ADRENAL

TUMOUR

KIDNEY

ADRENAL ADRENAL

ADRENAL ADRENAL

IVC

TUMOUR

GEROTA FASCIA

TUMOUR

KIDNEY

STAGE I STAGE II

STAGE III STAGE III

Confined to kidney and

<7cm in size

Confined to kidney and > 7cm in size

Involvement of vessels/adrena

l. NOT extending

beyond Gerota’s fascia

STAG

ING

SURGICAL MANAGEMENT

RADICAL NEPHRECTOMY

PARTIAL NEPHRECTOMY

CYTOREDUCTIVE NEPHRECTOMY

PALLIATIVE SURGERY

IMMUNOTHERAPY

MOLECULAR TARGETED AGENTS

RADIOTHERAPY

ADJUVANT THERAPY ?

TRIALS ARE CONTINUING

CHEMOTHERAPY

CHEMOTHERAPY EFFICACIOUS IN TUMOURS WITH

SARCOMATOID DIFFERENTIATION.

IMMUNOTHERAPY

IMMUNOTHERAPY

IL-2 IFN - α

GOOD PERFORMANCE STATUS.INTACT CARDIOPULMONARY

RESERVE.SIGNIFICANT TOXICITY.

ANTI-ANGIOGENESIS PATHWAY

MOLECULARLY TARGETED THERAPY

TYROSINE KINASE INHIBITORS

SUNITINIB SORAFENIB PAZOPANIB

HYPERTENSION

MOLECULARLY TARGETED THERAPY

mTOR

CELL PROLIFERATION

CELL METABOLISM

ANGIOGENESIS

PROTEIN SYNTHESIS

mTOR INHIBITORS

CELL MEMBRANCE

PTENPI3K

AKT

IMMUNOTHERAPY

TYROSINE KINASE INHIBITORS (TKI)

mTOR INHIBITORS

SECOND TKI

SEQUENTIAL THERAPY

FOR SELECT PATIENTS

NEPHRON SPARING

TECHNIQUES

ACTIVE SURVEILLANCE

OTHER OPTIONS

TUMOURS < 4 cm IN PTS WITH

SIGNIFICANT COMORBIDITIES

ENUCLEATION

THERMAL ABLATION

RADIOTHERAPY

• Effective palliative tool

• Stereotactic radiosurgery

CLINICAL TRIALS

TEMSIROLIMUS

TYROSINE KINASE

INHIBITORS

NON CLEAR CELL DISEASE

FUTURE STRATEGIES

• New systemic treatments for advanced RCC

• No established role of adjuvant therapy.

• Future therapeutic options.

SUMMARY