compressed parenchyma and fibrous tissue rather than a true histologiccapsule.
Unlike upper tract transitional cell carcinomas, most RCCs are not grossly infiltrative, with the notable exception of collecting duct RCC and some sarcomatoid variants
Several investigators have now
developed tools that combine various
prognostic factors, and this has greatly
improved our predictive capacity for
patients with RCC
IVC involvement
Locally invasive RCC
Local recurrence after radical/nephron
sparing surgery
Adjuvant therapy for RCC
Approximately one third of all newly
diagnosed RCC patients present with
synchronous metastatic disease
20% to 40% of patients with clinically
localized disease at diagnosis will
eventually develop metastases
Debulking or Cytoreductive
Nephrectomy in Patients with
Metastatic RCC• two randomized phase III studies conducted
by the Southwest Oncology Group (SWOG)
and the European Organization for Research
and Treatment of Cancer (EORTC).
Resection of Metastases
Palliative surgery
group of proteins with diverse biologic
functions,including immunomodulatory
properties[interferon alpha]
overall response rates of 16% to 26% in
patients treated with interferon-αdurable complete responses with this
agent are relatively rare (<2%)
response rates in the range of 15% to 20%7% to 9% of patients receiving high-dose
IL-2 are reported to have achieved complete regression of all metastatic tumor
combination of IL-2 and interferon resulted in a higher response rate (18.6%) and 1-year event-free survival (EFS 20%)
No survival benefit
experimental
Antagonists of the Vascular Endothelial
growth Factor Pathway• Bevacizumab
High response and progession free survival in
combination of Interferon[CALGB 90206, AVOREN]
Sorafenib• oral receptor kinase inhibitor with activity
against VEGFR2, PDGF receptor-β, and raf-1
Sunitinib• Tyrosine kinase inhibitor
• potent inhibitor of VEGFR2, PDGFR-β, c-KIT,
and fms-like tyrosine kinase-3.
• most widely used oral VEGFR kinase inhibitor
in the initial treatment of metastatic clear cell
RCC
Pazopanib
temsirolimus and everolimus
toxicity
No role
No role
mTOR
Chemotherapy-collecting duct type
Clinical trials
Thank you