NDLI: Metastasenresektion nach neoadjuvanter Systemtherapie mit Multityrosinkinaseinhibitoren beim metastasierten Nierenzellkarzinom.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Firek, P. Richter, S. Jaekel, J. Brehmer, B. Heidenreich, A.
Description	Author Affiliation: Firek P ( EURO-Prostatazentrum Aachen, Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum der RWTH Aachen, Pauwelsstrraße 30, 52074 Aachen, Deutschland. peter.firek@bonifatius-lingen.de)
Abstract	BACKGROUND: Metastatic renal cell carcinoma (mRCC) still poses a challenge to therapists in spite of the availability of multiple innovative molecular treatment options. Complete remission is rare and in cases of partial remission it is often unclear if necrosis or vital carcinoma tissue persists. We report on a cohort of patients who underwent metastasectomy after neoadjuvant therapy with multi-tyrosine kinase inhibitors (MTKI). METHODS: In 2009 a total of 11 patients (7 male and 4 female) underwent metastasectomy after achievement of ≥ 3 months stable partial remission. All patients received either sunitinib (n=7, mean 5.5 cycles), bevacizumab and interferon (IFN)- 2a (n=2, mean 8.5 months), temsirolimus (n=1, mean 9 months) or a combination of sunitinib followed by temsirolimus (n=1). Of the patients 7 presented with retroperitoneal lymph node metastases with a mean diameter of 3.5-12 cm, 2 patients with pulmonary metastases, 1 patient with lymph node and pancreas tail metastases and 1 female patient showed residual disease in the vena cava. RESULTS: All metastases were completely resected with negative surgical margins. In 82% of the cases histologically active, Ki-67 positive renal cell cancer tissue was identified. The following adjunctive interventions were necessary: vena cava resection with vascular prosthesis and reimplantation of the renal vein (n=3), partial liver resection (n=1), splenectomy (n=1) and pancreas tail resection (n=1). There were no significant perioperative complications but 1 patient developed fascial dehiscence and underwent revision surgery and 1 patient developed clinically insignificant pancreatitis. After a median follow-up of 12 months (range 8-19 months) 5 patients had no recurrence and 6 of the patients showed liver (n=3), lung (n=2) or bone (n=1) recurrences from which 3 patients died. CONCLUSIONS: Metastasectomy of mRCC is associated with a low rate of complications in experienced centers. Surgical resection of metastatic disease is indicated to achieve complete remission with a favorable prognosis because of biologically active kidney cancer tissue. Patients with isolated and resectable metastases are ideal candidates for such a procedure.
File Format	HTM / HTML
ISSN	03402592
Issue Number	3
Volume Number	51
e-ISSN	14330563
Journal	Der Urologe
Language	German
Publisher	Springer
Publisher Date	2012-03-01
Publisher Place	Germany
Access Restriction	Subscribed
Subject Keyword	Discipline Urology Antineoplastic Combined Chemotherapy Protocols Therapeutic Use Carcinoma, Renal Cell Drug Therapy Secondary Surgery Kidney Neoplasms Metastasectomy Methods Neoadjuvant Therapy Neoplasm, Residual Pancreatic Neoplasms Protein-tyrosine Kinases Antagonists & Inhibitors Aged Adverse Effects Pathology Combined Modality Therapy Female Humans Lymphatic Metastasis Male Middle Aged Neoplastic Cells, Circulating Prognosis English Abstract Journal Article
Alternative Title	Metastasectomy in renal cell cancer after neoadjuvant therapy with multi-tyrosine kinase inhibitors
Content Type	Text
Resource Type	Article
Subject	Urology

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