Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma

Eur Urol. 2018 Dec;74(6):805-809. doi: 10.1016/j.eururo.2018.08.008. Epub 2018 Aug 31.

Abstract

Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data. PATIENT SUMMARY: The CARMENA trial demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden poor risk patients experience hearing that removal of their primary tumour will not be beneficial, should be carefully considered.

Keywords: Cytoreductive nephrectomy; EAU guidelines; Metastatic; Renal cell cancer; Sunitinib.

Publication types

  • Practice Guideline

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell* / secondary
  • Carcinoma, Renal Cell* / surgery
  • Chemotherapy, Adjuvant
  • Clinical Decision-Making
  • Clinical Trials, Phase III as Topic / standards
  • Cytoreduction Surgical Procedures* / methods
  • Cytoreduction Surgical Procedures* / standards
  • Delphi Technique
  • Equivalence Trials as Topic
  • Europe
  • Evidence-Based Medicine / standards
  • Female
  • Humans
  • Kidney Neoplasms* / pathology
  • Kidney Neoplasms* / surgery
  • Male
  • Middle Aged
  • Neoplasms, Multiple Primary* / pathology
  • Neoplasms, Multiple Primary* / surgery
  • Nephrectomy* / methods
  • Nephrectomy* / standards
  • Patient Selection
  • Protein Kinase Inhibitors / therapeutic use
  • Treatment Outcome
  • Urology* / standards

Substances

  • Protein Kinase Inhibitors