Stage III Renal Cell Cancer
Current Clinical Trials
Stage III renal cell cancer is defined by the following clinical stage groupings:
- T1, N1, M0
- T2, N1, M0
- T3, N0, M0
- T3, N1, M0
- T3a, N0, M0
- T3a, N1, M0
- T3b, N0, M0
- T3b, N1, M0
- T3c, N0, M0
- T3c, N1, M0
Treatment information for patients whose disease has the following classification:
Radical resection is the accepted, often curative, therapy for stage III renal
cell cancer. The operation includes removal of
the kidney, adrenal gland, perirenal fat, and Gerota fascia, with or without
a regional lymph node dissection.[1] Lymphadenectomy is commonly employed, but
its effectiveness has not been definitively proven. External-beam radiation
therapy (EBRT) has been given before or after nephrectomy without conclusive evidence that
this improves survival when compared with the results of surgery alone; however, it may be of
benefit in selected patients with more extensive tumors. In patients who are
not candidates for surgery, arterial embolization can provide palliation. In
patients with bilateral stage T3a neoplasms (concurrent or subsequent),
bilateral partial nephrectomy or unilateral partial nephrectomy with
contralateral radical nephrectomy, when technically feasible, may be a preferred
alternative to bilateral nephrectomy with dialysis or transplantation.[2]
Treatment information for patients whose disease has the following classification:
Radical resection is the accepted, often curative, therapy for this stage of
renal cell cancer. The operation includes
removal of the kidney, adrenal gland, perirenal fat, and Gerota fascia, with
or without a regional lymph node dissection. Lymphadenectomy is commonly
employed, but its effectiveness has not been definitively proven. Surgery is
extended to remove the entire renal vein and caval thrombus and a portion of
the vena cava as necessary.[3] EBRT has been given before
or after nephrectomy without conclusive evidence that this improves survival when compared with the results of surgery alone; however, it may be of benefit in selected
patients with more extensive tumors. In patients who are not candidates for
surgery, arterial embolization can provide palliation. In patients with stage
T3b neoplasms who manifest concurrent or subsequent renal cell carcinoma in the
contralateral kidney, a partial nephrectomy, when technically feasible, may be a
preferred alternative to bilateral nephrectomy with dialysis or
transplantation.[2,4,5]
Treatment information for patients whose disease has the following classifications:
- T1, N1, M0
- T2, N1, M0
- T3, N1, M0
- T3a, N1, M0
- T3b, N1, M0
- T3c, N1, M0
This stage of renal cell cancer is curable with surgery in a small minority of
cases. A radical nephrectomy and lymph node dissection is necessary. The
value of preoperative and postoperative EBRT has not been
demonstrated, but EBRT may be used for palliation in
patients who are not candidates for surgery. Arterial embolization of the
tumor with gelfoam or other materials may be employed preoperatively to reduce
blood loss at nephrectomy or for palliation in patients with inoperable
disease.
Standard treatment options:
- Radical nephrectomy with renal vein and, as necessary, vena
caval resection (for T3b tumors).[3] Radical nephrectomy with lymph
node dissection.
- Preoperative embolization and radical nephrectomy.[6,7]
- EBRT for palliation.[6]
- Tumor embolization for palliation.[7]
- Palliative nephrectomy.
- Preoperative or postoperative EBRT and radical nephrectomy.[6]
- Clinical trials involving adjuvant interferon-alpha.
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III renal cell cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Phillips E, Messing EM: Role of lymphadenectomy in the treatment of renal cell carcinoma. Urology 41 (1): 9-15, 1993.
[PUBMED Abstract]
-
Novick AC, Streem S, Montie JE, et al.: Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. J Urol 141 (4): 835-9, 1989.
[PUBMED Abstract]
-
Hatcher PA, Anderson EE, Paulson DF, et al.: Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol 145 (1): 20-3; discussion 23-4, 1991.
[PUBMED Abstract]
-
deKernion JB: Management of renal adenocarcinoma. In: deKernion JB, Paulson DF, eds.: Genitourinary Cancer Management. Philadelphia, Pa: Lea and Febiger, 1987, pp 187-217.
-
Angermeier KW, Novick AC, Streem SB, et al.: Nephron-sparing surgery for renal cell carcinoma with venous involvement. J Urol 144 (6): 1352-5, 1990.
[PUBMED Abstract]
-
deKernion JB, Berry D: The diagnosis and treatment of renal cell carcinoma. Cancer 45 (7 Suppl): 1947-56, 1980.
[PUBMED Abstract]
-
Swanson DA, Wallace S, Johnson DE: The role of embolization and nephrectomy in the treatment of metastatic renal carcinoma. Urol Clin North Am 7 (3): 719-30, 1980.
[PUBMED Abstract]
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