RENAL-CELL CARCINOMA

Renal cell carcinoma (RCC) is characterized by (a) lack of early Namin g signs, which results in a high proportion of patients,vith metastase s at the time of diagnosis; (b) protean clinical manifestations; and ( c) resistance to radiotherapy and chemotherapy. The estimates of new d iagnoses and deaths from kidney cancer in the United States during 199 6 are 30,600 and 12,000, respectively. RCC occurs nearly twice as ofte n in men as in women. The age at diagnosis is generally older than 40 years; the median age is in the midsixties. The incidence of RCC has b een rising steadily. Between 1974 and 1990, there was a 38% increase i n the number of patients who had a diagnosis of RCC. This increase was accompanied by a significant improvement in 5-year survival. Both tre nds are likely the result of improved diagnostic capability. Newer rad iographic techniques, including ultrasonography, computed tomography, and magnetic resonance imaging, are detecting kidney tumors more frequ ently and at a lower disease stage, when tumors can be resected for cu re. Surgical treatment is the only curative therapy for localized RCC. Radical nephrectomy remains the main-stay of surgical management, but techniques are being modified. These modifications include partial ne phrectomy and resection of vena caval thrombi. In highly selected case s, surgical resection of locally recurrent RCC or of disease at a soli tary metastatic site is associated with long-term survival. Metastatic RCC is highly resistant to the many systemic therapies that have been extensively investigated. A minority of patients achieve complete or partial response to interferon, interleukin-2, or both. Response can b e dramatic but is rarely durable. Because most patients do not achieve response, these agents are not considered effective treatments for RC C, but the response in some patients indicates the need for continued research on their use. Identification of new agents with better antitu mor activity against metastases remains a high priority in clinical in vestigation of therapy for this refractory disease.