Pooleri Ginil Kumar, Nair Tiyadath Balagopalan, Sanjeevan Kalavampara V, Thomas Appu
Uro-Oncology division, Department of Urology, Amrita Institute of Medical Sciences, AIMS-Ponekkara(PO), Kochi 41, Kerala India.
Indian J Surg Oncol. 2012 Jun;3(2):114-9. doi: 10.1007/s13193-011-0100-8. Epub 2011 Nov 17.
Target molecule Treatment (TMT) have emerged as the primary treatment in metastatic renal cell carcinoma. Majority of the patients in pivot trials were post nephrectomy cases. The benefit of cytoreductive nephrectomy in the era of TMT is debated. The role of these molecules in the adjuvant settings and in neo adjuvant/pre surgical role has evoked interest. In this review the different molecules used in the treatment of metastatic renal cancer and its effect on the primary renal tumour is discussed. Information available in the public domain about the presurgical/neoadjuvant targeted molecular treatment (TMT) is reviewed to understand the benefits and adverse effects of this modality of treatment. Sunitinib and sorafenib are the most commonly used and effective molecules in the neo adjuvant/re surgical treatment of renal cell carcinoma . Bevacizumab is less effective and has more chance of surgical complications in these settings mainly due to poor wound healing secondary to prolonged wash off period . The patent and the surgeon should be aware of the unpredictability and possible adverse effects before advising these molecule pre operatively. The response of the primary renal tumour to the target molecule is different from that of the metastatic tumour. The side effects of the molecules and its effect on the peri operative morbidity and mortality should also be considered when we advise these molecules as pre surgical/neo adjuvant treatment.
靶向分子治疗（TMT）已成为转移性肾细胞癌的主要治疗方法。关键试验中的大多数患者为肾切除术后病例。在TMT时代，减瘤性肾切除术的益处存在争议。这些分子在辅助治疗以及新辅助/术前治疗中的作用引起了人们的兴趣。在本综述中，讨论了用于治疗转移性肾癌的不同分子及其对原发性肾肿瘤的影响。回顾了公共领域中有关术前/新辅助靶向分子治疗（TMT）的信息，以了解这种治疗方式的益处和不良反应。舒尼替尼和索拉非尼是肾细胞癌新辅助/再手术治疗中最常用且有效的分子。贝伐单抗效果较差，在这些情况下手术并发症的发生率更高，主要是因为冲洗期延长导致伤口愈合不良。在术前建议使用这些分子之前，患者和外科医生应了解其不可预测性和可能的不良反应。原发性肾肿瘤对靶向分子的反应与转移性肿瘤不同。当我们将这些分子作为术前/新辅助治疗建议时，还应考虑分子副作用及其对围手术期发病率和死亡率的影响。
