Program Description
In this CME-certified presentation, Dr. Christopher Wood covers the surgical treatment of renal cell carcinoma. As the only effective therapy for localized disease, surgery is a mainstay of treatment. The presentation will review the use of radical vs partial nephrectomy and open vs laparoscopic technique in localized disease, and the role of cytoreductive nephrectomy and metastasectomy in metastatic disease. Finally, Dr. Wood will address the challenges of integrating surgery into the current treatment landscape.

Target Audience
This activity has been designed for community- and hospital-based medical oncologists, hematologists, urologists, nephrologists, and allied healthcare providers who provide medical care and support to patients with renal cell carcinoma.

Learning Objectives
After completing this program, participants should be able to

	•	Select patients with localized RCC appropriate for nephron-sparing surgery
	•	Maximize outcomes in patients with metastatic RCC through appropriate use of cytoreductive nephrectomy
	•	Discuss the current state of ablative technologies for RCC

Faculty
Robert A. Figlin, MD (Activity Director)
Arthur and Rosalie Kaplan Chair in Oncology
Professor and Chair, Medical Oncology and Therapeutics Research
City of Hope National Medical Center and Beckman Research Institute
Associate Director for Clinical research
City of Hope Comprehensive Cancer Center
Duarte, California

Christopher G. Wood, MD, FACS
Associate Professor of Urology
Department of Urology
The University of Texas M.D. Anderson Cancer Center
Houston, Texas

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the City of Hope and Alliance Medical Communications. The City of Hope is accredited by the ACCME to provide continuing medical education for physicians.

Designation of Credit
This activity is designated for .5 AMA Physicians’ Recognition Award™ credits. To receive your CME credits you are requested to review the material in full and take the post-test and evaluation. Your evaluation of the activity and comments will remain confidential.

Disclosure
City of Hope takes responsibility for the content, quality and scientific integrity of this continuing medical education (CME) activity. Prior to their participation in this City of Hope CME activity, all faculty/presenters have disclosed any real or apparent vested commercial interest(s) in both those companies whose products may be discussed during the course of the activity and in those companies acting as commercial supporters of the activity. City of Hope further requires that prior to the activity, faculty/presenters have disclosed their intention to discuss any off-label and/or investigational (not yet approved for any purpose) use of pharmaceuticals or medical devices. Written disclosure of faculty/presenters’ specific commercial relationships and/or intent to discuss off-label and/or investigational is provided below.

Robert A. Figlin, MD (Activity Director)

Commercial Interest	Relationship
Amgen, GlaxoSmithKline plc; Keryx Biopharmaceuticals, Inc.; Pfizer Inc; Wyeth	Grant/Research Support
Keryx Biopharmaceuticals, Inc; Pfizer Inc; Wyeth	Consultant

Christopher G. Wood, MD

Commercial Interest	Relationship
Antigenics Inc.; Bristol-Myers Squibb Company; Ethicon, Inc.; Pfizer Inc; Pharmion Corporation	Consultant
Bayer Healthcare AG; Pfizer Inc	Speakers’ Bureau
Antigenics Inc.; Bayer Healthcare AG; Bristol-Myers Squibb Company; Ethicon, Inc.; Pharmion Corporation	Honorarium

Dr. Wood reported mention of the following off-label and/or investigational use of products within his presentation.

Product	Investigational and/or Off-Label Use
IL-2	Renal cell carcinoma
IFN-α	Renal cell carcinoma

References

1.	Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol. 2004;171:1071-1076.
2.	Flanigan RC, Salmon SE, Blumenstein BA, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001;345:1655-1659.
3.	Han KR, Pantuck AJ, Bui MH, et al. Number of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma. Urology. 2003;61:314-319.
4.	Kavolius JP, Mastorakos DP, Pavlovich C, et al. Resection of metastatic renal cell carcinoma. J Clin Oncol. 1998;16:2261-2266.
5.	Kuehnl A, Schmidt M, Hornung HM, Graser A, Jauch KW, Kopp R. Resection of malignant tumors invading the vena cava: perioperative complications and long-term follow-up. J Vasc Surg. 2007;46:533-540.
6.	Lambert EH, Pierorazio PM, Shabsigh A, Olsson CA, Benson MC, McKiernan JM. Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology. 2007;69:1054-1058.
7.	Leibovich BC, Blute ML, Cheville JC, et al. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004;17:1066-1070.
8.	Margulis V, Tamboli P, Jacobsohn KM, Swanson DA, Wood CG. Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinoma. BJU Int. 2007;100:1235-1239.
9.	Mickisch GH, Garin A, van Poppel H, et al. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001;358:966-970.
10.	National Comprehensive Cancer Network. "Kidney Cancer." NCCN Clinical Practice Guidelines in Oncology 2007;v.1.2008.
11.	Pahernik S, Roos F, Röhrig B, Wiesner C, Thüroff JW. Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2008;179:71-74.
12.	Pantuck AJ, Belldegrun AS, Figlin RA. Cytoreductive nephrectomy for metastatic renal cell carcinoma: is it still imperative in the era of targeted therapy? Clin Cancer Res. 2007;13(2 Pt 2):693s-696s.
13.	Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171(6 Pt 1):2181-2185.
14.	Rini BI, Campbell SC. The evolving role of surgery for advanced renal cell carcinoma in the era of molecular targeted therapy. J Urol. 2007;177:1978-1984.
15.	Rouviere O, Bouvier R, Negrier S, et al. Nonmetastatic renal cell carcinoma: is it really possible to define rational guidelines for post treatment follow up? Nat Clin Pract Oncol. 2006;3:200-213.
16.	Thompson RH, Boorjian SA, Lohse CM, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008;179:468-473.