**6. Radiotherapy**

and have further elucidated several new biomarkers [28–31]. Nonetheless, further investigation, testing and development is required before molecular approaches can be incorporated

Two trials that used adjuvant IFN-α [32, 33] and one study that used adjuvant high-dose IL-2 (82) were negative for any benefit. The latter study was designed and powered to show an improvement in predicted 2-year DFS from 40% for the observation group to 70% for the treatment group. Despite full accrual 30% improvement in 2-year DFS could not be achieved

Combination treatment with IFN-α and IL2 also failed to improve DFS in one trial [34].

The combination of cytokines with 5-fluorouracil (5-FU) also failed to improve DFS in the

In one randomized adjuvant trial, triple combination therapy using IL-2, IFN-α, and5-FU was associated with significant toxicity which leads to 35% of the patients did not complete the

Autologous irradiated tumor cells mixed with bacillus Calmette-Guérin (BCG) were tested in

Similarly, autologous, tumor-derived heat-shock protein (glycoprotein 96)-peptide complex (HSPPC-96; vitespen) did not result in a statistically significant improvement of DFS [41].

A trial with an autologous renal tumor cell vaccine only reported improved DFS in the vaccine group [42], but the number of patients lost after the randomization step, the imbalance of

The occasional response of patients with metastatic RCC to hormonal therapy with medroxy-

In a prospective randomized trial of adjuvant MPA after radical nephrectomy, 136 patients received either MPA 500 g (three times a week) for 1 year or observation. With a median follow up of 5 years. There were no significant differences in relapses between the adjuvant group and

this loss, and the absence of tabulation of OS led to criticism of the results [43].

progestrone acetate (MPA) provided a rationale in trying it in adjuvant sitting.

for clinical application in an efficient and economically viable manner.

**3. Immunotherapy IL2,IFα**

176 Evolving Trends in Kidney Cancer

which lead to early study closure.

study and also resulted in no benefit in DFS or OS [37].

two randomized trials and did not result in prolonged DFS [38–40].

This therapy has not been implemented in routine clinical practice.

the observation group (32.7 vs. 33.9%, respectively) [44].

adjuvant setting [35, 36].

**4. Tumor vaccines**

**5. Hormonal therapy**

Radiotherapy has been used for symptoms palliation in metastatic RCC like hematuria and painful bone metastasis. Also, long-term PFS has been reported for in a subset of patients following radiotherapy for solitary bone metastases [31].

One prospective, randomized study in 72 patients comparing administration of radiation of the kidney bed, and ipsilateral and contralateral lymph nodes for stages II and III RCC versus observation reported relapse rates of 48% in both groups. Forty-four percent of patients in the radiotherapy arm had significant complications that contributed to the death of 19% of patients [45–47].
