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This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

363SIUJ.ORG SIUJ  •  Volume 3, Number 6  •  November 2022

EDITORIAL

Tackling Kidney Cancer Through  
International Consensus
Philippe E. Spiess

Deputy Editor, SIUJ
Director of Publications and ICUD Initiatives, Société International d’Urologie

Soc Int Urol J.2021;3(6):363–365

DOI: 10.48083/MFMG8103

Since 1981, the International Consultation on Urological Diseases (ICUD) has been an important global initiative. 
Conceived and promoted by the World Health Organization, it gathers international expertise, advancing 
fundamental knowledge and promoting evidence-based care across the spectrum of urologic conditions—most 
notably on thematic topics that are important to practicing urologists and that are not otherwise well covered in the 
scientific literature.

Over the past decade, the ICUD has participated in collaborative consultations with WUOF and the SIU, which 
is well established as a society dedicated to serving a global urological community. In this context, over the past 
few months, I have been proud to take on the role as the director of publications for the SIU to oversee present and 
future ICUD initiatives. The current ICUD joint consultation, dedicated to kidney cancer, has been chaired by several 
international thought leaders on the subject (Professors Toni Choueiri, Grant Stewart, and Robert Uzzo), with sections 
dedicated to epidemiology (including screening), diagnostic imaging, management of locally advanced disease, 
therapies in refractory metastatic disease, and management of toxicity and side effects[1]. In this editorial, I would 
like to highlight some of the exceptional articles within this issue of the SIUJ, which is dedicated to summarizing the 
findings of this most recent ICUD initiative—findings our readers will be able to integrate into their clinical practice.

The article by Dr Sabrina Rossi et al. on the epidemiology of renal cell carcinoma provides an in-depth review of the 
current incidence, prevalence, and mortality of kidney cancer across the globe[2]. The authors also draw attention to 
the increasing incidence of this malignancy in recent years, which can be attributed to most cases being incidentally 
detected on abdominal axial imaging studies obtained for often unrelated reasons. As a result, many of the suspicious 
renal masses presently detected are defined as small renal masses (≤ 3 centimeters), often with a low metastatic 
potential, for which active surveillance may represent an appropriate therapeutic option, most notably in elderly 
patients and/or those with multiple life-threatening medical comorbidities. The authors touch on the risk factors 
predisposing to the development of kidney cancer, and although for most individual patients we can’t specifically 
pinpoint the underlying causes for carcinogenesis, these are likely to include the increasing prevalence of obesity, 
exposure to insecticides/pollutants, and genetic predisposition to kidney cancer among a small subset of patients. 
The authors provide an intriguing discussion on potential screening strategies for kidney cancer, most notably in 
higher risk patient populations (those who are over 65 years, smokers, morbidly obese, and/or in families with a  
high preponderance of cases of an established genetic condition such as von Hippel-Lindau). Ongoing trials including 
the consideration of screening for both thoracic aneurysms and kidney cancer should be followed carefully as they 
incorporate ultrasound imaging, which is non-invasive and cost-effective, but remains operator dependent.

Dr Jodi Maranchie and colleagues nicely detail the various known hereditary kidney cancer syndromes including 
von Hippel-Lindau, familial papillary, Birt-Hogg-Dubé, as well as a number of others that are rapidly becoming 
recognized conditions[3]. There is no question there is increasing awareness about these conditions and the multi-
organ clinical manifestations they may entail, and that urologists and other healthcare professionals must be aware 
of, most notably in patients with a family history of kidney cancer in 1 or more first-degree relatives and/or in patients 
less than 40 years of age with a diagnosis of kidney cancer.



364 SIUJ  •  Volume 3, Number 6  •  November 2022 SIUJ.ORG

EDITORIAL

In a comprehensive review, Dr Vinay Duddalwar and 
colleagues provide an excellent synopsis of the imaging 
modalities readily available in assessing a renal mass to 
determine whether it can be accurately characterized as 
suspicious for an underlying malignancy[4]. Although 
CT or MRI axial imaging with and without IV contrast 
remain the benchmark diagnostic imaging modalities 
for renal cell carcinoma in clinical practice, there are 
some exciting developments in renal contrast-enhanced 
ultrasonography, elastography, and PET-CT imaging 
that are rapidly gaining ground. Artificial intelligence 
and radiomics likely represent the new horizons in 
diagnostics in not only accurately characterizing in 
a consistent and potentially automated manner the 
suspicion that a renal mass may represent an underlying 
malignancy but also potentially determining its 
specific tumor histology and characteristics, as well as 
attributable prognosis.

In their article, Dr Mohammed Ali et al. summarize 
the current state of knowledge relating to renal ablative 
therapies in the management of small renal masses 
(typically ≤ 3 cm)[5]. They provide a concise overview of 
the indications for renal ablation, typically conducted in 
an image-guided manner percutaneously rather than 
laparoscopically, because of its less invasive nature and 
non-inferior local therapeutic outcomes. A number 
of ablative energy modalities are readily available, 
including radiofrequency, cryoablation, and microwave. 
All have their merits and drawbacks but cryoablation 
remains the most favored because of its high success 
rate in terms of effective ablation, particularly if a 
double freeze–thaw cycle is used, and the procedure is 
completed by an experienced clinician (most commonly 
an interventional radiologist at a referral center).

