metastatic immunotherapy such as common to the lung, bone, liver, brain and RCC, and local areas. Local recurrence after alpha-Interferon (IFN-α) Interleukin-2 show response about nephrectomy occurs in 2.9%, with (IL2) is more toxic than contralateral recurrence about 1,2% and and only give response showing worse prognosis. Surgery is the clear cell type to immunotherapy. first choice for local recurrence without 27,28,29. Some targeted therapy which inhibit distant metastasis. If there is any metastasis, the we may give systemic therapy. vascular endothelial growth factor 36,37,38 Based on our data, 21(72%) patients (VEGF); sunitinib, sorafenib, were performed radical nephrectomy, 2(7%) patients partial nephrectomy, and target of rapamycin (mTOR) pathways; and also give 6(21%) patients underwent palliative temsirolimus everolimus, better outcome than immunotherapy with radical nephrectomy, followed with more tolerable complications. treatment of 4(14%). Radical Sunitibin are nephrectomy was performed in almost all Biphosponator Zoledronic acid recommended for ones with hyperkalemia patients who were possible for surgery with with normal kidney function, which are good performance state, because RCC is given 4 mg every 4 weeks intravenously. radio and chemo resistance, so that there would be no further treatment after surgery. 4,30,31,32,33,34,35 Surveillance is for follow up of By resecting the kidney along with fascia possibility of recurrence and metastasis. Gerota and perirenal fat, we expect no Recurrence mostly occurs after 3 years of metastasis and recurrence. operation, 43% occur in the first year, 70% Two patients were performed partial in the second year, 80% in the third year nephrectomy because the tumors were and 93% in the fifth year. Metastasis is localized in trial pole of the kidney. While
metastatic RCC, immunotherapy such as alpha-Interferon (IFN-α) and Interleukin-2 (IL2) show response about is more toxic than and only clear cell type give response to immunotherapy. 27,28,29. Some targeted therapy which inhibit the vascular endothelial growth factor (VEGF); sunitinib, sorafenib, target of rapamycin (mTOR) pathways; temsirolimus and also everolimus, give better outcome than immunotherapy with more tolerable complications. Biphosponator Zoledronic acid are recommended for ones with hyperkalemia with normal kidney function, which are given 4 mg every 4 weeks intravenously. 4,30,31,32,33,34,35 Surveillance is for follow up of possibility of recurrence and metastasis. Recurrence mostly occurs after 3 years of operation, 43% occur in the first year, 70% in the second year, 80% in the third year and 93% in the fifth year. Metastasis is common to the lung, bone, liver, brain and local areas. Local recurrence after nephrectomy occurs in 2.9%, with contralateral recurrence about 1,2% and showing worse prognosis. Surgery is the first choice for local recurrence without distant metastasis. If there is any metastasis, we may give systemic therapy. 36,37,38 Based on our data, 21(72%) patients were performed radical nephrectomy, 2(7%) patients partial nephrectomy, and 6(21%) patients underwent palliative radical nephrectomy, followed with treatment of Sunitibin 4(14%). Radical nephrectomy was performed in almost all patients who were possible for surgery with good performance state, because RCC is radio and chemo resistance, so that there would be no further treatment after surgery. By resecting the kidney along with fascia Gerota and perirenal fat, we expect no metastasis and recurrence. Two patients were performed partial nephrectomy because the tumors were localized in pole of the kidney. While trial