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Lokale Therapie des Nierenzellkarzinoms

Local treatment of renal cell carcinoma

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Ziel

Ziel der Arbeit ist es, eine Übersicht über den aktuellen Stand in der lokalen Therapie des lokalisierten Nierenzellkarzinom zu geben.

Material und Methoden

Es wurden die aktuelle Literatur sowie die Leitlinien in der Behandlung des Nierenzellkarzinoms analysiert.

Ergebnisse

Goldstandard beim lokalisierten Nierenzellkarzinom ist die operative Resektion des Tumors im Gesunden. Die organerhaltende Nierenteilresektion sollte im klinischen Stadium T1/T2 angestrebt werden, wenn diese technisch möglich ist. Der Eingriff kann bei entsprechender Expertise des Operateurs minimalinvasiv erfolgen. Die Tumornephrektomie sollte minimalinvasiv angestrebt werden, um die postoperative Morbidität zu senken. Bei Patienten mit kleinen Nierenzellkarzinomen (<4 cm) kann bei hohen Komorbiditäten oder eingeschränkter Lebenserwartung ein ablative Therapie (Radiofrequenzablation, Kryoablation) oder eine aktive Überwachung angeboten werden. Eine Biopsie ist in diesem Fall empfohlen. Für multimodale Therapiestrategien (neoadjuvant, adjuvant) gibt es aktuell keine entsprechenden Daten.

Schlussfolgerung

Die Therapie des lokalisierten Nierenzellkarzinoms umfasst die Resektion des Tumors im Gesunden mit möglichst geringer Morbidität. Aktive Überwachung oder ablative Therapieoptionen kommen bei selektionierten Patienten in Betracht.

Abstract

Objektive

The aim of the review is to provide an overview of the current status in the local treatment of localized renal cell carcinoma.

Material and methods

The current literature as well as guidelines on the treatment of renal cell carcinoma were analyzed.

Results

The gold standard in the treatment of localized renal cell carcinoma is the complete resection of the tumor. Organ-preserving resection should be performed in clinical stage I/II if technically feasible. Minimally invasive surgery can be performed with appropriate expertise of the surgeon. Tumor nephrectomy should be minimally invasive in order to reduce postoperative morbidity. In patients with a small renal cell carcinoma (<4 cm), ablative therapy (radiofrequency ablation, cryoablation) or active surveillance may be offered in cases of high comorbidities or reduced life expectancy. A biopsy is recommended in this case. There is currently no evidence for multimodal treatment strategies (neoadjuvant, adjuvant).

Conclusion

Treatment of localized renal cell carcinoma involves complete resection of the tumor with morbidity as low as possible. Active surveillance or ablative therapy strategies may be considered for selected patients.

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Authors and Affiliations

  1. Klinik für Urologie, Klinikum Nürnberg, Universitätsklinik, Paracelsus Medizinische Privatuniversität, Prof. Ernst-Nathan-Straße 1, 90419, Nürnberg, Deutschland

    Florian Distler &  Sascha Pahernik

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  1. Florian Distler
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  2. Sascha Pahernik
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Correspondence to Sascha Pahernik.

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Interessenkonflikt

F. Distler und S. Pahernik geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Distler, F., Pahernik, S. Lokale Therapie des Nierenzellkarzinoms. Onkologe 25, 512–516 (2019). https://doi.org/10.1007/s00761-019-0595-0

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  • DOI: https://doi.org/10.1007/s00761-019-0595-0

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