The recent developments in the medical treatment of metastatic renal cell carcinoma have raised the question of the neoadjuvant use of targeted therapies in locally advanced renal tumours. Evidence at the level of case reports suggests that down-sizing of large renal carcinomas is feasible and small surgical series have so far shown that later surgical tumour removal is not impaired by neoadjuvant treatment. It is at present, however, far too early to fully assess whether such neoadjuvant treatment has an impact on patient survival or quality of life.