Under de senaste \u00e5ren har betydande framsteg gjorts inom den medicinska behandlingen av metastaserad njurcellscancer (mRCC) och flera olika nya behandlingsalternativ har utvecklats. Flera l\u00e4kemedel \u00e4r godk\u00e4nda och flera nya behandlingar testas.<\/p>\n<\/div>
Vissa patienter med mRCC har endast begr\u00e4nsad sjukdomsb\u00f6rda (t.ex. sm\u00e5 lungmetastaser och\/eller l\u00e4tt f\u00f6rstorade lymfk\u00f6rtlar ovanf\u00f6r eller nedanf\u00f6r diafragma) medan de \u00e4r asymtomatiska. Hos dessa patienter kan en kortare observationsperiod utan behandling \u00f6verv\u00e4gas, eftersom sjukdomen kan f\u00f6rbli stabil eller bara v\u00e4xa mycket l\u00e5ngsamt under en kortare eller l\u00e4ngre tidsperiod. Patienterna ska kontrolleras regelbundet med blodprover, datortomografi och kliniska kontroller. Vid signifikant tillv\u00e4xt\/uppkomst av nya metastaser, minskat antal blodkroppar och\/eller om patienten utvecklar symtom (fortskridande tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta) ska behandling s\u00e4ttas in. 1<\/sup><\/p>\n<\/div>2. Metastaskirurgi<\/h4><\/div>Kirurgisk resektion av solit\u00e4ra metastaser \u00e4r associerad med en 5-\u00e5rs\u00f6verlevnad p\u00e5 35\u201350 %. Vid solit\u00e4ra metastaser b\u00f6r behandlingen d\u00e4rf\u00f6r vara radikal resektion av metastaserna. 2<\/sup><\/p>\n<\/div>3. Stereotaktisk str\u00e5lbehandling (SBRT)<\/h4><\/div>Stereotaktisk str\u00e5lbehandling (SBRT) \u00e4r fokuserad str\u00e5lbehandling i h\u00f6g dos, som ges 1\u20135 g\u00e5nger, till en eller ett f\u00e5tal metastaser. Syftet med SBRT \u00e4r att med h\u00f6g precision rikta in behandlingen p\u00e5 relevanta metastaser och med minsta m\u00f6jliga skada p\u00e5 omgivande normal v\u00e4vnad.<\/p>\nOm det finns en eller ett f\u00e5tal metastaser som inte kan tas bort kirurgiskt (cerebrum, lungor, lymfk\u00f6rtel, recidiv p\u00e5 nefrektomist\u00e4lle, skelett osv.) kan stereotaktisk str\u00e5lbehandling \u00f6verv\u00e4gas<\/a>.<\/p>\nBeslut om stereotaktisk str\u00e5lbehandling, oavsett om det g\u00e4ller cerebrala eller perifera metastaser, fattas vid en multidisciplin\u00e4r konferens. Mer information finns i avsnittet om str\u00e5lbehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) f\u00f6ljt av onkologisk behandling<\/h4><\/div>\n\n\nNefrektomi har dokumenterats orsaka regression av metastaser vid metastaserad sjukdom, \u00e4ven om det \u00e4r ett s\u00e4llsynt (1 %) fenomen. 3<\/sup><\/p>\nD\u00e5 IL-2-baserad immunterapi anv\u00e4ndes rekommenderades cytoreduktiv nefrektomi (CN) f\u00f6r patienter med god funktionsstatus f\u00f6re behandling.<\/p>\nSedan tyrosinkinash\u00e4mmare (TKI) har blivit standardbehandling har tv\u00e5 prospektiva studier unders\u00f6kt indikationen f\u00f6r CN f\u00f6re TKI. B\u00e5da studierna avslutades i f\u00f6rtid p\u00e5 grund av d\u00e5lig rekrytering, men slutsatsen fr\u00e5n b\u00e5da studierna var att det inte fanns n\u00e5gon \u00f6verlevnadsf\u00f6rdel med CN f\u00f6re TKI. Det har f\u00f6rekommit mycket kritik mot b\u00e5da studierna och enligt EAU-riktlinjerna ger data bara tillr\u00e4ckligt underlag f\u00f6r slutsatsen att patienter som tillh\u00f6r en grupp med d\u00e5lig prognos enligt IMDC (se avsnittet om verktyg f\u00f6r prognostisk stratifiering av patienter med mRCC<\/a>) INTE ska erbjudas CN f\u00f6re TKI. 4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f6re systemisk behandling kan fortsatt rekommenderas:<\/p>\n\ni kliniska pr\u00f6vningar<\/li>\nf\u00f6r patienter med gott AT (funktionsstatus = 0\u20131)<\/a> med stor prim\u00e4rtum\u00f6r och liten metastasvolym som inte har spridit sig till CNS, skelett eller lever<\/li>\nf\u00f6r patienter som har symtom fr\u00e5n prim\u00e4rtum\u00f6ren i form av hematuri eller sm\u00e4rta 5<\/sup><\/li>\n<\/ul>\nBeslutet om CN ska alltid fattas vid en multidisciplin\u00e4r konferens (MDK<\/a>). 