Renal cell carcinoma can be treated through several surgical and non-surgical methods. Surgical treatments include partial or radical nephrectomy to remove part or all of the kidney. Non-surgical treatments include biologic response modifiers like interleukin-2 and interferons, molecular targeted therapies using drugs like sunitinib, bevacizumab, and pazopanib, and chemotherapy with drugs like floxuridine and carboplatin. Radiation therapy can be used for palliation of pain from metastatic lesions, while renal artery embolization controls symptoms for inoperable patients.

1. Renal Cell Carcinoma
Treatment

2. Surgical Treatment
• Partial Nephrectomy:
is the removal of part of the kidney, usually because of a tumor, while sparing the remainder from
damage or removal. It typically is performed if the renal tumor is less than 7-cm or the patient has
only one kidney.

3. Surgical Treatment
• Radical Nephrectomy:
is a type of inpatient surgery where your entire kidney is removed, as well as the fat surrounding
it, and sometimes the adrenal gland and lymph nodes.
• Palliative Nephrectomy:
removal of the kidney to reduce symptoms
without curative intent.

4. Biologic response modifiers
• Interleukin-2:
IL-2 is a T-cell growth factor and activator of T cells and natural killer (NK) cells. IL-2 affects tumor
growth by activating lymphoid cells in vivo without affecting tumor proliferation directly. High-
dose interleukin-2 (IL-2) can induce durable long-term remission in 10% of patients with advanced
kidney cancer, and must be considered for robust patients with excellent cardiopulmonary
reserve. This treatment should generally be administered in centers with significant experience in
using this agent. Patients who do not have access to high-dose IL-2, who refuse it, or who are not
candidates for it should consider one of the approved targeted therapies.

5. Biologic response modifiers
• Interferons:
The interferons are natural glycoproteins with antiviral, antiproliferative, and immunomodulatory
properties. These agents have a direct antiproliferative effect on renal tumor cells in vitro,
stimulate host mononuclear cells, and enhance expression of major histocompatibility complex
molecules. Interferon alfa, which is derived from leukocytes, has an objective response rate of
approximately 15% (range, 0-29%).

6. Molecular-Targeted Agents
• Sunitinib (multikinase inhibitor)
• Bevacizumab in combination with interferon
• Pazopanib (tyrosine kinase inhibitor)
• Temsirolimus (mTOR inhibition blocks)
• Everolimus (kinase inhibitors)
• Lenvatinib in combination with everolimus
• Nivolumab (plus ipilimumab or cabozantinib)
• Avelumab in combination with axitinib
• Cabozantinib (kinase inhibitors)
• Sorafenib
• Axitinib (tyrosine kinase inhibitor)
• Avelumab
• Pembrolizumab

7. Chemotherapy
The following chemotherapeutic agents all have been used in advanced renal cell
cancer (RCC):
• Floxuridine (5-fluoro 2'-deoxyuridine [FUDR])
• 5-fluorouracil (5-FU)
• Vinblastine
• Paclitaxel (Taxol)
• Carboplatin
• Ifosfamide
• Gemcitabine
• Doxorubicin

8. Radiation Therapy
Radiation therapy may be considered as the primary therapy for palliation in patients whose clinical
condition precludes surgery, because of either extensive disease or poor overall condition. A dose of
4500 centigray (cGy) is delivered, with consideration of a boost up to 5500 cGy. Preoperative
radiation therapy yields no survival advantage.
Palliative radiation therapy is often used for local or symptomatic metastatic disease, such as painful
osseous lesions or brain metastasis, to halt potential neurologic progression. Surgery should also be
considered for solitary brain or spine lesions, followed by postoperative radiotherapy.
About 11% of patients develop brain metastasis during the course of their disease. Renal cell
carcinoma is a radioresistant tumor, but radiation treatment of brain metastasis improves quality of
life, local control, and overall survival duration. Patients with untreated brain metastasis have a
median survival time of 1 month, which can be improved with glucocorticoid therapy and brain
irradiation. Stereotactic radiosurgery is more effective than surgical extirpation for local control and
can be performed on multiple lesions.

9. Renal Artery Embolization
Renal artery embolization with ethanol and gelatin sponge pledgets has been found effective for
palliative treatment in patients who are not candidates for surgery, or who refuse surgery. A
retrospective study in 8 patients with stage IV disease found that ethanol ablation controlled
hematuria and flank pain.