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Cytoreductive Nephrectomy

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Kidney Cancer

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Abstract

Cytoreductive nephrectomy (CN) remains 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. 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. 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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Abbreviations

ccRCC:

Clear cell renal cell carcinoma

CN:

Cytoreductive nephrectomy

EORTC:

European Organization for Research and Treatment of Cancer

FDA:

Food and Drug Administration

IL-2:

Interleukin-2

MDACC:

MD Anderson Cancer Center

mRCC:

Metastatic renal cell carcinoma

MSKCC:

Memorial Sloan Kettering Cancer Center

NCI:

National Cancer Institute

OS:

Overall survival

PFS:

Progression-free survival

RCC:

Renal cell carcinoma

SWOG:

Southwest Oncology Group

UCLA:

University of California Los Angeles

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Author information

Authors and Affiliations

  1. Department of Urology, Louisiana State University School of Medicine, 1542 Tulane Avenue, Suite 547, New Orleans, LA, 70112, USA

    Scott E. Delacroix Jr. MD, Brian F. Chapin MD, Jose Karam MD & Christopher G. Wood MD

  2. Department of Urology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1373, Houston, TX, 77030, USA

    Brian F. Chapin MD, Jose Karam MD & Christopher G. Wood MD

Authors
  1. Scott E. Delacroix Jr. MD
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  2. Brian F. Chapin MD
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  3. Jose Karam MD
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  4. Christopher G. Wood MD
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Corresponding author

Correspondence to Christopher G. Wood MD .

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Editors and Affiliations

  1. Department of Internal Medicine, Division of Hematology - Oncology, University of California Davis, School of Medicine UC Davis Comprehensive Cancer center, Sacramento, California, USA

    Primo N. Lara

  2. Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Eric Jonasch

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Delacroix, S.E., Chapin, B.F., Karam, J., Wood, C.G. (2015). Cytoreductive Nephrectomy. In: Lara, P., Jonasch, E. (eds) Kidney Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-17903-2_10

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  • DOI: https://doi.org/10.1007/978-3-319-17903-2_10

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