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Aurilio G, Mauri G, Rossi D, Della Vigna P, Bonomo G, Varano GM, Maiettini D, Rocca MC, Verri E, Cullurà D, Nolé F, Orsi F. Image-Guided Ablations in Patients with Recurrent Renal Cell Carcinoma. J Clin Med 2023; 12:4902. [PMID: 37568303 PMCID: PMC10420241 DOI: 10.3390/jcm12154902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Renal cell carcinoma (RCC) is one of the most frequently diagnosed tumors and a leading cause of death. The high risk of local recurrence and distant metastases represent a significant clinical issue. Different image-guided ablation techniques can be applied for their treatment as an alternative to surgery, radiotherapy or systemic treatments. A retrospective analysis was conducted at our institution, including a total number of 34 RCC patients and 44 recurrent RCC tumors in different locations (kidney, lung, adrenal gland, liver, pancreas, pararenal and other) using microwave ablation, radiofrequency ablation, cryoablation and laser ablation. The estimated time to local and distant tumor progression after treatment were 22.53 ± 5.61 months and 24.23 ± 4.47 months, respectively. Systemic treatment was initiated in 10/34 (29%) treated patients with a mean time-to-systemic-therapy of 40.92 ± 23.98 months. Primary technical success was achieved in all cases and patients while the primary efficacy rate was achieved in 43/44 (98%) cases and 33/34 (97%) patients, respectively, with a secondary technical success and efficacy rate of 100%. At a mean follow-up of 57.52 months ± 27.86 months, local tumor progression occurred in 3/44 (7%) cases and distant progression in 25/34 (74%) patients. No significant complications occurred. Image-guided ablations can play a role in helping to better control recurrent disease, avoiding or delaying the administration of systemic therapies and their significant adverse effects.
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Affiliation(s)
- Gaetano Aurilio
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Giovanni Mauri
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Duccio Rossi
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Paolo Della Vigna
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Guido Bonomo
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Gianluca Maria Varano
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Daniele Maiettini
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Maria Cossu Rocca
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Elena Verri
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Daniela Cullurà
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Franco Nolé
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Franco Orsi
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
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Hopkins DT, Waters D, Manecksha RP, Lynch TH. Isolated soft tissue mass of the finger as the first presentation of oligometastatic renal cell carcinoma. BMJ Case Rep 2022; 15:e248718. [PMID: 35580945 PMCID: PMC9114857 DOI: 10.1136/bcr-2021-248718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his 70s was referred to plastic surgery with a suspected foreign body in the pulp of his right index finger. An excisional biopsy was performed for a presumed foreign body granuloma. Histology revealed metastatic renal cell carcinoma (mRCC). CT imaging demonstrated a 7.4 cm heterogeneous mass arising from the upper pole of the left kidney consistent with primary renal malignancy, in addition to a 9 mm lung nodule. He underwent an uncomplicated left laparoscopic cytoreductive nephrectomy and made a satisfactory recovery. To our knowledge, this is the first reported case of primary mRCC presenting with digital soft tissue metastasis. Cytoreductive nephrectomy with metastasectomy is the preferred management for mRCC where feasible. For unfavourable mRCC cases, first-line systemic therapy is indicated. Adjuvant systemic therapy in mRCC is currently limited to clinical trials, though promising data emerging on the use of pembrolizumab may herald a future shift in practice.
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Affiliation(s)
- David T Hopkins
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Darragh Waters
- Department of Urology, Saint James's Hospital, Dublin, Ireland
| | - Rustom P Manecksha
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Thomas H Lynch
- Department of Urology, Saint James's Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin School of Medicine, Dublin, Ireland
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Oncological outcomes of surgery for isolated retroperitoneal recurrence in renal cancer patients after radical nephrectomy. Urol Oncol 2021; 40:111.e27-111.e34. [PMID: 34961683 DOI: 10.1016/j.urolonc.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 10/15/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
AIMS Isolated retroperitoneal recurrence (IRR) in renal cancer patients after radical nephrectomy (RN) is a rare event and poses a therapeutic dilemma. We evaluated oncologic outcomes in surgically treated patients with IRR and established prognostic factors associated with survival. The benefit of metastasis-directed therapy (MDT) in those with clinical progression after extirpation of IRR was assessed. METHODS This was a retrospective single-institutional study in which 60 renal cancer patients after previous RN underwent surgery for suspicion of IRR within the period of 2004-2019; in 55 of them, RCC recurrence was histologically confirmed. No patient had distant metastatic disease at the time of IRR diagnosis. In cases of clinical progression after IRR surgery, MDT (metastasectomy, stereotactic radiotherapy) was selectively used. Kaplan-Meier curves were used to estimate survival outcomes. Univariable and multivariable Cox proportional hazards regression analyses were used to evaluate associations between clinicopathological parameters and cancer-specific survival. RESULTS Median age at IRR diagnosis was 64 years (range 23-81). IRR was diagnosed at a median of 42 months (IQR 19-99) after RN. Surgical complications of grade 3-5 after IRR extirpation were rare (7%). Median follow-up time was 50 months (IQR 19-80). Five-year recurrence-free survival and cancer-specific survival rates were 32% and 66%, respectively. Radiographic progression was observed in 34 (62%) patients at a median of 11 months after IRR surgery, out of which 22 patients (40%) underwent MDT. When compared with 12 patients without MDT, the MDT patients had a prolonged median time to systemic treatment of 58 (vs. 16 months), and median cancer-specific survival of 88 (vs. 46 months). Upon multivariable analysis, the interval from nephrectomy ≤12 months (HR 7.77), tumour grade 3-4 (HR 13.24) and female sex (HR 7.42) were determined to be independent prognostic factors of cancer-related mortality. CONCLUSION Aggressive surgical therapy of IRR is feasible with relatively low morbidity. More than half of the patients experience long-term survival. The interval from nephrectomy to IRR less than 12 months, tumour grade 3-4 and female sex were negative prognostic predictors. In the case of progression, metastasis-directed therapy may prolong the interval to initiation of systemic treatment.
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Hirokawa F, Ueno M, Nakai T, Kaibori M, Nomi T, Iida H, Tanaka S, Komeda K, Hayami S, Kosaka H, Hokuto D, Kubo S, Uchiyama K. Treatment strategy for resectable colorectal cancer liver metastases from the viewpoint of time to surgical failure. Langenbecks Arch Surg 2021; 407:699-706. [PMID: 34741671 DOI: 10.1007/s00423-021-02372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The efficacy of pre or postoperative chemotherapy for resectable colorectal cancer liver metastases (CRLM) is disputed. This study aimed to examine the risk factors for time to surgical failure (TSF) and analyze the efficacy of pre or postoperative chemotherapy prior to liver resection for CRLM. METHODS The clinicopathological factors of 567 patients who underwent initial hepatectomy for CRLM at 7 university hospitals between April 2007 and March 2013 were retrospectively analyzed. The prognostic factors were identified and then stratified into two groups according to the number of preoperative prognostic factors: the high-score group (H-group, score 2-4) and the low-score group (L-group, score 0 or 1). RESULTS Patients who experienced unresectable recurrence within 12 months after initial treatment had a significantly shorter prognosis than other patients (p < 0.001). Multivariate analysis identified age ≥ 70 (p = 0.001), pT4 (p = 0.015), pN1 (p < 0.001), carbohydrate antigen 19-9 ≥ 37 U/ml (p = 0.002), Clavien-Dindo grade ≥ IIIa (p = 0.013), and postoperative chemotherapy (p = 0.006) as independent prognostic factors. In the H-group, patients who received chemotherapy had a better prognosis than those who did not (p = 0.001). CONCLUSION Postoperative chemotherapy is beneficial in colorectal cancer patients with more than two of the following factors: age ≥ 70, carbohydrate antigen 19-9-positivity, pT4, and lymph node metastasis.