In a nicely detailed review on the surgical manage-
ment of locally advanced renal cell carcinoma (most 
notably IVC tumor thrombi) Dr Vsevolod Matveev et 
al. discuss important surgical tips and tricks in tackling 
such complex surgical cases, including the emerging role 
of pre-surgical systemic therapy in attempting to regress 
the burden of disease or allow acute medical conditions 
to be optimized before proceeding with surgical care[6].

Dr Naomi Haas and colleagues present a thoughtful 
discussion on the rapidly evolving role of neoadjuvant 

and adjuvant therapy for renal cell carcinoma[7]. 
Although neoadjuvant therapy can provide some local 
tumor burden reduction, making surgical resection 
in theory potentially less morbid and/or in certain 
instances rendering primary tumors more amenable 
to nephron-sparing surgery, individual responses are 
harder to predict and must be considered on a case-by-
case basis—and in most instances should be considered 
as part of a clinical trial. In terms of adjuvant therapy, 
KEYNOTE 564 was truly pioneering in establishing 
the potential benefit of adjuvant pembrolizumab with 
respect to disease-free endpoints (overall survival to be 
reported) in patients with high-risk localized tumors (or 
following isolated site of metastatectomy < 1 year of prior 
nephrectomy) post-resection[8]. Clearly, this has been 
paradigm-shifting, most notably as the prior adjuvant 
therapy studies using targeted therapies (ASSURE and 
S-TRAC) were equivocal in terms of the benefits they 
rendered.

 In a critically important review, Dr Lisa Pickering 
and colleagues provide a detailed summary of the acute 
and chronic (minor and major) toxicities of the rapidly 
evolving systemic therapeutic landscape of advanced 
renal cell carcinoma[9]. This includes a characterization 
of the immune-related adverse events, which although 
less frequent, can be life-threatening and occasionally 
more difficult to predict. The authors note that the 
emergence of triple agent combinations using a number 
of checkpoint inhibitors and/or targeted therapies 
offers an exciting new opportunity to improve patient 
outcomes but is fraught with apprehension in terms of 
the risk and severity of adverse events. Although our 
experience with such triple agent combinations is early, 
it remains quite promising; a meticulous and systematic 
approach to screening and treating these patients on 
triple agent combinations is of pivotal importance.

In conclusion, we are excited to share these important 
contributions with our readers. We deeply appreciate—
and congratulate—all the chairs and the contributors to 
this 2nd WUOF/SIU-ICUD collaboration focused on 
renal cell carcinoma. It provides an important resource 
for all global healthcare professionals caring for kidney 
cancer patients.



365SIUJ.ORG SIUJ  •  Volume 3, Number 6  •  November 2022

Tackling Kidney Cancer Through International Consensus

References

1. Klotz L, Stewart GD, Uzzo RG, Choueri TK, eds. 2nd WUOF/SIU 
ICUD on kidney cancer. World Urologic Oncology Federation/Société 
Internationale d’Urologie–International Consultation on Urological 
Diseases;2022. 

2. Rossi S, Tanaka H, Usher-Smith JA, Bernhard J-C, Fujii Y, Stewart 
GD. 20 22 W UOF/SIU-International Consultation on Urologic 
Diseases: kidney cancer screening and epidemiology. Soc Int Urol 
J.2022;3(6): doi: 10.48083/ XBCX3386

3. Maranchie J, Such BM, Bratslavsky G, Maher ER. 2022 WUOF/
SIU-International Consultation on Urologic Diseases: hereditar y 
renal cell carcinoma syndromes. Soc Int Urol J.2022;3(6) doi: 
10.48083/CBTO5325

4. Duddalwar VA, Lee W-K, Lindenberg ML, Gonzalez EM, Choyke P, 
King KG, Vikram R. 2022 WUOF/SIU-International Consultation on 
Urologic Diseases: Imaging of Renal Cell Carcinoma. Soc Int Urol 
J.2022;3(6): doi: 10.48083/SDMV1045

5. A li M, Ruiz VA , P su t k a SP, L iu D, Siv a S. 2 0 2 2 W UOF/
SIU-International Consultation on Urologic Diseases: ablative 
therapies for localized primary renal cell carcinoma. Soc Int Urol 
J.2022;3(6): doi: 10.48083/UEML5802

6. Matveev V, Psutka SP, Stewart GD, Bratslavsky G, Abel EJ. 2022 
W UOF/SIU-International Consultation on Urologic Diseases: 
management of locally advanced renal cell carcinoma. Soc Int Urol 
J.2022;3(6): doi: 10.48083/EGWH6536

7. Haas N, Shevach J, Davis ID, Eisen T, Gross-Goupil M, Kapoor A, et 
al. 2022 WUOF/SIU-International Consultation on Urologic Diseases: 
neoadjuvant and adjuvant therapy for renal cell carcinoma. Soc Int 
Urol J.2022;3(6): doi: 10.48083/ VSQG7437

8. Choueiri TK, Tomczak P, Park SH, Venugopal B, Ferguson T, Chang 
Y-Het al. Adjuvant pembrolizumab af ter nephrectomy in renal-
cell carcinoma. N Engl J Med.2021;385(8):683-694. doi: 10.1056/
NEJMoa2106391

9. Young K, Schmit t AM, Mukherji D, Spain L, Schmidinger M, 
Pickering LM. 2022 W UOF/SIU-International Consultation on 
Urologic Diseases: management of toxicity from RCC therapies. 
Soc Int Urol J.2022;3(6): doi: 10.48083/SYAB9165




