When are the treatment guidelines for stage II and III renal cell carcinoma (RCC)?

Updated: Jun 08, 2020
  • Author: Kush Sachdeva, MD; Chief Editor: E Jason Abel, MD  more...
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Answer

For stage II renal tumors, the National Comprehensive Cancer Network (NCCN) guideline recommends partial nephrectomy or radical nephrectomy as primary treatment. For stage III, the NCCN guideline recommends radical nephrectomy, or partial nephrectomy if clinically indicated. Examples of cases in which partial nephrectomy is appropriate include the following:

  • Unilateral stage I-III tumors where technically feasible
  • Uninephric state
  • Renal insufficiency
  • Bilateral renal masses
  • Familial RCC
  • Patients at relative risk for developing progressive chronic kidney disease due to young age or medical risk factors (ie, hypertension, diabetes, nephrolithiasis)

The European Society for Medical Oncology (ESMO) guideline recommends laparoscopic radical nephrectomy for T2 tumors (> 7 cm). For locally advanced RCC (T3 and T4), open radical nephrectomy is the standard of care, though a laparoscopic approach can be considered. However, systemic adrenalectomy or extensive lymph node dissection is not recommended when there is no evidence of adrenal or lymph node invasion. There is no recommended adjuvant treatment. Adjuvant and neoadjuvant treatment should not be considered outside of clinical trials. [76]


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