5<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagande i kliniska pr\u00f6vningar<\/h4><\/div>\n\n\nM\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referenser<\/h4><\/div>\nActive surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Rini B et al. Lancet Oncol 2016; 17: 1317\u201324.<\/em><\/li>\nDaRenCa guidelines<\/em><\/li>\nFreed SZ, Halperin JP, Gordon M. Idiopathic regression of metastases from renal cell carcinoma. The Journal of urology. 977;118(4):538\u201342.<\/em><\/li>\nAxel Bex et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74: 805-809<\/em><\/li>\nDaRenCa guidelines, ESMO guideline og Bhindi et al. Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol; 2019: 111-128<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div>Testa dina kunskaper<\/h4><\/div><\/div><\/div><\/div><\/div>Under en observationsperiod kan f\u00f6ljande symtom vara sk\u00e4l att inleda behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och h\u00e5ravfall<\/label><\/div>\u00d6kad tr\u00f6tthet, infektion, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div><\/fieldset><\/div>(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Kirurgisk resektion av solit\u00e4ra metastaser \u00e4r associerad med en 5-\u00e5rs\u00f6verlevnad p\u00e5 35\u201350 %. Vid solit\u00e4ra metastaser b\u00f6r behandlingen d\u00e4rf\u00f6r vara radikal resektion av metastaserna. 2<\/sup><\/p>\n<\/div>3. Stereotaktisk str\u00e5lbehandling (SBRT)<\/h4><\/div>Stereotaktisk str\u00e5lbehandling (SBRT) \u00e4r fokuserad str\u00e5lbehandling i h\u00f6g dos, som ges 1\u20135 g\u00e5nger, till en eller ett f\u00e5tal metastaser. Syftet med SBRT \u00e4r att med h\u00f6g precision rikta in behandlingen p\u00e5 relevanta metastaser och med minsta m\u00f6jliga skada p\u00e5 omgivande normal v\u00e4vnad.<\/p>\nOm det finns en eller ett f\u00e5tal metastaser som inte kan tas bort kirurgiskt (cerebrum, lungor, lymfk\u00f6rtel, recidiv p\u00e5 nefrektomist\u00e4lle, skelett osv.) kan stereotaktisk str\u00e5lbehandling \u00f6verv\u00e4gas<\/a>.<\/p>\nBeslut om stereotaktisk str\u00e5lbehandling, oavsett om det g\u00e4ller cerebrala eller perifera metastaser, fattas vid en multidisciplin\u00e4r konferens. Mer information finns i avsnittet om str\u00e5lbehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) f\u00f6ljt av onkologisk behandling<\/h4><\/div>\n\n\nNefrektomi har dokumenterats orsaka regression av metastaser vid metastaserad sjukdom, \u00e4ven om det \u00e4r ett s\u00e4llsynt (1 %) fenomen. 3<\/sup><\/p>\nD\u00e5 IL-2-baserad immunterapi anv\u00e4ndes rekommenderades cytoreduktiv nefrektomi (CN) f\u00f6r patienter med god funktionsstatus f\u00f6re behandling.