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Affiliation(s)
- Fumitoshi Hirokawa
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kinki University, Osaka-Sayama, Japan
| | - Masaki Kaibori
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takeo Nomi
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Komeda
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Shinya Hayami
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hisashi Kosaka
- Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
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Marchioni M, Sountoulides P, Furlan M, Mir MC, Aretano L, Rubio-Briones J, Alvarez-Maestro M, Di Nicola M, Bazán AA, Antonelli A, Simeone C, Schips L. Management of local recurrence after radical nephrectomy: surgical removal with or without systemic treatment is still the gold standard. Results from a multicenter international cohort. Int Urol Nephrol 2021; 53:2273-2280. [PMID: 34417970 PMCID: PMC8494713 DOI: 10.1007/s11255-021-02966-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/30/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the survival outcomes of patients with local recurrence after radical nephrectomy (RN) and to test the effect of surgery, as monotherapy or in combination with systemic treatment, on cancer-specific mortality (CSM). METHODS Patients with local recurrence after RN were abstracted from an international dataset. The primary outcome was CSM. Cox's proportional hazard models tested the main predictors of CSM. Kaplan-Meier method estimates the 3-year survival rates. RESULTS Overall, 96 patients were included. Of these, 44 (45.8%) were metastatic at the time of recurrence. The median time to recurrence after RN was 14.5 months. The 3-year cancer-specific survival rates after local recurrence were 92.3% (± 7.4%) for those who were treated with surgery and systemic therapy, 63.2% (± 13.2%) for those who only underwent surgery, 22.7% (± 0.9%) for those who only received systemic therapy and 20.5% (± 10.4%) for those who received no treatment (p < 0.001). Receiving only medical treatment (HR: 5.40, 95% CI 2.06-14.15, p = 0.001) or no treatment (HR: 5.63, 95% CI 2.21-14.92, p = 0.001) were both independently associated with higher CSM rates, even after multivariable adjustment. Following surgical treatment of local recurrence 8 (16.0%) patients reported complications, and 2/8 were graded as Clavien-Dindo ≥ 3. CONCLUSIONS Surgical treatment of local recurrence after RN, when feasible, should be offered to patients. Moreover, its association with a systemic treatment seems to warrantee adjunctive advantages in terms of survival, even in the presence of metastases.
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Affiliation(s)
- Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy.
- Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University "G. d'Annunzio" Chieti-Pescara, Via dei Vestini, Campus universitario, 66100, Chieti, Italy.
| | | | - Maria Furlan
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Maria Carmen Mir
- Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain
| | - Lucia Aretano
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Jose Rubio-Briones
- Department of Urology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy
| | | | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy
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Ray S, Cheaib JG, Biles MJ, Pineault KG, Johnson MH, Ged YM, Markowski MC, Singla N, Allaf ME, Pierorazio PM. Local and Regional Recurrences of Clinically Localized Renal Cell Carcinoma after Nephrectomy: A 15 Year Institutional Experience with Prognostic Features and Oncologic Outcomes. Urology 2021; 154:201-207. [PMID: 33864855 PMCID: PMC9774049 DOI: 10.1016/j.urology.2021.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate outcomes for patients with local recurrence (LR) of clinically localized renal cell carcinoma (RCC) without concurrent systemic metastasis from our institution, an event that occurs rarely (1%-3%) after surgery. LR may be a harbinger of poor outcomes, and the best management of these patients is unclear. MATERIALS/METHODS We retrospectively reviewed patients surgically treated for clinically localized RCC (cT1-2N0M0) with subsequent LR (in the partial or radical nephrectomy bed) and/or regional recurrence (RR; in the abdomen distant from the direct site of surgery) without concurrent metastasis from our institutional database (2004-2018). Comparative and survival analyses were performed. RESULTS Out of 3038 total patients, 1895 had clinically localized RCC, with 30 patients (1.6%) having isolated LR/RR. Median time to recurrence was 26.5 months (IQR:16-35). Of 26 patients treated with local therapy, 14 (53.8%) recurred over a median follow-up time of 29.5 months (IQR:12-45). The 1-year and 2-year secondary recurrence-free survival rates are 60.7% and 49.7%, respectively. Two or more sites of locoregional recurrence significantly predicted secondary recurrence/metastasis after local therapy for local recurrence (hazard ratio: 2.22, P= .04). CONCLUSION Our results suggest local therapy is appropriate for select patients with LR/RR, with almost 50% of patients undergoing a second local therapy remaining alive with "local cure" and no secondary recurrence. The number of sites of recurrence can be used to better select patients that will benefit from local therapy or systemic/combination therapy. This work provides a framework onto which further studies regarding local therapy and locoregional recurrence of RCC can be performed.
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Kim SH, Park B, Hwang EC, Hong SH, Jeong CW, Kwak C, Byun SS, Chung J. A Retrospective, Multicenter, Long-Term Follow-Up Analysis of the Prognostic Characteristics of Recurring Non-Metastatic Renal Cell Carcinoma After Partial or Radical Nephrectomy. Front Oncol 2021; 11:653002. [PMID: 34262859 PMCID: PMC8273547 DOI: 10.3389/fonc.2021.653002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
This study aimed to compare the cancer-specific survival (CSS) and overall survival (OS) of nephrectomized patients with non-metastatic renal cell carcinoma (nmRCC) and local recurrence without distant metastasis (LR group), those with metastasis without local recurrence (MET group), and those with both local recurrence and metastasis (BOTH group). This retrospective multicenter study included 464 curatively nephrectomized patients with nmRCC and disease recurrence between 2000 and 2012; the follow-up period was until 2017. After adjusting for significant clinicopathological factors using Cox proportional hazard models, CSS and OS were compared between the MET (n = 50, 10.7%), BOTH (n = 95, 20.5%), and LR (n = 319, 68.8%) groups. The CSS and OS rates were 34.7 and 6.5% after a median follow-up of 43.9 months, respectively. After adjusting for significant prognostic factors of OS and CSS, the MET group had hazard ratios (HRs) of 0.51 and 0.57 for OS and CSS (p = 0.039 and 0.103), respectively, whereas the BOTH group had HRs of 0.51 and 0.60 for OS and CSS (p < 0.05), respectively; LR was taken as a reference. The 2-year OS and CSS rates from the date of nephrectomy and disease recurrence were 86.9% and 88.9% and 63.5% and 67.8%, respectively, for the LR group; 89.5% and 89.5% and 48.06% and 52.43%, respectively, for the MET group; and 96.8% and 96.8% and 86.6% and 82.6%, respectively, for the BOTH group. Only the LR and BOTH groups had significant differences in the 2-year OS and CSS rates (p < 0.05). In conclusion, our study showed that the LR group had worse survival prognoses than any other group in nephrectomized patients with nmRCC.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Urologic Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Boram Park
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine and Hospital, Seoul, South Korea
| | - Seok Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jinsoo Chung
- Department of Urology, Urologic Cancer Center, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
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Early Recurrence After Initial Hepatectomy for Colorectal Liver Metastases. Int Surg 2021. [DOI: 10.9738/intsurg-d-17-00018.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
This study investigated the frequency of early recurrence in patients who had undergone hepatectomy for colorectal cancer liver metastasis (CRLM) and assessed the indications for adjuvant chemotherapy in these patients.
Methods
This retrospective analysis included 133 consecutive patients who underwent initial hepatectomy for CRLM between April 2000 and May 2010 and have been followed more than 5 years.
Results
Of the 133 patients, 83 (62%) experienced tumor recurrence, with 14 of the 83 recurrences within 6 months after initial hepatectomy. Overall survival was significantly poorer in patients with recurrences within 6 months than those without any recurrence (P = 0.015). The frequency of adjuvant chemotherapy was significantly lower in patients with recurrences within 6 months than those without recurrences within 6 months. Multivariate analysis showed that H-2 classification was the only independent risk factor for recurrence within 6 months after hepatectomy (P = 0.002). Adjuvant chemotherapy improved prognosis in patients classified as H2.
Conclusions
Patients who experienced tumor recurrence within 6 months after initial hepatectomy for CRLM had a poorer prognosis than patients who experienced recurrence after 6 months. Patients with H2-classification of CRLM should receive preoperative adjuvant chemotherapy.
