Abstract
Introduction:
Locally advanced renal tumors show a high progression rate after surgery. Surgical treatment of renal tumors has some unique characteristics related to involvement of the adrenal gland, vena cava, or regional lymph nodes.
Objective:
To review the current treatment of locally advanced renal tumors.
Materials and methods:
A review is made of both the different drugs used and the different therapeutic possibilities in these tumors.
Results:
Systemic treatment with angiogenesis inhibitors may improve the natural history of these patients. Systemic treatment may be administered before surgery or as an adjuvant to surgical treatment. Early studies showed a decrease in tumor mass when treatment is administered before surgery, but no prospective randomized studies providing adequate evidence for recommending neoadjuvant treatment are available.
Conclusions:
Availability of systemic treatment with angiogenesis inhibitors may open an important field in the treatment of these tumors in both the neoadjuvant setting and as adjuvants to surgery, but no sufficiently solid scientific evidence as to recommend their use is currently available. Randomized studies with sunitinib and sorafenib will probably suggest the adequate approach to be used when their final results are reported.
MeSH terms
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Adrenalectomy
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Angiogenesis Inhibitors / therapeutic use
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Antibodies, Monoclonal / therapeutic use
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Antibodies, Monoclonal, Humanized
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Antineoplastic Agents / therapeutic use
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Benzenesulfonates / therapeutic use
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Bevacizumab
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Carcinoma, Renal Cell / blood supply
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Carcinoma, Renal Cell / drug therapy
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Carcinoma, Renal Cell / pathology
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Carcinoma, Renal Cell / surgery
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Carcinoma, Renal Cell / therapy*
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Chemotherapy, Adjuvant
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Clinical Trials as Topic / statistics & numerical data
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Combined Modality Therapy
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Humans
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Indoles / therapeutic use
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Intracellular Signaling Peptides and Proteins / antagonists & inhibitors
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Kidney Neoplasms / blood supply
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Kidney Neoplasms / drug therapy
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Kidney Neoplasms / pathology
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Kidney Neoplasms / surgery
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Kidney Neoplasms / therapy*
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Lymph Node Excision
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Neoadjuvant Therapy
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Neoplasm Proteins / antagonists & inhibitors
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Nephrectomy
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Niacinamide / analogs & derivatives
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Phenylurea Compounds
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Protein Kinase Inhibitors / therapeutic use
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Protein Serine-Threonine Kinases / antagonists & inhibitors
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Protein-Tyrosine Kinases / antagonists & inhibitors
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Pyridines / therapeutic use
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Pyrroles / therapeutic use
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Sirolimus / analogs & derivatives
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Sirolimus / therapeutic use
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Sorafenib
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Sunitinib
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TOR Serine-Threonine Kinases
Substances
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Angiogenesis Inhibitors
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Humanized
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Antineoplastic Agents
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Benzenesulfonates
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Indoles
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Intracellular Signaling Peptides and Proteins
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Neoplasm Proteins
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Phenylurea Compounds
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Protein Kinase Inhibitors
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Pyridines
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Pyrroles
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Niacinamide
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Bevacizumab
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temsirolimus
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Sorafenib
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MTOR protein, human
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Protein-Tyrosine Kinases
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Protein Serine-Threonine Kinases
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TOR Serine-Threonine Kinases
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Sunitinib
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Sirolimus