<\/p>\nSedan tyrosinkinash\u00e4mmare (TKI) har blivit standardbehandling har tv\u00e5 prospektiva studier unders\u00f6kt indikationen f\u00f6r CN f\u00f6re TKI. B\u00e5da studierna avslutades i f\u00f6rtid p\u00e5 grund av d\u00e5lig rekrytering, men slutsatsen fr\u00e5n b\u00e5da studierna var att det inte fanns n\u00e5gon \u00f6verlevnadsf\u00f6rdel med CN f\u00f6re TKI. Det har f\u00f6rekommit mycket kritik mot b\u00e5da studierna och enligt EAU-riktlinjerna ger data bara tillr\u00e4ckligt underlag f\u00f6r slutsatsen att patienter som tillh\u00f6r en grupp med d\u00e5lig prognos enligt IMDC (se avsnittet om verktyg f\u00f6r prognostisk stratifiering av patienter med mRCC<\/a>) INTE ska erbjudas CN f\u00f6re TKI. 4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f6re systemisk behandling kan fortsatt rekommenderas:<\/p>\n\ni kliniska pr\u00f6vningar<\/li>\nf\u00f6r patienter med gott AT (funktionsstatus = 0\u20131)<\/a> med stor prim\u00e4rtum\u00f6r och liten metastasvolym som inte har spridit sig till CNS, skelett eller lever<\/li>\nf\u00f6r patienter som har symtom fr\u00e5n prim\u00e4rtum\u00f6ren i form av hematuri eller sm\u00e4rta 5<\/sup><\/li>\n<\/ul>\nBeslutet om CN ska alltid fattas vid en multidisciplin\u00e4r konferens (MDK<\/a>). 5<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagande i kliniska pr\u00f6vningar<\/h4><\/div>\n\n\nM\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referenser<\/h4><\/div>\nActive surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Rini B et al. Lancet Oncol 2016; 17: 1317\u201324.<\/em><\/li>\nDaRenCa guidelines<\/em><\/li>\nFreed SZ, Halperin JP, Gordon M. Idiopathic regression of metastases from renal cell carcinoma. The Journal of urology. 977;118(4):538\u201342.<\/em><\/li>\nAxel Bex et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74: 805-809<\/em><\/li>\nDaRenCa guidelines, ESMO guideline og Bhindi et al. Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol; 2019: 111-128<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div>Testa dina kunskaper<\/h4><\/div><\/div><\/div><\/div><\/div>Under en observationsperiod kan f\u00f6ljande symtom vara sk\u00e4l att inleda behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och h\u00e5ravfall<\/label><\/div>\u00d6kad tr\u00f6tthet, infektion, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div><\/fieldset><\/div>(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Stereotaktisk str\u00e5lbehandling (SBRT) \u00e4r fokuserad str\u00e5lbehandling i h\u00f6g dos, som ges 1\u20135 g\u00e5nger, till en eller ett f\u00e5tal metastaser. Syftet med SBRT \u00e4r att med h\u00f6g precision rikta in behandlingen p\u00e5 relevanta metastaser och med minsta m\u00f6jliga skada p\u00e5 omgivande normal v\u00e4vnad.<\/p>\n
Om det finns en eller ett f\u00e5tal metastaser som inte kan tas bort kirurgiskt (cerebrum, lungor, lymfk\u00f6rtel, recidiv p\u00e5 nefrektomist\u00e4lle, skelett osv.) kan stereotaktisk str\u00e5lbehandling \u00f6verv\u00e4gas<\/a>.<\/p>\nBeslut om stereotaktisk str\u00e5lbehandling, oavsett om det g\u00e4ller cerebrala eller perifera metastaser, fattas vid en multidisciplin\u00e4r konferens. Mer information finns i avsnittet om str\u00e5lbehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) f\u00f6ljt av onkologisk behandling<\/h4><\/div>\n\n\nNefrektomi har dokumenterats orsaka regression av metastaser vid metastaserad sjukdom, \u00e4ven om det \u00e4r ett s\u00e4llsynt (1 %) fenomen. 3<\/sup><\/p>\nD\u00e5 IL-2-baserad immunterapi anv\u00e4ndes rekommenderades cytoreduktiv nefrektomi (CN) f\u00f6r patienter med god funktionsstatus f\u00f6re behandling.