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Feasibility and Safety of Robotic Excision of Ipsilateral Retroperitoneal Recurrence After Nephrectomy for Renal Cell Carcinoma. Urology 2020; 145:159-165. [DOI: 10.1016/j.urology.2020.07.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 11/24/2022]
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Renal fossa recurrence after radical nephrectomy: Current management, and oncological outcomes. Urol Oncol 2019; 38:42.e7-42.e12. [PMID: 31711833 DOI: 10.1016/j.urolonc.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/30/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney cancers represent 2% of cancers worldwide; the most common type is renal clear cell carcinoma (RCC). Surgical treatment remains the only effective therapy for localized renal cell carcinoma. Approximately 20% to 38% of patients undergoing radical nephrectomy (RN) for localized RCC will have subsequent disease progression, with 0.8% to 3.6% of local recurrences within the ipsilateral retroperitoneum (RFR). The main objective of this study is to evaluate prognostic features, oncological outcomes, and current management for renal fossa recurrence in patients with history of RN for RCC. MATERIALS AND METHODS We retrospectively analyzed 733 patients who underwent open or laparoscopic RN for unilateral T1-T4 N0 M0 RCC between 2010 and 2016 at the Urology Department of Hospital Italiano de Buenos Aires. RESULTS During the mentioned period, of a total of 733 RNs (open/laparoscopic), 561 patients with RCC were included in the study. After a median follow-up time of 24 months (12-36) (interquartile range), 21 (3.74%) patients out of 561, developed renal fossa recurrence. Of these, 13 (2.31%) patients were diagnosed with isolated local renal fossa recurrence and different treatment approaches were adopted; 11 patients underwent open surgical resection, 1 patient laparoscopic surgical resection, and 1 case was treated with cryoablation. Regarding cancer-specific survival, estimated 4-year cancer-specific survival in patients without RFR, with isolated RFR (iRFR) and not isolated RFR (niRFR) was 82.7% (CI 95% 70.2-95.2), 69.2% (IC 44.2-94.2) and 0%, respectively (log rank test P < 0.0001 being niRFR group different to others. Non isolated RFR was a death risk factor with a HR of 11.4 (4.8-27.2) compared with iRFR or no recurrence. Overall, 51% (IC 26.6-71.2) of patients with any RFR died at 4 years follow-up. CONCLUSION Although RFR is a rare condition, in the absence of distant metastatic disease, aggressive surgical resection should be our aim. High pathological tumoral stage at original nephrectomy and high tumoral grade are independent risk factors for RFR. This group of patients needs closer follow-up to detect earlier recurrences and decide a treatment strategy.
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Rodríguez-Fernández IA, Rodríguez-Romo L, Hernandez-Barajas D, Gonzalez-Conchas GA, Verdines-Perez A, Templeton AJ, Ocana A, Seruga B, Tannock IF, Amir E, Vera-Badillo FE. Adjuvant Radiation Therapy After Radical Nephrectomy in Patients with Localized Renal Cell Carcinoma: A Systematic Review and Meta-analysis. Eur Urol Oncol 2018; 2:448-455. [PMID: 31277782 DOI: 10.1016/j.euo.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/08/2018] [Accepted: 10/06/2018] [Indexed: 01/03/2023]
Abstract
CONTEXT Adjuvant radiation therapy has been recommended for patients at higher risk of relapse from renal cell carcinoma (RCC) to improve disease-free survival (DFS) and overall survival (OS) after radical nephrectomy. OBJECTIVE To quantify the benefit of adjuvant radiation therapy. EVIDENCE ACQUISITION A systematic review of electronic databases identified publications exploring the association between adjuvant radiation therapy and locoregional recurrence (LRR), DFS, and OS among patients after radical nephrectomy for early-stage RCC. Hazard ratios for DFS were weighted and pooled using the generic inverse variance and random effects model. Odds ratios for LRR, DFS, and OS at 5yr were weighted and pooled in a meta-analysis using Mantel-Haenszel random-effects modeling. EVIDENCE SYNTHESIS Twelve studies comprising 1624 patients were included in the analysis. Ten studies were retrospective and two were randomized controlled trials. Adjuvant radiation therapy was delivered to 37% of patients. The median follow-up was 49mo. Adjuvant radiation therapy was not associated with better DFS or OS at 5yr, but was associated with less LRR. CONCLUSIONS With the caveat that confounding by indication may result from pooling data from predominantly nonrandomized studies, adjuvant radiation after radical nephrectomy was not associated with improved DFS or OS but was associated with less LRR. PATIENT SUMMARY Radiation therapy after resection of renal cell carcinoma with a high risk of relapse may reduce the risk of local recurrence but not the risk of disease recurrence or death after 5yr.
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Affiliation(s)
- Iván A Rodríguez-Fernández
- Centro Universitario Contra el Cáncer, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico; Department of Radiation Oncology, Klinikum rechts der Isar, TU München, Munich, Germany
| | - Laura Rodríguez-Romo
- Centro Universitario Contra el Cáncer, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico; Department of Medical Oncology, Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - David Hernandez-Barajas
- Centro Universitario Contra el Cáncer, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Galileo A Gonzalez-Conchas
- Centro Universitario Contra el Cáncer, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Adrian Verdines-Perez
- Centro Universitario Contra el Cáncer, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Arnoud J Templeton
- Department of Medical Oncology, St. Claraspital, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Alberto Ocana
- Medical Oncology Department and Translational Research Unit, Albacete University Hospital, Castilla La Mancha University, Albacete, Spain
| | - Bostjan Seruga
- Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ian F Tannock
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Eitan Amir
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Francisco E Vera-Badillo
- Centro Universitario Contra el Cáncer, Hospital Universitario, Universidad Autónoma de Nuevo León, Monterrey, Mexico; Department of Medical Oncology, Faculty of Medicine, Queen's University, Kingston, ON, Canada.
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Gofrit ON, Rabinovich I, Yutkin V, Pode D, Duvdevani M, Landau EH, Hidas G, Goldberg SN. Abbreviated CT protocol for postoperative surveillance of renal cancer. Urol Oncol 2018; 36:498.e9-498.e13. [PMID: 30228095 DOI: 10.1016/j.urolonc.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Postoperative surveillance protocols after nephrectomy for kidney cancer include periodic computed tomography (CT) scans of the chest and abdomen. A single study exposes the patient to 21 mSv (equivalent to 7-year exposure to natural background radiation). The objective of this study was to evaluate the hypothesis that an abbreviated CT protocol restricted to the chest and upper abdomen (i.e., to the level of the intervertebral disk L3-L4) is sufficient for routine postnephrectomy follow-up as it detects most tumor recurrence with lower radiation exposure. METHODS We identified 493 patients treated with radical or partial nephrectomy for localized kidney cancer and followed with periodic CT scans of the chest and abdomen for prolonged periods. The frequency and location of cancer recurrence were documented. The ratio of infield recurrence for the complete chest, and abdomen and for the abbreviated protocol was recorded. The decrease in radiation exposure was calculated. RESULTS At a median follow up of 96 months, 82 patients (16.6%) developed recurrence. The frequent sites of recurrence were the lungs (53), the bones (9), and local recurrence (22). Complete chest and abdominal CT identified 78 of the recurrences (95%) and the abbreviated protocol identifying all but one of these (94%). The abbreviated protocol exposed the patient to 48% (standard deviation 4.3%) less radiation compared to the full protocol. CONCLUSIONS Using an abbreviated CT protocol that includes the chest and upper abdomen for surveillance after surgery of localized kidney cancer decreases radiation exposure by half with only a minor decrease in the sensitivity of the examination.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel.
| | - Igal Rabinovich
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Vladimir Yutkin
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Dov Pode
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | | | - Ezekiel H Landau
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
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Systematic Review of the Management of Local Kidney Cancer Relapse. Eur Urol Oncol 2018; 1:512-523. [PMID: 31158097 DOI: 10.1016/j.euo.2018.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/03/2018] [Accepted: 06/15/2018] [Indexed: 12/26/2022]
Abstract
CONTEXT Management of locally recurrent renal cancer is complex. OBJECTIVE In this systematic review we analyse the available literature on the management of local renal cancer recurrence. EVIDENCE ACQUISITION A systematic search (PubMed, Web of Science, CINAHL, Clinical Trials, and Scopus) of English literature from 2000 to 2017 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. EVIDENCE SYNTHESIS The search identified 1838 articles. Of those, 36 were included in the evidence synthesis. The majority of the studies identified were retrospective and not controlled. Local recurrence after thermal ablation (TA) may be managed with repeat TA. Alternatively, salvage nephrectomy is possible. However, a higher rate of complications should be expected than after primary nephrectomy. Salvage nephrectomy and TA represent treatment options for local recurrence after partial nephrectomy. Local retroperitoneal recurrence after radical nephrectomy is ideally treated with surgical resection, for which minimally invasive approaches might be applicable to select patients. For large recurrences, addition of intraoperative radiation may improve local control. Local tumour destruction appears to be more beneficial than systemic therapy alone for local recurrences. CONCLUSIONS Management of local renal cancer relapse varies according to the clinical course and prior treatments. The available data are mainly limited to noncontrolled retrospective series. After nephron-sparing treatment, TA represents an effective treatment with low morbidity. For local recurrence after radical nephrectomy, the low-level evidence available suggests superiority of surgical excision relative to systemic therapy or best supportive care. As a consequence, surgery should be prioritised when feasible and applicable. PATIENT SUMMARY In renal cell cancer, the occurrence and management of local recurrence depend on the initial treatment. This cancer is a disease with a highly variable clinical course. After initial organ-sparing treatment, thermal ablation offers good cancer control and low rates of complications. For recurrence after radical nephrectomy, surgical excision seems to provide the best long-term cancer control and it is superior to medical therapy alone.
