Evolving treatment paradigms for renal cancer
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| Format: | Buch |
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| Sprache: | English |
| Veröffentlicht: |
Philadelphia, PA
Saunders
2012
|
| Schriftenreihe: | Urologic clinics of North America
39,2 |
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| Online-Zugang: | Inhaltsverzeichnis |
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| 245 | 1 | 0 | |a Evolving treatment paradigms for renal cancer |c guest ed. William C. Huang ... |
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| adam_text | Evolving Treatment Paradigms for Renal Cancer
Contents
Foreword
xi
Samir S.Taneja
Preface: Evolving Treatment Paradigms for Renal Cancer
xiii
William C. Huang and Samir S.Taneja
Histologie
Variants of Renal Cell Carcinoma: Does Tumor Type Influence Outcome?
119
Fang-Ming Deng and Jonathan Melamed
Each
histologie type
of renal cell carcinoma (RCC) has different pathologic and clin¬
ical parameters; however, the independent role of
histologie type
in outcome predic¬
tion remains contested. Most studies show relevance for outcome of each
histologie
type when correlated with survival by univariate analysis, whereas few studies show
differences in outcome once other key prognostic factors, such as stage and grade,
are considered. These studies highlight the challenges to prove outcome relevance.
Despite the contested independent value of type for outcome prediction, separation
of RCC into types is well accepted and can be substantiated on clinical, pathologic,
molecular, and general outcome differences.
The Surgical Approach to Multifocal Renal Cancers: Hereditary Syndromes, Ipsilateral
Multifocality, and Bilateral Tumors
133
Brian Shuch, Eric A. Singer, and Gennady Bratslavsky
Although the management of sporadic renal tumors is challenging enough, dealing
with those with bilateral, multifocal, and hereditary kidney cancer adds an additional
level of complexity. A clinician managing this patient population must understand
the hereditary syndromes and the genetic testing available. Treating physicians
must be familiar with enucleative surgery, complex or multiple tumor partial
nephrectomy, complex renal reconstruction, re-operative renal surgery, and active
surveillance strategies. With proper management, most patients affected with bilat¬
eral, multifocal, or hereditary RCC can have a long life expectancy while maintaining
adequate renal function.
Current Practice Patterns in the Surgical Management of Renal Cancer in the
United States
149
Ganesh Sivarajan and William
С
Huang
Over the last two decades, there has been a rising incidence of renal tumors, partic¬
ularly, small renal masses (<4 cm) resulting in a downward size and stage migration.
This has brought about a paradigm shift in the management of newly diagnosed
renal masses, such that nephron-sparing surgery, minimally invasive techniques,
and active surveillance are frequently considered preferable to the historical gold
standard of open radical nephrectomy. Population-based cohort studies indicate,
however, that the widespread adoption of these techniques has been relatively
slow and incomplete leading to significant disparities in the delivery of care through¬
out the country. Further investigation is required to determine the barriers to diffu¬
sion of new techniques and technology as well as to ensure equal access to
quality care in the United States.
Contents
Contemporary Imaging of the Renal Mass
161
Stella K. Kang and Hersh
Chandarana
Contemporary imaging techniques for renal mass evaluation are essential to clin¬
ical management and surgical planning. Ultrasonography can be used to distin¬
guish cystic from solid lesions but is less sensitive and accurate in renal mass
characterization than computed tomography (CT) and magnetic resonance imag¬
ing
(MRI).
Multiphase CT imaging before and after administration of contrast is
the primary imaging modality for characterization and staging of renal lesions.
MRI
is increasingly used as a problem solving tool. Advanced
MRI
techniques
such as diffusion-weighted imaging and perfusion-weighted imaging are being
explored in assessment of renal lesions. These techniques are discussed in
this article.
Approach to the Small Renal Mass: to Treat or Not to Treat
171
Simon P. Kim and R. Houston Thompson
Accurately conveying the benefits and risks of treatment interventions to patients
diagnosed with small renal masses (SRMs) is essential to appropriately identify
which patients will achieve better
oncologic
outcomes and confer a survival advan¬
tage from primary therapy. Treatment decisions to determine the ideal management
with nephrectomy, thermal ablation, or active surveillance for patients diagnosed
with an SRM remain highly complex. Existing prediction tools that incorporate
various key clinical variables may facilitate an informed decision about the best man¬
agement of SRM by more appropriately selecting treatment individualized to the
characteristics of the SRM and the patient s clinical characteristics.
Does Renal Mass Ablation Provide Adequate Long-term
Oncologic
Control?