<\/p>\nSedan tyrosinkinash\u00e4mmare (TKI) har blivit standardbehandling har tv\u00e5 prospektiva studier unders\u00f6kt indikationen f\u00f6r CN f\u00f6re TKI. B\u00e5da studierna avslutades i f\u00f6rtid p\u00e5 grund av d\u00e5lig rekrytering, men slutsatsen fr\u00e5n b\u00e5da studierna var att det inte fanns n\u00e5gon \u00f6verlevnadsf\u00f6rdel med CN f\u00f6re TKI. Det har f\u00f6rekommit mycket kritik mot b\u00e5da studierna och enligt EAU-riktlinjerna ger data bara tillr\u00e4ckligt underlag f\u00f6r slutsatsen att patienter som tillh\u00f6r en grupp med d\u00e5lig prognos enligt IMDC (se avsnittet om verktyg f\u00f6r prognostisk stratifiering av patienter med mRCC<\/a>) INTE ska erbjudas CN f\u00f6re TKI. 4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f6re systemisk behandling kan fortsatt rekommenderas:<\/p>\n\ni kliniska pr\u00f6vningar<\/li>\nf\u00f6r patienter med gott AT (funktionsstatus = 0\u20131)<\/a> med stor prim\u00e4rtum\u00f6r och liten metastasvolym som inte har spridit sig till CNS, skelett eller lever<\/li>\nf\u00f6r patienter som har symtom fr\u00e5n prim\u00e4rtum\u00f6ren i form av hematuri eller sm\u00e4rta 5<\/sup><\/li>\n<\/ul>\nBeslutet om CN ska alltid fattas vid en multidisciplin\u00e4r konferens (MDK<\/a>). 5<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagande i kliniska pr\u00f6vningar<\/h4><\/div>\n\n\nM\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referenser<\/h4><\/div>\nActive surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Rini B et al. Lancet Oncol 2016; 17: 1317\u201324.<\/em><\/li>\nDaRenCa guidelines<\/em><\/li>\nFreed SZ, Halperin JP, Gordon M. Idiopathic regression of metastases from renal cell carcinoma. The Journal of urology. 977;118(4):538\u201342.<\/em><\/li>\nAxel Bex et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74: 805-809<\/em><\/li>\nDaRenCa guidelines, ESMO guideline og Bhindi et al. Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol; 2019: 111-128<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div>Testa dina kunskaper<\/h4><\/div><\/div><\/div><\/div><\/div>Under en observationsperiod kan f\u00f6ljande symtom vara sk\u00e4l att inleda behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och h\u00e5ravfall<\/label><\/div>\u00d6kad tr\u00f6tthet, infektion, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div><\/fieldset><\/div>(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Beslut om stereotaktisk str\u00e5lbehandling, oavsett om det g\u00e4ller cerebrala eller perifera metastaser, fattas vid en multidisciplin\u00e4r konferens. Mer information finns i avsnittet om str\u00e5lbehandling<\/a>.<\/p>\n<\/div>4. Cytoreduktiv nefrektomi (CN) f\u00f6ljt av onkologisk behandling<\/h4><\/div>\n\n\nNefrektomi har dokumenterats orsaka regression av metastaser vid metastaserad sjukdom, \u00e4ven om det \u00e4r ett s\u00e4llsynt (1 %) fenomen. 3<\/sup><\/p>\nD\u00e5 IL-2-baserad immunterapi anv\u00e4ndes rekommenderades cytoreduktiv nefrektomi (CN) f\u00f6r patienter med god funktionsstatus f\u00f6re behandling.<\/p>\nSedan tyrosinkinash\u00e4mmare (TKI) har blivit standardbehandling har tv\u00e5 prospektiva studier unders\u00f6kt indikationen f\u00f6r CN f\u00f6re TKI. B\u00e5da studierna avslutades i f\u00f6rtid p\u00e5 grund av d\u00e5lig rekrytering, men slutsatsen fr\u00e5n b\u00e5da studierna var att det inte fanns n\u00e5gon \u00f6verlevnadsf\u00f6rdel med CN f\u00f6re TKI. Det har f\u00f6rekommit mycket kritik mot b\u00e5da studierna och enligt EAU-riktlinjerna ger data bara tillr\u00e4ckligt underlag f\u00f6r slutsatsen att patienter som tillh\u00f6r en grupp med d\u00e5lig prognos enligt IMDC (se avsnittet om verktyg f\u00f6r prognostisk stratifiering av patienter med mRCC<\/a>) INTE ska erbjudas CN f\u00f6re TKI. 4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f6re systemisk behandling kan fortsatt rekommenderas:<\/p>\n\ni kliniska pr\u00f6vningar<\/li>\nf\u00f6r patienter med gott AT (funktionsstatus = 0\u20131)<\/a> med stor prim\u00e4rtum\u00f6r och liten metastasvolym som inte har spridit sig till CNS, skelett eller lever<\/li>\nf\u00f6r patienter som har symtom fr\u00e5n prim\u00e4rtum\u00f6ren i form av hematuri eller sm\u00e4rta 5<\/sup><\/li>\n<\/ul>\nBeslutet om CN ska alltid fattas vid en multidisciplin\u00e4r konferens (MDK<\/a>). 