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Surgical resection of locally recurrent renal cell carcinoma after nephrectomy: Oncological outcome and predictors of survival. Urol Oncol 2017; 36:11.e1-11.e6. [PMID: 28927783 DOI: 10.1016/j.urolonc.2017.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/15/2017] [Accepted: 08/21/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the course of disease of patients surgically treated for locally recurrent renal cell carcinoma (LRRCC) after nephrectomy and to identify potential predictive factors for long-term survival. PATIENTS AND METHODS We, retrospectively, identified 54 patients who underwent surgical resection of LRRCC after open nephrectomy for localized kidney cancer. The median age at time of surgery for LRRCC was 65 years. Survival rates were determined with the Kaplan-Meier method. Mantel-Haenszel hazard ratios were calculated. Comparisons were made with the log-rank test. Cox proportional hazard models were used to analyze combined effects of variables. RESULTS Median time to local recurrence after nephrectomy was 36 months (5-242 months). Median follow-up after surgery for LRRCC was 39 months. At time of analysis 18 patients (33%) were alive without any evidence of disease, 8 patients (15%) were alive with disease, 20 patients (37%) died of renal cell carcinoma, and 8 patients (15%) died of other causes. A 5-year overall survival (OS) was 60% (95% CI: 0.44-0.73) and 10-year OS was 32% (95% CI: 0.15-0.51). The median survival after surgery for LRRCC was 79 months. In univariate analysis OS differed significantly by the time period between primary surgery and occurrence of LRRCC (<2 years vs. ≥2 years: 10-year OS rate 31% (95% CI: 10.2-55.0) vs. 45% (95% CI: 21.5-65.8; hazard ratio = 0.26; P = 0.0034). In multivariate analysis sarcomatoid features in the primary nephrectomy specimen, positive surgical margins of the LRRCC specimen and a Charlson score of ≥2 were associated with a significantly worse prognosis in this cohort. CONCLUSION In patients with a disease-free interval of more than 2 years after surgery for the primary tumor, surgical removal of LRRCC may achieve long-term survival in most patients. In those with a shorter disease-free interval, long-term survival is unlikely.
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15
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Parodi A, Traverso P, Kalli F, Conteduca G, Tardito S, Curto M, Grillo F, Mastracci L, Bernardi C, Nasi G, Minaglia F, Simonato A, Carmignani G, Ferrera F, Fenoglio D, Filaci G. Residual tumor micro-foci and overwhelming regulatory T lymphocyte infiltration are the causes of bladder cancer recurrence. Oncotarget 2016; 7:6424-35. [PMID: 26824503 PMCID: PMC4872724 DOI: 10.18632/oncotarget.7024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/02/2016] [Indexed: 12/28/2022] Open
Abstract
Bladder cancer has an unexplained, high recurrence rate. Causes of recurrence might include the presence of sporadic tumor micro-foci in the residual urothelial tissue after surgery associated with an inverted ratio between intratumoral effector and regulatory T cell subsets. Hence, surgical specimens of both tumors and autologous, macroscopically/histologically free-of-tumor tissues were collected from 28 and 20 patients affected by bladder or renal cancer, respectively. The frequencies of effector (IFNγ+ and IL17+ T cells) and regulatory (CD4+CD25hiCD127lo and CD8+CD28-CD127loCD39+ Treg) T cell subpopulations among tumor infiltrating lymphocytes were analyzed by immunofluorescence, while the gene expression of MAGE-A1 and MAGE-A2 tumor-associated antigens was studied by RT-PCR. The results show that both the T cell infiltrate and the frequency of MAGE-A1/A2 gene expression were comparable in tumors and in autologous free-of-tumor tissues in bladder cancer, while the autologous free-of-tumor renal tissues showed reduced T cell infiltrate and frequency of MAGE gene expression as compared to the autologous tumors. Importantly, the intra-tumor T effector/Treg cell ratio was consistently <1 in bladder cancer patients (n. 7) who relapsed within two years, while it was always >1 in patients (n. 6) without recurrence (regardless of tumor stage) (P = 0.0006, Odds ratio = 195). These unprecedented findings clarify the pathogenic mechanism of bladder cancer recurrence and suggest that microscopically undetectable micro-foci of tumor may predispose to recurrence when associated with an inverted intratumoral T effector/Treg cell ratio.
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Affiliation(s)
- Alessia Parodi
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Paolo Traverso
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Francesca Kalli
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | | | - Samuele Tardito
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Monica Curto
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Federica Grillo
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Luca Mastracci
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Cinzia Bernardi
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Giorgia Nasi
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Francesco Minaglia
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Alchiede Simonato
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Giorgio Carmignani
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Francesca Ferrera
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Daniela Fenoglio
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Gilberto Filaci
- Centre of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliero Universitaria San Martino - IST - Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.,Department of Internal Medicine, University of Genoa, Genoa, Italy
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Management of Recurrent Venous Tumor Thrombus Following Inferior Vena Cava Thrombectomy: Is Surgery the Right Answer? Eur Urol Focus 2016; 2:631-632. [PMID: 28723496 DOI: 10.1016/j.euf.2016.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/01/2016] [Indexed: 11/23/2022]
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17
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Psutka SP, Heidenreich M, Boorjian SA, Bailey GC, Cheville JC, Stewart-Merrill SB, Lohse CM, Atwell TD, Costello BA, Leibovich BC, Thompson RH. Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes. BJU Int 2016; 119:116-127. [DOI: 10.1111/bju.13620] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah P. Psutka
- Department of Urology; Mayo Clinic; Rochester MN USA
- Division of Urology; John H. Stroger Jr. Hospital of Cook County; Chicago IL USA
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Surgical Management of Local Recurrences of Renal Cell Carcinoma. Surg Res Pract 2016; 2016:2394942. [PMID: 26925458 PMCID: PMC4746394 DOI: 10.1155/2016/2394942] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/10/2016] [Indexed: 01/20/2023] Open
Abstract
Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach) and nonsurgical alternatives (cryoablation, radiofrequency ablation) have yet to be described. In selected patients, surgical resection may have to be complemented with (neo)adjuvant radiotherapy or medical treatment.
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Postoperative surveillance imaging for patients undergoing nephrectomy for renal cell carcinoma. Urol Oncol 2015; 33:499-502. [PMID: 26411549 DOI: 10.1016/j.urolonc.2015.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 12/18/2022]
Abstract
The American Urological Association and the National Comprehensive Cancer Network guidelines regarding postoperative surveillance for renal cell carcinoma (RCC) have provided a standardized framework for imaging following nephrectomy. These stage-stratified recommendations are based on retrospective studies that identified the timeline and location of RCC recurrences. However, the simplified and generalizable protocols offered by the American Urological Association and the National Comprehensive Cancer Network are not without limitations. Studies have found that RCC recurrences continue to be missed even with perfect compliance to these protocols and that RCC recurrences occur not infrequently after the required surveillance window of 5 years. Furthermore, recent studies evaluating the use of adjuvant systemic therapy in patients who are at a high risk for RCC recurrence or metastasis after nephrectomy have yielded disappointing results. This calls into question what interventions we can offer patients to improve survival once RCC recurrences are detected during postoperative surveillance; an effective surveillance strategy requires effective treatment options. The future of personalized medicine with genetic profiling of patients with RCC may offer a potential solution by providing better risk stratification to determine the intensity of surveillance imaging as well as to determine which patients will actually derive survival benefit from intervention on recurrent disease.