181
Stephen Faddegon and Jeffrey A. Cadeddu
Renal ablation (RA) is no longer used exclusively in patients with limited life expec¬
tancy. There are few studies reporting a minimum follow-up of
5
years. Biases and
discrepancies within the literature are abundant. The outcomes of any series must
be interpreted in the context of median follow-up time, reported tumor characteris¬
tics, ablation technique and training background of the practitioner, and the defini¬
tion of tumor recurrence. The long-term
oncologic
efficacy of radiofrequency
ablation
(RFA)
and cryoablation appear similar, although the percutaneous
RFA
technique may necessitate
reablation
in more cases. RA is associated with slightly
higher rates of local recurrence compared to surgical excision.
The Influence of Surgical Approach to the Renal Mass on Renal Function
191
Brian R. Lane and Christopher M. Whelan
The National Kidney Foundation estimates that
26
million Americans are living
with chronic kidney disease (CKD). The high prevalence of obesity, heart disease,
hypertension, and diabetes places millions more at risk for developing CKD.
Although long-term sufficient renal function is routine in screened kidney donors,
CKD is present in more than
30%
of patients with a newly diagnosed renal mass
and develops in most patients who undergo radical nephrectomy and a portion of
those who undergo nephron-sparing approaches. Herein, the authors review the
effect of the surgical approach on renal function for patients presenting with
a renal mass.
Contents
Partial Nephrectomy:
Contemporary Outcomes, Candidate Selection, and Surgical
Approach
199
Emil
Kheterpal and Samir S. Taneja
Localized kidney cancer is ideally managed with surgical extirpation. Historically
renal cell carcinoma has been treated with radical nephrectomy, but partial nephrec¬
tomy has become increasingly used because of a growing body of evidence dem¬
onstrating equivalent
oncologic
control and a potential benefit in overall survival.
In this article, the authors demonstrate that partial nephrectomy carries excellent
oncologic
efficacy. They additionally review the growing indications for partial
nephrectomy and factors influencing candidate selection. The authors also compare
the relative outcomes of open and minimally invasive techniques. Several factors
influence outcome, and surgeon experience should dictate the choice of technique.
Integration of Surgery and Systemic Therapy for Renal Cell Carcinoma
211
Patrick A. Kenneyand Christopher G. Wood
Proper integration of surgery and systemic therapy is essential for improving out¬
comes in renal cell carcinoma (RCC). There is no current role for adjuvant therapy
after nephrectomy for clinically localized disease. The potential benefits of neoadju-
vant therapy for locally advanced nonmetastatic disease are in need of further study.
In metastatic disease, the proper integration of cytoreductive surgery and systemic
therapy remains to be elucidated. Presurgical targeted therapy is feasible and may
be beneficial. Pending the results of randomized controlled trials, upfront cytoreduc¬
tive nephrectomy in appropriate patients will likely continue as the paradigm of
choice in metastatic RCC.
Defining an Individualized Treatment Strategy for Metastatic Renal Cancer
233
Brian Hu,
Primo
N.
Lara
Jr,
and Christopher P. Evans
Treatment of metastatic renal cell carcinoma (mRCC) has evolved dramatically
within the past
10
years with the advent of therapy targeting the angiogenesis and
mammalian target of rapamycin (mTOR) pathways. These therapies rapidly sup¬
planted ¡mmunotherapy as a first-line systemic treatment option. Response rates,
however, continue to vary, largely due to mRCC s clinical and molecular heteroge¬
neity. This article reviews current understanding of mRCC biology and available
treatments, discusses novel
biomarkers
that improve prognostication and may be
able to predict response, and integrates available literature on surgical and systemic
therapies into an individualized strategy.
Index
251
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| indexdate | 2024-12-24T02:41:35Z |
| institution | BVB |
| isbn | 9781455739493 |
| language | English |
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| title | Evolving treatment paradigms for renal cancer |
| title_auth | Evolving treatment paradigms for renal cancer |
| title_exact_search | Evolving treatment paradigms for renal cancer |
| title_full | Evolving treatment paradigms for renal cancer guest ed. William C. Huang ... |
| title_fullStr | Evolving treatment paradigms for renal cancer guest ed. William C. Huang ... |
| title_full_unstemmed | Evolving treatment paradigms for renal cancer guest ed. William C. Huang ... |
| title_short | Evolving treatment paradigms for renal cancer |
| title_sort | evolving treatment paradigms for renal cancer |
| topic | Therapie (DE-588)4059798-2 gnd Nierenkrebs (DE-588)4171882-3 gnd |
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