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Renal cell carcinoma (RCC) is the most common cancer of the kidney (Motzer et.al., 1999). In the United States each year 57.000 new patients are being diagnosed with RCC resulting in 12.900 deaths (Linehan et.al., 2011). The median age at diagnosis today is 64 years and even though it represents only 3% of all cancers, the incidence is increasing steadily. With rising prevalence of some known risk factors like hypertension and population ageing, the incidence of RCC is expected to be rising even more in subsequent years. With increasing incidence of renal cell carcinoma (RCC) combined with population ageing, questions about the treatment of elderly and frail patients with RCC are becoming more and more relevant. Many of the patients with newly diagnosed RCC are in advanced age and/or have some major comorbidities which often results in their poor performance status. Elderly or frail patients are frequently excluded from clinical trials, because the results of their treatment are often difficult to interpret. This is also true for patients with heart, lung, liver or other major co-morbidities. Excluding these patients from clinical trials leads to lack of evidence-based guidelines for their treatment and often poses to oncologists a difficult dilemma when they need to decide what treatment options to offer to patients (Scuch et.al., 2008). In the present chapter we would like to present current recommendations for diagnostics and treatment of elderly and frail patients with RCC. In the second part of the chapter results of the analysis of metastatic RCC patients treated in a single institution with emphasis on differences in the treatment between good and poor performance status patients are presented.

Treatment of Renal Cell Carcinoma in Elderly and Frail Patients