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20
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Thomas AZ, Adibi M, Borregales LD, Hoang LN, Tamboli P, Jonasch E, Tannir NM, Matin SF, Wood CG, Karam JA. Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy. J Urol 2015; 194:316-22. [PMID: 25758610 PMCID: PMC4666307 DOI: 10.1016/j.juro.2015.02.2943] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Isolated local retroperitoneal recurrence after radical nephrectomy for renal cell carcinoma poses a therapeutic challenge. We investigated outcomes in patients with localized retroperitoneal recurrence treated with surgical resection. MATERIALS AND METHODS This was a retrospective, single institutional study of 102 patients with retroperitoneal recurrence treated with surgery from 1990 to 2014. Demographics, clinical and pathological features, location of retroperitoneal recurrence and perioperative complications are reported using descriptive statistics. We studied recurrence-free and cancer specific survival using univariate and multivariate analyses. RESULTS Median age at retroperitoneal recurrence diagnosis was 55 years (IQR 49-64). Cancer was pT3-4 in 62 patients (60.8%) and pN1 in 20 (19.6%). No patients had distant metastatic disease at retroperitoneal recurrence surgery. Median time from nephrectomy to retroperitoneal recurrence diagnosis was 19 months (IQR 5-38.8). The median size of the resected retroperitoneal recurrence was 4.5 cm (IQR 2.7-7). Median followup after recurrence surgery was 32 months (IQR 16-57). Metastatic progression was observed in 60 patients (58.8%) postoperatively. Neoadjuvant and salvage systemic therapy was administered in 46 (45.1%) and 48 patients (47.1%), respectively. On multivariate analysis pathological nodal stage at original nephrectomy and maximum diameter of retroperitoneal recurrence were identified as independent risk factors for cancer specific death. CONCLUSIONS Clinicopathological factors at nephrectomy as well as retroperitoneal recurrence surgery are important prognosticators. Aggressive surgical resection offers potential cure in a substantial number of patients with retroperitoneal recurrence with acceptable complications and still has a dominant role in the management of isolated locally recurrent RCC.
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Affiliation(s)
- Arun Z Thomas
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mehrad Adibi
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Leonardo D Borregales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ly N Hoang
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pheroze Tamboli
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric Jonasch
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nizar M Tannir
- Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Surena F Matin
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christopher G Wood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jose A Karam
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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21
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Bex A. Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma. EJC Suppl 2015. [PMID: 26217128 PMCID: PMC4041303 DOI: 10.1016/j.ejcsup.2013.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Department of Urology, Amsterdam, The Netherlands
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Local Recurrence of Renal Cancer After Surgery: Prime Time for Percutaneous Thermal Ablation? Cardiovasc Intervent Radiol 2015; 38:1542-7. [PMID: 25902857 DOI: 10.1007/s00270-015-1100-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study was to retrospectively assess the safety and efficacy of radiofrequency thermal ablation (RFA) for retroperitoneal relapse following surgery for renal cell carcinoma (RCC). PATIENTS AND METHODS After open radical nephrectomy or nephron-sparing surgery, eight patients with no evidence of distant metastases were treated for retroperitoneal relapse of RCC with RFA. A total of 16 lesions were ablated. Technical success, tumor response, follow-up duration, and complications were retrospectively analyzed. RESULTS Disease progression after surgery occurred within a mean time of 57 months (range 9-120). Recurrent tumor size varied from 5 to 34 mm. Five patients previously underwent surgical resection of retroperitoneal recurrent lesions. Six patients were treated with percutaneous approach, while two with recurrent nodes located on the anterior pancreatic surface underwent laparotomic RFA approach. All lesions were completely ablated and patients were followed up with CT at 30 days, after 3 and every 6 months. There was no residual enhancement after a mean follow-up of 12 months (range 7-17). Both patients treated with laparotomic approach had a grade 2 complication according to the Clavien-Dindo classification. CONCLUSIONS In our small series, RFA after relapse of surgically removed RCC was safe and effective. Percutaneous and laparotomic thermal ablation should be assessed as first line loco-regional treatment on a larger patient group.
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23
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Dabestani S, Bex A. Metastasectomy. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fayek IS, Habashy HF, Habashy NF. Isolated loco-regional recurrence after radical nephrectomy for renal cell carcinoma: A study of 22patients. J Egypt Natl Canc Inst 2014; 26:161-6. [DOI: 10.1016/j.jnci.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/23/2014] [Accepted: 05/29/2014] [Indexed: 01/15/2023] Open
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Paly JJ, Hallemeier CL, Biggs PJ, Niemierko A, Roeder F, Martínez-Monge R, Whitson J, Calvo FA, Fastner G, Sedlmayer F, Wong WW, Ellis RJ, Haddock MG, Choo R, Shipley WU, Zietman AL, Efstathiou JA. Outcomes in a Multi-institutional Cohort of Patients Treated With Intraoperative Radiation Therapy for Advanced or Recurrent Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys 2014; 88:618-23. [DOI: 10.1016/j.ijrobp.2013.11.207] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
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Breda A, Konijeti R, Lam JS. Patterns of recurrence and surveillance strategies for renal cell carcinoma following surgical resection. Expert Rev Anticancer Ther 2014; 7:847-62. [PMID: 17555395 DOI: 10.1586/14737140.7.6.847] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Renal cell carcinoma (RCC) remains one of the most lethal urologic malignancies, with up to 40% of patients eventually dying of cancer progression. Despite advances in the diagnosis, staging and treatment of patients with RCC, approximately a third of patients who undergo surgery for clinically localized RCC will suffer a recurrence. Timely identification of recurrences following surgical extirpation is imperative in the treatment of these patients. RCC is known to metastasize through hematogenous routes of spread to distant organ sites and via lymphatic channels to regional lymph nodes. The path of tumor escape is associated with diverse clinical outcomes and a unique tumor biology. A consensus on surveillance regimens for patients following surgical resection of localized disease is lacking. The most extensively used system for providing prognostic information regarding survival and recurrence of disease has historically been the tumor-node-metastasis (TNM) classification system. As a result, most contemporary surveillance protocols have tailored follow-up regimens according to stage-based stratifications. Numerous studies have recently demonstrated that certain clinical and histopathological factors can improve the prediction of tumor recurrence. The incorporation of these prognostic factors into stage-based stratification models should be better than stage alone in attempting to provide a rational approach to identifying treatable recurrences while minimizing unnecessary exams and tests, as well as patient anxiety. Advances in the understanding of the pathogenesis, behavior and molecular biology of RCC have paved the way for developments that may enhance early diagnosis and prognostication, and improve survival for patients. Lastly, molecular markers should, in the future, revolutionize surveillance protocols for RCC by tailoring follow-up to specific molecular classifications.
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Affiliation(s)
- Alberto Breda
- David Geffen School of Medicine, University of California--Los Angeles, Department of Urology, Los Angeles, CA 90095-1738, USA.
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Habl G, Uhl M, Hensley F, Pahernik S, Debus J, Röder F. Intraoperative electron radiation therapy (IOERT) in patients with locally recurrent renal cell carcinoma. Radiat Oncol 2013; 8:282. [PMID: 24295293 PMCID: PMC3922867 DOI: 10.1186/1748-717x-8-282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To analyze our experience with intraoperative electron radiation therapy (IOERT) followed by moderate doses of external beam radiation therapy (EBRT) in patients with locally recurrent renal cell carcinoma. METHODS From 1992 to 2010, 17 patients with histologically proven, locally recurrent renal cell carcinoma (median tumor size 7 cm) were treated by surgery and IOERT with a median dose of 15 Gy. All patients met the premise of curative intent including 7 patients with oligometastases at the time of recurrent surgery, which were resected and/or irradiated. The median time interval from primary surgery to local recurrence was 26 months. Eleven patients received additional 3D-conformal EBRT with a median dose of 40 Gy. RESULTS Surgery resulted in free but close margins in 6 patients (R0), while 9 patients suffered from microscopic (R1) and 2 patients from macroscopic (R2) residual disease. After a median follow-up of 18 months, two local recurrences were observed, resulting in an actuarial 2-year local control rate of 91%. Eight patients developed distant failures, predominantly to liver and bone, resulting in an actuarial 2-year progression free survival of 32%. An improved PFS rate was found in patients with a larger time interval between initial surgery and recurrence (> 26 months). The actuarial 2-year overall survival rate was 73%. Lower histological grading (G1/2) was the only factor associated with improved overall survival. Perioperative complications were found in 4 patients. No IOERT specific late toxicities were observed. CONCLUSIONS Combination of surgery, IOERT and EBRT resulted in high local control rates with low toxicity in patients with locally recurrent renal cell cancer despite an unfavorable surgical outcome in the majority of patients. However, progression-free and overall survival were still limited due to a high distant failure rate, indicating the need for intensified systemic treatment especially in patients with high tumor grading and short interval to recurrence.
