Aggressive Versus Conservative Management of Stage IV Renal Cell Carcinoma

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Abstract
Improved modalities to treat metastatic human renal cell carcinoma will require an aggressive surgical and chemotherapeutic approach. Nephrectomy with hormonal and nonhormonal chemotherapy improves median survival and 3 yr survival significantly. The use of xenogeneic specific immune RNA and BCG offers promising immunotherapeutic modalities that may be combined with surgical and chemotherapeutic regimens. Early diagnosis of metastatic disease is important to evaluate properly the results of various modalities of treatment and possibly to improve the efficiency of these modalities. The management of solitary metastatic nodules should involve aggressive resection of the primary and metastatic nodule. Adjuvant hormonal and nonhormonal chemotherapy should be considered in all stages of the disease.