5<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagande i kliniska pr\u00f6vningar<\/h4><\/div>\n\n\nM\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referenser<\/h4><\/div>\nActive surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Rini B et al. Lancet Oncol 2016; 17: 1317\u201324.<\/em><\/li>\nDaRenCa guidelines<\/em><\/li>\nFreed SZ, Halperin JP, Gordon M. Idiopathic regression of metastases from renal cell carcinoma. The Journal of urology. 977;118(4):538\u201342.<\/em><\/li>\nAxel Bex et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74: 805-809<\/em><\/li>\nDaRenCa guidelines, ESMO guideline og Bhindi et al. Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol; 2019: 111-128<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div>Testa dina kunskaper<\/h4><\/div><\/div><\/div><\/div><\/div>Under en observationsperiod kan f\u00f6ljande symtom vara sk\u00e4l att inleda behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och h\u00e5ravfall<\/label><\/div>\u00d6kad tr\u00f6tthet, infektion, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div><\/fieldset><\/div>(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Nefrektomi har dokumenterats orsaka regression av metastaser vid metastaserad sjukdom, \u00e4ven om det \u00e4r ett s\u00e4llsynt (1 %) fenomen. 3<\/sup><\/p>\nD\u00e5 IL-2-baserad immunterapi anv\u00e4ndes rekommenderades cytoreduktiv nefrektomi (CN) f\u00f6r patienter med god funktionsstatus f\u00f6re behandling.<\/p>\nSedan tyrosinkinash\u00e4mmare (TKI) har blivit standardbehandling har tv\u00e5 prospektiva studier unders\u00f6kt indikationen f\u00f6r CN f\u00f6re TKI. B\u00e5da studierna avslutades i f\u00f6rtid p\u00e5 grund av d\u00e5lig rekrytering, men slutsatsen fr\u00e5n b\u00e5da studierna var att det inte fanns n\u00e5gon \u00f6verlevnadsf\u00f6rdel med CN f\u00f6re TKI. Det har f\u00f6rekommit mycket kritik mot b\u00e5da studierna och enligt EAU-riktlinjerna ger data bara tillr\u00e4ckligt underlag f\u00f6r slutsatsen att patienter som tillh\u00f6r en grupp med d\u00e5lig prognos enligt IMDC (se avsnittet om verktyg f\u00f6r prognostisk stratifiering av patienter med mRCC<\/a>) INTE ska erbjudas CN f\u00f6re TKI. 4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f6re systemisk behandling kan fortsatt rekommenderas:<\/p>\n\ni kliniska pr\u00f6vningar<\/li>\nf\u00f6r patienter med gott AT (funktionsstatus = 0\u20131)<\/a> med stor prim\u00e4rtum\u00f6r och liten metastasvolym som inte har spridit sig till CNS, skelett eller lever<\/li>\nf\u00f6r patienter som har symtom fr\u00e5n prim\u00e4rtum\u00f6ren i form av hematuri eller sm\u00e4rta 5<\/sup><\/li>\n<\/ul>\nBeslutet om CN ska alltid fattas vid en multidisciplin\u00e4r konferens (MDK<\/a>). 5<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagande i kliniska pr\u00f6vningar<\/h4><\/div>\n\n\nM\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referenser<\/h4><\/div>\nActive surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Rini B et al. Lancet Oncol 2016; 17: 1317\u201324.