[Treatment of renal carcinoma with distant metastases].

BACKGROUND

There is no effective standard therapy for patients with distant metastases from renal cell carcinoma. Physicians should, however, know about the different treatment options and their efficacy in order to adequately inform and treat their patients.

MATERIAL AND

METHODS

Current relevant literature and experience at the Norwegian Radium Hospital are reviewed with emphasis on systemic therapy.

RESULTS

Nephrectomy is indicated if the aim is to palliate or prevent local symptoms due to a large primary tumour, or if the operation renders a patient eligible for a clinical trial. Local symptoms due to metastatic lesions should be managed surgically or by radiotherapy. Hormone treatment and current chemotherapy are ineffective. In selected patients interferon-alpha (IFN-alpha) results in an approximately 15% response rate and 4-6 months' prolongation of life. Combination therapy with interleukins or with other drugs is experimental.

INTERPRETATION: Patients with metastatic renal cell carcinoma should primarily be included in clinical trials. If this is not possible, interferon-alpha monotherapy represents today's standard systemic treatment, to be offered to selected and informed patients.