Steven L. Chang, MD, MS, Editor

Michael L. Blute Sr., MD Editor

The management approaches for kidney cancer have undergone a dramatic transformation over the past 20 years. While recent developments in systemic therapeutic options for advanced disease have received a great deal of attention, in truth it is but one of a multitude of notable breakthroughs in the care of patients with kidney cancer, all of which have served to improve patient outcomes.

Arguably, the most important development for kidney cancer has been the shift to an integrated multimodal approach. This issue of Urologic Clinics of North America takes the reader on a comprehensive journey demonstrating the innumerable improvements in the various disciplines critical in the treatment of kidney cancer. There have been enhancements in the assessment of renal masses and renal cysts from advancements in imaging to the increasing utilization of renal mass biopsy—with biomarkers on the horizon to achieve greater diagnostic precision. Both the recent refinements in the pathologic classification of kidney cancer and better understanding of hereditary syndromes have established the underlying molecular and genetic alterations of kidney cancer, which in turn laid the groundwork for game-changing pharmacotherapies. The advent of these systemic therapies, including tyrosine kinase inhibitors and more recently immuno-oncology, as well as the simultaneous shift to lower stages of disease at presentation has consequently impacted the role of surgery. Historically, expeditious surgery was the only option. Now, for low-stage disease (eg, small renal masses and renal cysts), surgery is weighed against nonsurgical options, such as active surveillance and thermal ablation, with strong consideration for patient comorbidities and treatment consequences (eg, chronic kidney disease). For high-stage disease, multidisciplinary management with a focus on quality of life, by addressing paraneoplastic syndrome and other presenting symptoms, along with oncologic outcomes requires a careful coordination between urology, medical oncology, and other specialties. Even radiation therapy, previously not considered an option because kidney cancer was thought to be radioresistant, is now showing promise as a curative treatment for low-stage disease and an effective modality for palliation and consolidation for high-stage disease. Future developments will undoubtedly lead to further evolution in the multimodal treatment of kidney cancer.

The advancements described in this issue were the culmination of an amazing international network of clinicians and researchers collaborating across clinics, academia, and industry. The determined efforts of patients, family members, and patient advocates impacted by kidney cancer are at the core of the progress. While there remains much work ahead, the rapid pace of the advancements in recent years fuels the optimism for further paradigm shifts in the treatment of kidney cancer in the next 20 years.

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DOI: https://doi.org/10.1016/j.ucl.2023.02.002

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© 2023 Published by Elsevier Inc.

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