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Affiliation(s)
- Gregor Habl
- Department of Radiation Oncology, University of Heidelberg, Im Neuenheimer Feld 400 Heidelberg 69120, Germany.
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Paparel P, Bigot P, Matillon X, Bensalah K, Salomon L, Baumert H, Bastide C, Thuret R, Karsenty G, Long JA, Ammi M, Bessede T, Bin S, Roux A, Escudier B, Rioux Leclercq N, Pignot G, Soulie M, Patard JJ. Local recurrence after radical nephrectomy for kidney cancer: management and prediction of outcomes. a multi-institutional study. J Surg Oncol 2013; 109:126-31. [DOI: 10.1002/jso.23473] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/25/2013] [Indexed: 01/03/2023]
Affiliation(s)
- Philippe Paparel
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Lyon Sud University Hospital, Claude Bernard University Lyon 1; Lyon France
| | - Pierre Bigot
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Angers University Hospital; Angers France
| | - Xavier Matillon
- Department of Urology; Lyon Sud University Hospital, Claude Bernard University Lyon 1; Lyon France
| | - Karim Bensalah
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Pontchaillou University Hospital; Rennes France
| | - Laurent Salomon
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Henri Mondor University Hospital; Créteil France
| | - Hervé Baumert
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Saint-Louis University Hospital; Paris France
| | - Cyril Bastide
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Nord University Hospital; Marseille France
| | - Rodolphe Thuret
- Department of Urology; Lapeyronie University Hospital; Montpellier France
| | - Gilles Karsenty
- Department of Urology; La conception University Hospital; Marseille France
| | - Jean Alexandre Long
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Grenoble University Hospital; Grenoble France
| | - Myriam Ammi
- Department of Urology; Angers University Hospital; Angers France
| | - Thomas Bessede
- Department of Urology; Bicêtre University Hospital, Le Kremlin Bicêtre; France
| | - Sylvie Bin
- Hospices Civils de Lyon; Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique; Lyon France
| | - Adeline Roux
- Hospices Civils de Lyon; Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique; Lyon France
| | - Bernard Escudier
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Medical Oncology; Institut Gustave Roussy; Villejuif France
| | - Nathalie Rioux Leclercq
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Pathology; Pontchaillou University Hospital; Rennes France
| | - Géraldine Pignot
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Bicêtre University Hospital, Le Kremlin Bicêtre; France
| | - Michel Soulie
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Toulouse University Hospital; Toulouse France
| | - Jean-Jacques Patard
- Cancerology Committee of the French Association of Urology (CCAFU); Paris France
- Department of Urology; Bicêtre University Hospital, Le Kremlin Bicêtre; France
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Takahashi S, Konishi M, Kinoshita T, Gotohda N, Kato Y, Saito N, Sugito M, Yoshino T. Predictors for early recurrence after hepatectomy for initially unresectable colorectal liver metastasis. J Gastrointest Surg 2013; 17:939-48. [PMID: 23400510 DOI: 10.1007/s11605-013-2162-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/30/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Early recurrence correlates with poor survival following various cancer surgeries and puts considerable stress on patients both physically and mentally. This retrospective study investigated the predictive factors for early recurrence after surgical resection for initially unresectable colorectal liver metastasis to elucidate indications for conversion strategies. METHODS We retrospectively studied 46 patients who underwent hepatectomy after chemotherapy for initially unresectable colorectal liver metastasis from 1997 to 2010. RESULTS Recurrences occurred within 6 months after hepatectomy in 13 patients (37 %). The median survival time of 21.2 months and the 5-year survival rate of 0 % after hepatectomy in patients with recurrence within 6 months were significantly worse than those in patients with recurrence more than 6 months after hepatectomy. Recurrence in less than 6 months was significantly correlated with impossibility of anticancer therapy for recurrence after hepatectomy (p = 0.01). Eight or more hepatic tumors after chemotherapy were the only predictor of recurrence within 6 months (p = 0.01; odds ratio 9.6; 95 % confidence interval 1.5-60.6). CONCLUSION Recurrence within 6 months was significantly correlated with a poorer outcome following surgery for initially unresectable colorectal liver metastasis. Surgical indication for initially unresectable colorectal liver metastasis with eight or more hepatic tumors after chemotherapy should be considered carefully in the light of mental and physical status, co-morbidity, and alternative treatment plans.
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Affiliation(s)
- Shinichiro Takahashi
- Department of Hepato-biliary Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan.
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El Hajj A, Thanigasalam R, Molinié V, Massoud W, Fourati M, Girard F, Escudier B, Baumert H. Feasibility and oncological outcomes of laparoscopic treatment for local relapse of renal cell carcinoma. BJU Int 2013; 112:E307-13. [DOI: 10.1111/j.1464-410x.2012.11724.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Albert El Hajj
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | | | - Vincent Molinié
- Department of Pathology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Walid Massoud
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Mohamed Fourati
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Frederic Girard
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
| | - Bernard Escudier
- Department of Oncology; Gustave Roussy Institute; Villejuif; France
| | - Hervé Baumert
- Department of Urology; Paris Saint Joseph Hospital Trust; Paris; France
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Calvo FA, Sole CV, Martinez-Monge R, Azinovic I, Aristu J, Zudaire J, Garcia-Sabrido JL, Berian JM. Intraoperative EBRT and resection for renal cell carcinoma : twenty-year outcomes. Strahlenther Onkol 2012; 189:129-36. [PMID: 23223810 DOI: 10.1007/s00066-012-0272-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 11/08/2012] [Indexed: 01/21/2023]
Abstract
PURPOSE We report the outcomes of a multimodality treatment approach combining maximal surgical resection and intraoperative electron radiotherapy (IOERT) with or without external beam radiation therapy (EBRT) in patients with locoregionally (LR) recurrent renal cell carcinoma (RCC) after radical nephrectomy or LR advanced primary RCC. PATIENTS AND METHODS From 1983 to 2008, 25 patients with LR recurrent (n = 10) or LR advanced primary (n = 15) RCC were treated with this approach. Median patient age was 60 years (range, 16-79 years). Fifteen patients (60%) received perioperative EBRT (median dose, 44 Gy). Surgical resection was R0 (negative margins) in 6 patients (24%) and R1 (residual microscopic disease) in 19 patients (76%). The median dose of IOERT was 14 Gy (range, 9-15). Overall survival (OS) and relapse patterns were calculated using the Kaplan-Meier method. RESULTS Median follow-up for surviving patients was 22.2 years (range, 3.6-26 years). OS and DFS at 5 and 10 years were 38% and 18% and 19% and 14%, respectively. LR control (tumor bed or regional lymph nodes) and distant metastases-free survival rates at 5 years were 80% and 22%, respectively. The death rate within 30 days of surgery and IOERT was 4% (n = 1). Six patients (24%) experienced acute or late toxicities of grade 3 or higher according to the National Cancer Institute Common Toxicity Criteria (NCI-CTCAE) v4. CONCLUSION In patients with LR recurrent or LR advanced primary RCC, a multimodality approach consisting of maximal surgical resection and IOERT with or without adjuvant EBRT yielded encouraging local control results, justifying further evaluation.
