[Guideline 'Renal cell carcinoma'].
Each year, more than 1500 new cases of renal cell carcinoma are diagnosed in the Netherlands, and approximately 850 patients die due to this disease. The guideline 'Renal cell carcinoma' contains clinical practice recommendations on the diagnosis (imaging, pathological assessment, histopathological classification) and treatment (surgery, chemo-, immuno-, and radiotherapy) of renal cell carcinoma. For diagnostic imaging, chest and abdominal CT is recommended. Scintigraphy is not recommended. The term 'Grawitz tumour' is obsolete and should be replaced by 'renal cell carcinoma' with histological subtype specification according to the 2004 WHO classification. Laparoscopic radical nephrectomy is as effective as open surgery for localised tumours (T1 and T2) and possibly also for T3 tumours. The laparoscopic approach is associated with less morbidity due to the less invasive nature of this technique. This operation requires experience. In partial nephrectomy, a small margin of healthy tissue is sufficient. Frozen section examination of the resection edges does not appear to be required. In patients with metastatic renal cell carcinoma who are eligible for immunotherapy, removal of the tumour prolongs survival. Metastasectomy prolongs survival in patients with a solitary metastasis. Most currently available cytotoxic agents are ineffective against renal cell carcinoma. Interferon-alpha may have a role in the treatment of patients with renal cell carcinoma and favourable prognostic factors, given the survival advantage demonstrated with this agent in clinical trials. The guideline is available in English at www.oncoline.nl.
Mulders
P F A
PF
Universitair Medisch Centrum St Radboud, Postbus 9101, 6500 HB Nijmegen. p.mulders@uro.umcn.nl
Brouwers
A H
AH
Hulsbergen-van der Kaa
C A
CA
van Lin
E N J T
EN
Osanto
S
S
de Mulder
P H M
PH
D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D008207:Lymphatic Metastasis; D009392:Nephrectomy; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome