Renal Cell Carcinoma

Full Text Guidelines Summary of Changes Scientific Publications & Appendices Pocket Guidelines Archive Panel

To access the pdfs & translations of individual guidelines, please as EAU member.
Non-EAU members can view the web versions.
To become an EAU member, click here.

B. Ljungberg (Chair), L. Albiges, K. Bensalah, A. Bex (Vice-chair), R.H. Giles (Patient Advocate), M. Hora, M.A. Kuczyk, T. Lam, L. Marconi, A.S. Merseburger, T. Powles, M. Staehler, A. Volpe
Guidelines Associates: Y. Abu-Ghanem, S. Dabestani, S. Fernández-Pello Montes, F. Hofmann, T. Kuusk, R. Tahbaz

1.INTRODUCTION

1.1.Aims and scope

The European Association of Urology (EAU) Renal Cell Cancer (RCC) Guidelines Panel has compiled these clinical guidelines to provide urologists with evidence-based information and recommendations for the management of RCC.

It must be emphasised that clinical guidelines present the best evidence available to the experts but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise and judgement when making treatment decisions for individual patients, but rather help to focus decisions whilst also taking personal values and preferences/individual circumstances of patients into account. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The RCC Guidelines Panel is an international group of clinicians consisting of urological surgeons, oncologists, methodologists, a pathologist and a radiologist, with particular expertise in the field of renal cancer care. Since 2015, the Panel has incorporated a patient advocate to provide a consumer perspective for its guidelines.

All experts involved in the production of this document have submitted potential conflict of interest statements, which can be viewed on the EAU website Uroweb: http://uroweb.org/guideline/renalcellcarcinoma/.

1.3.Acknowledgement

The RCC Guidelines Panel is most grateful for the continued methodological and scientific support provided by Prof.Dr. O. Hes (pathologist, Pilzen, Czech Republic) for two sections of this document: Histological diagnosis and Other renal tumours.

1.4.Available publications

A quick reference document (Pocket Guidelines) is available, both in print and as an app for iOS and Android devices, presenting the main findings of the RCC Guidelines. These are abridged versions which may require consultation together with the full text version. Several scientific publications are available, as are a number of translations of all versions of the EAU RCC Guidelines [1,2]. All documents can be accessed on the EAU website: http://uroweb.org/guideline/renal-cell-carcinoma/.

1.5.Publication history and summary of changes

1.5.1.Publication history

The EAU RCC Guidelines were first published in 2000. This 2019 RCC Guidelines document presents a limited update of the 2018 publication.

1.5.2.Summary of changes

All chapters of the 2019 RCC Guidelines have been updated, based on the 2018 version of the Guidelines. References have been added throughout the document.

New data have been included in the following sections, resulting in changed recommendations:

3.4 Recommendations for the management of other renal tumours

Recommendations

Strength rating

Treat Bosniak type III cysts the same as RCC or offer cautious surveillance.

Weak

Treat Bosniak type IV cysts the same as RCC.

Strong

Offer active surveillance to patients with biopsy-proven oncocytomas, as an acceptable alternative to surgery or ablation.

Weak

7.2.5.1 Summary of evidence and recommendations for adjuvant therapy

Summary of evidence

LE

After nephrectomy, in selected high-risk patients, adjuvant sunitinib improved disease-free survival in one of the two available studies, but not overall survival.

1b

Adjuvant sorafenib, pazopanib or axitinib does not improve disease-free survival or overall survival after nephrectomy.

1b

Recommendations

Strength rating

Do not offer adjuvant therapy with sorafenib, pazopanib or axitinib.

Strong

7.3.1.1.2 Summary of evidence and recommendations for local therapy of advanced/metastatic renal cell cancer

Summary of evidence

LE

Cytoreductive nephrectomy followed by sunitinib is non-inferior to sunitinib alone in patients with metastatic ccRCC.

1a

Sunitinib alone is non-inferior compared to immediate cytoreductive nephrectomy followed by sunitinib in patients with MSKCC intermediate and poor risk who require systemic therapy with VEGFR-TKIs.

1a

Recommendations

Strength rating

Do not perform cytoreductive nephrectomy (CN) in MSKCC poor-risk patients.

Strong

Do not perform immediate CN in MSKCC intermediate-risk patients who have an asymptomatic synchronous primary tumour and require systemic therapy with vascular endothelial growth factor receptor (VEGFR)-tyrosine kinase inhibitor (TKI).

Weak

Start systemic therapy without CN in MSKCC intermediate-risk patients who have an asymptomatic synchronous primary tumour and require systemic therapy with VEGFR-TKI.

Weak

Discuss delayed CN in MSKCC intermediate-risk patients under VEGFR-TKI therapy who derive long-term sustained benefit and/or minimal residual metastatic burden.

Weak

Perform immediate CN in patients with good performance who do not require systemic therapy.

Weak

Perform immediate CN in patients with oligometastases when complete local treatment of the metastases can be achieved.

Weak

Top
×