Milan, 28 March 2008 - Prof. Michael Jewett spoke on the detection and mapping of regional lymph nodes in his lecture on the second day of the 23rd EAU Annual Congress held in Milan, Italy. Jewett underscored that conventional imaging (CT/MRI/PET) are no longer sufficient in mapping regional lymph nodes.
 “New imaging techniques promise more accurate surgical navigation than traditional eye-hand coordination,” he said.

Jewett also said that the active and fascinating area of study by multi-disciplinary research teams will contribute significantly to further improving current lymph node detection techniques.
Given as part of the Sociéetée International d’Urologie (SIU) lecture, Jewett also highlighted the following points:

*Micro and nano mestastases cannot be reliably detected in GU cancers despite targeted probes;
*It is not possible to define one or several Sentinel Lymph Nodes that would allow reduction in the extent of treatment of regional lymph nodes;
* There is a need for consensus on nomenclature for the regional nodes of GU cancers;
* Medical professionals need to be sensitive to the costs of new imaging techniques, particularly often done as additional studies;
*Vessels will continue to be a surrogate for lymph node fields in surgery and RT.

Debate on nephrectomy in EAU-ESMO joint session

A joint session of the European Association of Urology (EAU) and the European Society for Medical Oncology (ESMO) featuring a debate on metastatic renal cell carcinoma (mRCC) highlighted the persistent arguments for or against therapies such as nephrectomy amidst the rise of novel treatment strategies.

Moderated by Per Anders Abrahamsson and Cora Sternberg, Peter Mulders (Netherlands) and Tim Eisen (UK) presented the pro-con arguments, with Mulders arguing for nephrectomy and Eisen insisting that nephrectomy is no longer necessary for most kidney cancer patients.  

In his presentation Mulders said that based on the available data it is advised to perform a tumour nephrectomy prior to the start of immunotherapy, noting that issues like debulking and immunological reasons are the main rationale for such an approach.
He however noted that in asymptomatic patients there is no role for tumour nephrectomy if immunotherapy is not considered

He also added that if no systemic treatment is given, surgery or embolisation can be considered for palliative reasons (gross hematuria, pain, paraneoplastic syndrome). Mulders further noted that best results are obtained in patients after tumour nephrectomy

Meanwhile, Tim Eisen argued for targeted therapy but pointed out that ‘immunotherapy rarely sinks the primary tumour.’

“Targeted therapies are effective in the primary tumour…and TKIs (tyrosine kinase inhibitors) may provide rapid palliative benefit,” said Eisen.

Eisen said specialists should “spare patients who will not benefit from nephrectomy” and added that “the benefit of targeted therapy is evident before immunotherapy.”
 Moreover, Eisen said there are patients with high surgical risk, and thus it would be recommended to select patients who may benefit from nephrectomy

In his concluding statements, Eisen argued: “Targeted therapy is safe and effective irrespective of whether nephrectomy is performed. The large majority of mRCC patients do not need a nephrectomy.”

Abrahamsson and Sternberg noted that both sides presented eloquent arguments and that the discussion only reflected the dynamic developments and progress that have been made with cytostatic targeted biologic therapy in advanced renal cell carcinoma.