- European Society for Medical Oncology (ESMO) issues guidelines for the treatment of renal cell carcinoma (RCC).
- Local disease
- T1 tumors (
- T2 tumors (>7 cm): laparoscopic RN is the preferred treatment.
- Locally advanced disease
- T3 and T4 tumors: perform open RN; laparoscopic RN can be considered.
- Advanced and metastatic RCC (mRCC)
- Perform cytoreductive nephrectomy in patients with good performance status except in intermediate-/poor-risk patients with asymptomatic primary tumors.
- Offer RT in unresectable disease and in patients unsuitable for surgery.
- Consider palliative RT to prevent progression in critical sites.
- mRCC with brain metastases: consider corticosteroids for temporary relief of cerebral symptoms, consider whole-brain radiotherapy (WBRT; 20/30 Gy in 4-10 fractions) for effective symptom control.
- Consider stereotactic radiosurgery±WBRT for good-prognosis patients with single unresectable brain metastasis.
- Good-/intermediate-risk group: offer vascular endothelial growth factor-targeted agents and tyrosine kinase inhibitor (TKIs) as first-line systemic treatment; tivozanib can also be considered.
- Intermediate-/poor-risk group: nivolumab+ipilimumab is recommended; cabozantinib can also be considered.
- Consider nivolumab/cabozantinib for second-line treatment after TKIs and in patients previously treated with 2 TKIs.
- Consider lenvatinib+everolimus after TKIs.