Contemporary management of renal tumors with venous tumor thrombus.
OBJECTIVE
Renal cell carcinoma with intravenous tumor thrombus remains one of the most intriguing and challenging topics in urological oncology. With better understanding of the biology of intravascular tumor invasion and improvements in overall survival, the surgical and medical treatment of these patients is being completely redefined.


METHODS
We performed a MEDLINE(R) search for relevant articles on renal cell carcinoma with intravenous tumor thrombus.


RESULTS
We describe the staging systems, prognostic factors and surgical techniques involved in the management of renal cell carcinoma with intravenous tumor thrombus. We also review long-term survival of local, advanced and metastatic renal cell carcinoma with tumor thrombus invasion. Finally, we propose a clinical algorithm for the treatment of patients with renal cell carcinoma invading the venous system.


CONCLUSIONS
Management of a kidney cancer tumor invading the venous system should now consider the primary biology and natural behavior of a given tumor in that specific patient rather than only focusing on the level and extent of venous invasion. Treatment must be individualized for every patient based on performance status, tumor biology and risk of surgery.
Pouliot
Frédéric
F
Institute of Urologic Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Shuch
Brian
B
Larochelle
Jeffrey C
JC
Pantuck
Allan
A
Belldegrun
Arie S
AS
D000465:Algorithms; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D011379:Prognosis; D012082:Renal Veins; D014682:Vena Cava, Inferior