CHICAGO – Data from a randomized phase III trial showing that many people with renal cell carcinoma (RCC) can avoid surgery to remove the kidney "flipped the existing paradigm," said Sumanta Pal, medical oncologist with Duarte, Calif.-based City of Hope. "Even in the context of patients with advanced disease that has spread to the lungs, liver and other sites [cases account for about 20 percent of all worldwide], we've been removing the kidney, but admittedly this isn't based on a very high level of evidence until now," he said.