<\/em><\/li>\nDaRenCa guidelines<\/em><\/li>\nFreed SZ, Halperin JP, Gordon M. Idiopathic regression of metastases from renal cell carcinoma. The Journal of urology. 977;118(4):538\u201342.<\/em><\/li>\nAxel Bex et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74: 805-809<\/em><\/li>\nDaRenCa guidelines, ESMO guideline og Bhindi et al. Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol; 2019: 111-128<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div>Testa dina kunskaper<\/h4><\/div><\/div><\/div><\/div><\/div>Under en observationsperiod kan f\u00f6ljande symtom vara sk\u00e4l att inleda behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och h\u00e5ravfall<\/label><\/div>\u00d6kad tr\u00f6tthet, infektion, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div><\/fieldset><\/div>(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
D\u00e5 IL-2-baserad immunterapi anv\u00e4ndes rekommenderades cytoreduktiv nefrektomi (CN) f\u00f6r patienter med god funktionsstatus f\u00f6re behandling.<\/p>\n
Sedan tyrosinkinash\u00e4mmare (TKI) har blivit standardbehandling har tv\u00e5 prospektiva studier unders\u00f6kt indikationen f\u00f6r CN f\u00f6re TKI. B\u00e5da studierna avslutades i f\u00f6rtid p\u00e5 grund av d\u00e5lig rekrytering, men slutsatsen fr\u00e5n b\u00e5da studierna var att det inte fanns n\u00e5gon \u00f6verlevnadsf\u00f6rdel med CN f\u00f6re TKI. Det har f\u00f6rekommit mycket kritik mot b\u00e5da studierna och enligt EAU-riktlinjerna ger data bara tillr\u00e4ckligt underlag f\u00f6r slutsatsen att patienter som tillh\u00f6r en grupp med d\u00e5lig prognos enligt IMDC (se avsnittet om verktyg f\u00f6r prognostisk stratifiering av patienter med mRCC<\/a>) INTE ska erbjudas CN f\u00f6re TKI. 4<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n\n\n\nCytoreduktiv nefrektomi f\u00f6re systemisk behandling kan fortsatt rekommenderas:<\/p>\n\ni kliniska pr\u00f6vningar<\/li>\nf\u00f6r patienter med gott AT (funktionsstatus = 0\u20131)<\/a> med stor prim\u00e4rtum\u00f6r och liten metastasvolym som inte har spridit sig till CNS, skelett eller lever<\/li>\nf\u00f6r patienter som har symtom fr\u00e5n prim\u00e4rtum\u00f6ren i form av hematuri eller sm\u00e4rta 5<\/sup><\/li>\n<\/ul>\nBeslutet om CN ska alltid fattas vid en multidisciplin\u00e4r konferens (MDK<\/a>). 5<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagande i kliniska pr\u00f6vningar<\/h4><\/div>\n\n\nM\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referenser<\/h4><\/div>\nActive surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Rini B et al. Lancet Oncol 2016; 17: 1317\u201324.<\/em><\/li>\nDaRenCa guidelines<\/em><\/li>\nFreed SZ, Halperin JP, Gordon M. Idiopathic regression of metastases from renal cell carcinoma. The Journal of urology. 977;118(4):538\u201342.<\/em><\/li>\nAxel Bex et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74: 805-809<\/em><\/li>\nDaRenCa guidelines, ESMO guideline og Bhindi et al. Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol; 2019: 111-128<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div>Testa dina kunskaper<\/h4><\/div><\/div><\/div><\/div><\/div>Under en observationsperiod kan f\u00f6ljande symtom vara sk\u00e4l att inleda behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och h\u00e5ravfall<\/label><\/div>\u00d6kad tr\u00f6tthet, infektion, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div><\/fieldset><\/div>(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Cytoreduktiv nefrektomi f\u00f6re systemisk behandling kan fortsatt rekommenderas:<\/p>\n
