A treatment approach in a group of 1498 patients with renal cell carcinoma (RCC) was studied. Out of these, 86 patients had the primarily generalised form. For the therapy of primary advanced metastasis, the treatment strategy was changed from conservative to an active approach. Such approach is based on the removal of 75 % of the tumor mass, the patient should be in good conditions with no metastases in CNS, bone and liver, and the primary tumor should not be a sarcoma. The new treatment strategy of patients with advanced RCC combines surgery and chemoimmunotherapy. 47 patients from the studied group were treated with combined INF alpha+IL-2+5FU+isotretinoin using the Atzpodien scheme. The toxicity wasminimal and only in six patients the treatment was interrupted because of the disease progression. Results of this treatment strategy are encouraging, however, further randomised trials are recommended.

        Key words: renal cell carcinoma, surgery, chemotherapy, immunotherapy.