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Affiliation(s)
- F A Calvo
- Department of Oncology, Institute of Sanitary Research, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
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Bex A. Metastasectomy. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kaibori M, Iwamoto Y, Ishizaki M, Matsui K, Yoshioka K, Asano H, Kwon AH. Predictors and outcome of early recurrence after resection of hepatic metastases from colorectal cancer. Langenbecks Arch Surg 2011; 397:373-81. [DOI: 10.1007/s00423-011-0861-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 10/10/2011] [Indexed: 11/29/2022]
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Hallemeier CL, Choo R, Davis BJ, Pisansky TM, Gunderson LL, Leibovich BC, Haddock MG. Long-term outcomes after maximal surgical resection and intraoperative electron radiotherapy for locoregionally recurrent or locoregionally advanced primary renal cell carcinoma. Int J Radiat Oncol Biol Phys 2011; 82:1938-43. [PMID: 21514065 DOI: 10.1016/j.ijrobp.2011.02.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/02/2011] [Accepted: 02/11/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To report outcomes of a multimodality therapy combining maximal surgical resection and intraoperative electron radiotherapy (IOERT) for patients with locoregionally (LR) recurrent renal cell carcinoma (RCC) after radical nephrectomy or LR advanced primary RCC. METHODS AND MATERIALS From 1989 through 2005, a total of 22 patients with LR recurrent (n = 19) or LR advanced primary (n = 3) RCC were treated with this multimodality approach. The median patient age was 63 years (range 46-78). Twenty-one patients (95%) received perioperative external beam radiotherapy (EBRT) with a median dose of 4,500 cGy (range, 4,140-5,500). Surgical resection was R0 (negative margins) in 5 patients (23%) and R1 (residual microscopic disease) in 17 patients (77%). The median IOERT dose delivered was 1,250 cGy (range, 1,000-2,000). Overall survival (OS) and disease-free survival (DFS) and relapse patterns were estimated using the Kaplan-Meier method. RESULTS The median follow-up for surviving patients was 9.9 years (range, 3.6-20 years). The OS and DFS at 1, 5, and 10 years were 91%, 40%, and 35% and 64%, 31%, and 31%, respectively. Central recurrence (within the IOERT field), LR relapse (tumor bed or regional lymph nodes), and distant metastases at 5 years were 9%, 27%, and 64%, respectively. Mortality within 30 days of surgery and IOERT was 0%. Five patients (23%) experienced acute or late National Cancer Institute Common Toxicity Criteria (NCI-CTCAE) Version 4 Grade 3 to 5 toxicities. CONCLUSIONS In patients with LR recurrent or LR advanced primary RCC, a multimodality approach of perioperative EBRT, maximal surgical resection, and IOERT yielded encouraging results. This regimen warrants further investigation.
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Suson KD, Richard H, Phelan MW. Cryoablation of Renal Fossa Recurrence After Radical Nephrectomy. J Endourol 2011; 25:559-62. [DOI: 10.1089/end.2010.0463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Kristina D. Suson
- Division of Urology, University of Maryland Medical Center, Baltimore, Maryland
| | - Howard Richard
- Division of Vascular and Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael W. Phelan
- Division of Urology, University of Maryland Medical Center, Baltimore, Maryland
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Alt AL, Boorjian SA, Lohse CM, Costello BA, Leibovich BC, Blute ML. Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer 2011; 117:2873-82. [PMID: 21692048 DOI: 10.1002/cncr.25836] [Citation(s) in RCA: 283] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 11/12/2010] [Accepted: 11/12/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although a role for resection of solitary metastases from renal cell carcinoma (RCC) has been described, the utility of surgery in patients with multiple sites of disease has been less well defined. The authors report the survival of patients who underwent complete metastasectomy for multiple RCC metastases. METHODS The authors identified 887 patients who underwent nephrectomy for RCC between 1976 and 2006 who developed multiple metastatic lesions. The impact of complete metastasectomy on survival was evaluated controlling for the timing, location, and number of metastases and for patient performance status. RESULTS Of 887 patients, 125 (14%) underwent complete surgical resection of all metastases. Complete metastasectomy was associated with a significant prolongation of median cancer-specific survival (CSS) (4.8 years vs 1.3 years; P < .001). Patients who had lung-only metastases had a 5-year CSS rate of 73.6% with complete resection versus 19% without complete resection (P < .001). A survival advantage from complete metastasectomy also was observed among patients with multiple, nonlung-only metastases, who had a 5-year CSS rate of 32.5% with complete resection versus 12.4% without complete resection (P < .001). Complete resection remained predictive of improved CSS for patients who had ≥ 3 metastatic lesions (P < .001) and for patients who had synchronous (P < .001) and asynchronous (P = .002) multiple metastases. Moreover, on multivariate analysis, the absence of complete metastasectomy was associated significantly with an increased risk of death from RCC (hazard ratio, 2.91; 95% confidence interval, 2.17-3.90; P < .001). CONCLUSIONS The current results indicated that complete resection of multiple RCC metastases may be associated with long-term survival and should be considered when technically feasible in appropriate surgical candidates.
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Affiliation(s)
- Angela L Alt
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota, USA
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Yohannan J, Feng T, Berkowitz J, Connolly SS, Pierorazio P, Allaf ME. Laparoscopic Resection of Local Recurrence After Previous Radical Nephrectomy for Clinically Localized Renal-Cell Carcinoma: Perioperative Outcomes and Initial Observations. J Endourol 2010; 24:1609-12. [DOI: 10.1089/end.2010.0051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jithin Yohannan
- James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Tom Feng
- James Buchanan Brady Urological Institute, Baltimore, Maryland
| | - Jared Berkowitz
- James Buchanan Brady Urological Institute, Baltimore, Maryland
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Ielpo B, Mazzetti C, Venditti D, Buonomo O, Petrella G. A case of metachronous splenic metastasis from renal cell carcinoma after 14 years. Int J Surg 2010; 8:353-5. [PMID: 20438874 DOI: 10.1016/j.ijsu.2010.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 04/24/2010] [Indexed: 10/19/2022]
Abstract
We present a case of a patient who developed a metachronous splenic metastasis from renal clear cell carcinoma, for which he has undergone a left nephrectomy 14 years earlier. During his routine follow up a CT scan showed a splenic mass which was considered an isolated metastasis possibly originating from the renal cancer. A splenectomy was performed and histopatological examination of the spleen confirmed the presence of clear cell carcinoma with infiltration of the capsule. Splenic metastases are uncommon and from the reported literature we understand that splenic metastasis from renal cell carcinoma is extremely rare. The optimal treatment seems to be splenectomy with a good long term outcome. With this report the authors would like to discuss the possibility that it could be a case of local recurrence rather than a real metastasis. A revision of previous reports in the literature is performed too.
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Affiliation(s)
- Benedetto Ielpo
- Department of Emergency Surgery, Tor Vergata University Hospital, Rome, Italy.
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Tsivian A, Benjamin S, Shtricker A, Tsivian M, Kyzer S, Sidi AA. Laparoscopic removal of local renal cell carcinoma recurrence. Int Braz J Urol 2009; 35:436-41. [PMID: 19719859 DOI: 10.1590/s1677-55382009000400007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2009] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe an entirely laparoscopic technique for excising a recurrence of local renal cell carcinoma (RCC). MATERIALS AND METHODS The patient is placed in a full flank position. A 10-mm trocar is inserted using Hasson's technique with three additional ports in the upper abdomen. After lysis of adhesions, the psoas muscle, ureteral and gonadal vein remnants, inferior vena cava or aorta, and renal vessel stumps are dissected and isolated. The specimen, including the mass, the adrenal gland, and the ipsilateral pararenal and paracaval or para-aortic tissue within Gerota's fascia remnants, are excised en bloc and removed inside an Endocatch-II bag. RESULTS To date we have used this technique for excising RCC recurrences in three patients. Pathologic examination showed clear cell type RCC Fuhrman grade 2 in the specimens of two patients and chromophobe type in one. No patient has had further recurrence after 50, 38 and 12 months of follow-up. CONCLUSIONS An entirely laparoscopic surgical approach for excising local RCC recurrence has not, to our knowledge, been previously described. This method can be effectively applied while adhering to oncologic principles, with minimal blood loss and low morbidity.