Beslutet om CN ska alltid fattas vid en multidisciplin\u00e4r konferens (MDK<\/a>). 5<\/sup><\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div>5. Deltagande i kliniska pr\u00f6vningar<\/h4><\/div>\n\n\nM\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>Referenser<\/h4><\/div>\nActive surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Rini B et al. Lancet Oncol 2016; 17: 1317\u201324.<\/em><\/li>\nDaRenCa guidelines<\/em><\/li>\nFreed SZ, Halperin JP, Gordon M. Idiopathic regression of metastases from renal cell carcinoma. The Journal of urology. 977;118(4):538\u201342.<\/em><\/li>\nAxel Bex et al. Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma. Eur Urol 2018; 74: 805-809<\/em><\/li>\nDaRenCa guidelines, ESMO guideline og Bhindi et al. Systematic Review of the Role of Cytoreductive Nephrectomy in the Targeted Therapy Era and Beyond: An Individualized Approach to Metastatic Renal Cell Carcinoma. Eur Urol; 2019: 111-128<\/em><\/li>\n<\/ol>\n<\/div><\/div><\/div>Testa dina kunskaper<\/h4><\/div><\/div><\/div><\/div><\/div>Under en observationsperiod kan f\u00f6ljande symtom vara sk\u00e4l att inleda behandling:<\/h5><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och h\u00e5ravfall<\/label><\/div>\u00d6kad tr\u00f6tthet, infektion, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div>\u00d6kad tr\u00f6tthet, viktminskning, dyspn\u00e9 och\/eller sm\u00e4rta<\/label><\/div><\/fieldset><\/div>(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
M\u00f6jligheten att delta i en klinisk pr\u00f6vning d\u00e4r nya l\u00e4kemedel testas, eventuellt i kombination med redan godk\u00e4nda l\u00e4kemedel, ska alltid \u00f6verv\u00e4gas.<\/p>\n<\/div>\n<\/section>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>
(Anv\u00e4ndning av quizen \u00e4r helt anonym!)<\/small><\/p>\n<\/div><\/div><\/div><\/i><\/div>\n<\/div>Det \u00e4r r\u00e4tt!<\/p>\n<\/div><\/i><\/div><\/p>\n<\/div>Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/form><\/div>Forts\u00e4tt till n\u00e4sta avsnitt: 4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/span>Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
Det \u00e4r r\u00e4tt!<\/p>\n<\/div>
Det \u00e4r fel!<\/p>\n<\/div>\n<\/div><\/div>
Utforska den h\u00e4r kapitelmenyn<\/p><\/h5><\/span><\/div><\/div><\/div><\/div><\/div><\/div><\/div>4.1 Behandlingsalternativ f\u00f6r metastaserad njurcancer (mRCC)<\/span><\/i><\/a><\/div>4.2 Onkologisk behandling: M\u00e5lriktade l\u00e4kemedel<\/span><\/i><\/a><\/div>4.3 Onkologisk behandling: Immunterapi<\/span><\/i><\/a><\/div>4.4 Str\u00e5lbehandling<\/span><\/i><\/a><\/div>4.5 Underst\u00f6djande v\u00e5rd<\/span><\/i><\/a><\/div><\/div><\/div><\/div><\/div><\/div><\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":7546,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":""},"class_list":["post-7550","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/comments?post=7550"}],"version-history":[{"count":14,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions"}],"predecessor-version":[{"id":11199,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7550\/revisions\/11199"}],"up":[{"embeddable":true,"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/pages\/7546"}],"wp:attachment":[{"href":"https:\/\/d1s07skqdwll4z.cloudfront.net\/sv\/wp-json\/wp\/v2\/media?parent=7550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}