title: There is no place for targeted therapy neoadjuvant treatment in Polish Health System - An analysis of radical nephrectomies in patients with large kidney tumors.
abstract: BACKGROUND
  Despite the introduction of better diagnostic tools, very large kidney tumors are still not so rare in our country. The paper presents our experience in the treatment of 12 patients with kidney tumors larger than 14 cm in size.
  
  
  METHODS
  Between spring 2009 and autumn 2011, radical nephrectomies were performed in 12 patients due to a large kidney tumor (larger than 14 cm in size). Symptoms (hematuria, weight loss, anemia, etc.) were not present in all the patients, but the kidney tumor was confirmed by imaging studies (ultrasound, CT, MRI) in all of them.
  
  
  RESULTS
  Full recovery was observed with no severe complications in all of the patients treated with radical nephrectomy. Pathological staging was correctly established by imaging studies in all of them. After a few months, five of patients (41.6%) required systemic therapy due to lymph node involvement.
  
  
  CONCLUSIONS
  Patients with large kidney tumors should be treated in selected medical centers that have experience in the treatment of such cases. Radical nephrectomy has to be the method of choice in the treatment of patients with this kind of tumor and its diameter should not disqualify from surgical treatment, which is still the only chance for the patients to be cured, as no adjuvant chemotherapy treatment has proved to be significantly effective.
authors.affiliation: Department of Urology, Medical University of Gdańsk, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Kłącz
authors.affiliation: Department of Urology, Medical University of Gdańsk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Matuszewski
authors.affiliation: Department of Urology, Medical University of Gdańsk, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Michajłowski
authors.affiliation: Department of Urology, Medical University of Gdańsk, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zachalski
authors.affiliation: Department of Urology, Medical University of Gdańsk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Markuszewski
authors.affiliation: Department of Urology, Medical University of Gdańsk, Poland.
authors.forename: Kazimierz
authors.initials: K
authors.lastname: Krajka
keywords: RCC; kidney masses; kidney tumor; nephrectomy; upper urinary tract