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Affiliation(s)
- Alexander Tsivian
- Departments of Urologic Surgery and Surgery B, Wolfson Medical Center, Holon, Israel
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Galisteo EG, Morales Jiménez P, Hernández Alcaraz D, Baena González V. [Local recurrence of renal tumors]. Actas Urol Esp 2009; 33:603-8. [PMID: 19658315 DOI: 10.1016/s0210-4806(09)74195-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Margulis V, McDonald M, Tamboli P, Swanson DA, Wood CG. Predictors of Oncological Outcome After Resection of Locally Recurrent Renal Cell Carcinoma. J Urol 2009; 181:2044-51. [DOI: 10.1016/j.juro.2009.01.043] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Vitaly Margulis
- Departments of Urology and Pathology (PT), University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Michelle McDonald
- Departments of Urology and Pathology (PT), University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Pheroze Tamboli
- Departments of Urology and Pathology (PT), University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - David A. Swanson
- Departments of Urology and Pathology (PT), University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Christopher G. Wood
- Departments of Urology and Pathology (PT), University of Texas M. D. Anderson Cancer Center, Houston, Texas
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May M, Brookman-Amissah S, Pflanz S, Knoll N, Roigas J, Gunia S, Hoschke B, Kendel F. [Value of the postoperative Störkel score. Predict disease-free survival of patients with surgically resected renal cell carcinoma]. Urologe A 2008; 48:284-90. [PMID: 19104768 DOI: 10.1007/s00120-008-1912-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the value of clinical and pathological parameters defining the Störkel score in order to predict outcomes of patients with surgically treated renal cell carcinoma (RCC). MATERIAL AND METHODS A total of 834 consecutive patients having radical or partial nephrectomy were retrospectively reviewed. For each patient with RCC, the prognostic Störkel score was calculated according to the following variables: Robson stage, Thoenes nuclear grading, histological type, pattern of growth, and age. Based on the Störkel score, patients were divided into groups: those with good prognosis (GP), intermediate prognosis (IP), and poor prognosis (PP). Cancer-specific survival (CSS) and overall survival (OS) were estimated using the Kaplan-Meier method. The accuracy of prediction of CSS and OS with the Störkel score was analyzed using Kaplan-Meier analysis, proportional hazards regression, and graphic representation [(Kaplan-Meier curves, area under the curve (AUC)]. In 564 patients who were still alive, the median follow-up was 79 months (mean 84.8 months). RESULTS In the GP, IP, and PP groups, CSS after 8 years was 86.7%, 75.6%, and 13.7%, respectively (p<0.001). In the multiple analysis, only the Robson stage and Thoenes nuclear grading independently predicted CSS. Accordingly, the prognostic accuracy of the Störkel score (CSS prediction: AUC=0.744, 95% CI=0.70-0.79) was not better than with a reduced model that included the Robson stage and grading only (CSS prediction: AUC=0.765, 95%CI=0.72-0.81). CONCLUSIONS Of all parameters included in the Störkel score, only the Robson stage and nuclear grading are significant prognostic factors. Hence, we recommend an accordant modification of the score with additional variables.
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Affiliation(s)
- M May
- Klinik für Urologie, Carl-Thiem-Klinikum, Thiemstrasse 111, 03048 Cottbus.
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Cho J, Kim GE, Rha KH, Ahn JB, Lee CG, Suh CO, Seong J, Keum KC, Kim SI, Lee YH. Hypofractionated high-dose intensity-modulated radiotherapy (60 Gy at 2.5 Gy per fraction) for recurrent renal cell carcinoma: a case report. J Korean Med Sci 2008; 23:740-3. [PMID: 18756070 PMCID: PMC2526393 DOI: 10.3346/jkms.2008.23.4.740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A patient with renal cell carcinoma (RCC) developed synchronous bone metastasis with metachronous relapses to the bone and renal fossa. The primary lesion was initially removed surgically, and the metastatic bone lesions and locally recurrent tumours were treated by a high-fractional dose and high-total-dose intensity-modulated radiotherapy (IMRT, 60 Gy at 2.5 Gy per fraction) without significant side effects. All the grossly relapsed tumors underwent complete remission (CR) within a short time after IMRT. To date, CR has been maintained for more than two years. This case study reports the successful treatment of radioresistant RCC using a new scheme that involves a fractionation regimen with a high precision radiotherapy.
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Affiliation(s)
- Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seodaemoon-gu, Seoul, Korea.
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Lam JS, Bergman J, Breda A, Schulam PG. Importance of surgical margins in the management of renal cell carcinoma. ACTA ACUST UNITED AC 2008; 5:308-17. [DOI: 10.1038/ncpuro1121] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 03/20/2008] [Indexed: 02/02/2023]
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Nóbrega de Jesus CM, Silva Casafus FA, Agostinho AD. Surgical treatment of renal cell carcinoma recurrence at the renal fossa following radical nephrectomy. SAO PAULO MED J 2008; 126:194-6. [PMID: 18711661 DOI: 10.1590/s1516-31802008000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 05/05/2008] [Indexed: 11/22/2022] Open
Abstract
CONTEXT Isolated renal cell carcinoma recurrence at the renal fossa is a rare event. This condition occurs in 1 to 2% of radical nephrectomy cases. It is usually seen in postoperative follow-up imaging examinations such as abdominal computed tomography or abdominal ultrasound. There is controversy among urologists and oncologists regarding the best way to treat this rare situation, because of the few cases in the literature. CASE REPORT We report on a case of isolated recurrence at the renal fossa due to renal cell carcinoma (RCC), four and a half years after radical nephrectomy, without evidence of metastases in other organs. The diagnosis was made from abdominal tomography performed during outpatient follow-up, in which a retroperitoneal mass was observed in the renal fossa. Excision was carried out by means of a subcostal transversal incision, without complications. One and a half years after the procedure, there was evidence of metastasis in the left lung and, six months later, another recurrence at the ninth anterior right rib, while the patient remained asymptomatic. Aggressive surgical treatment is a good method for controlling this rare situation of single retroperitoneal RCC recurrence. Abdominal tomography must continue to be performed over long periods of follow-up, to monitor for RCC following radical nephrectomy, in order to diagnose any late retroperitoneal recurrences. These must be treated as single RCC metastases.
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Editorial Comment. Urology 2008. [DOI: 10.1016/j.urology.2007.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Single Center Preliminary Experience with Hand-Assisted Laparoscopic Resection of Isolated Renal Cell Carcinoma Fossa Recurrences. Urology 2008; 71:495-9; discussion 499-500. [DOI: 10.1016/j.urology.2007.08.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 06/28/2007] [Accepted: 08/15/2007] [Indexed: 11/18/2022]
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Skolarikos A, Alivizatos G, Laguna P, de la Rosette J. A Review on Follow-Up Strategies for Renal Cell Carcinoma after Nephrectomy. Eur Urol 2007; 51:1490-500; discussion 1501. [PMID: 17229521 DOI: 10.1016/j.eururo.2006.12.031] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Accepted: 12/24/2006] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To provide a comprehensive review of the evidence supporting the necessity for follow-up after nephrectomy for renal cell carcinoma. METHODS We searched the Medline, MeSH, EMBASE, and Cochrane databases using the terms "renal cell cancer," "kidney neoplasm," "follow-up," "surveillance," "prognosis," and "staging" to look for human/English language/Randomized Controlled Trials/Clinical trials/Review articles/Meta-analysis/Practiced Guidelines, and Editorials. RESULTS No consensus currently exists on surveillance guidelines after radical or partial nephrectomy for renal cell carcinoma. The rationale for follow-up strategies is to detect local recurrence or metastatic disease and to allow appropriate treatment. Most of the surveillance protocols recommend various follow-up strategies for all tumour stages. The emphasis on follow-up should be during the first 3-5 yr after nephrectomy. There is no consensus about which investigations should be performed and at what intervals. Most surgeons rely on symptom enquiry, physical examination, chest x-ray, and computed tomography scanning. A protocol based on the stage of the initial tumour is adapted by the majority of the investigators. Patients should be followed similarly after radical or partial nephrectomy on the basis of stage-oriented protocols. The combination of various prognostic factors requires further validation over stage-based protocols. There is a paucity of guidelines in the literature regarding follow-up for patients with hereditary forms of renal cell carcinoma. CONCLUSIONS Current guidelines for follow-up are based on observational and case studies. While this fact precludes a high level of evidence-based guidelines, we have to conclude that this is the best available evidence to date.
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Affiliation(s)
- Andreas Skolarikos
- Athens Medical School, 2nd Department of Urology, Sismanoglio Hopsital, Athens, Greece.
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Mathers MJ, Lazica DA, Klotz T, Sommer F, Roth S. [Secondary prevention after urological tumor diseases. Focusing on the kidneys, testes, and bladder]. Urologe A 2007; 46:636-41. [PMID: 17487469 DOI: 10.1007/s00120-007-1353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
It is generally agreed upon that patients require a caring as well as careful medical follow-up after cancer treatment. The goal of secondary prevention is to recognize a recurrence at an early stage and to use the curative chance while the tumor mass is still small. There is evidence of a medically effective and successful follow-up for tumors of the testicle and the bladder. For quality reasons, these follow-up regimes should be adhered to for quality reasons. In other diseases, e.g., renal cell carcinoma, prospective randomized studies are missing which demonstrate the effectiveness of follow-ups. In these cases asymptomatic patients should be stratified to individualized follow-up care.
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Affiliation(s)
- M J Mathers
- Urologische Gemeinschaftspraxis, Kooperationspraxis der Klinik für Urologie und Kinderurologie, Klinikum Wuppertal, Universität Witten/Herdecke, Fastenrathstrasse 1, 42853 Remscheid, Germany.
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