831P - A retrospective study of metastasectomy in metastatic renal cell carcinoma

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Renal Cell Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Aneta Suder
Authors A. Suder1, K. Thillai2, S. Rudman3, A. Chandra4, G. Rottenberg5, B. Challacombe6, G. Kooiman7, P. Srinivasan8, T. O'Brien6, S. Chowdhury9
  • 1Medical Oncology, Guy's and St Thomas's NHS Trust, London/UK
  • 2Medical Oncology, Guys Hospital, London/UK
  • 3Medical Oncology Offices, 4th Floor Bermondsey Wing, Guys Hospital, Guys and St Thomas's NHS Trust, SE1 9RT - London/UK
  • 4Pathology, Guys Hospital, London/UK
  • 5Radiology, Guy's Hospital, London/UK
  • 6Urology, Guys and St Thomas's NHS Trust, London/UK
  • 7Urology, Kings College, London/UK
  • 8Institute Of Liver Studies, Kings College, London/UK
  • 9Department Of Medical Oncology, Guys Hospital, London/UK

Abstract

Introduction

Despite significant advances in the systemic therapy for metastatic renal cell carcinoma (mRCC) long term survival is rare. Systemic VEGF directed therapy can be toxic and is expensive. Metastatectomy can delay or even completely avoid systemic therapy. 5-year cancer specific survival rates of up to 73% have been reported in select patients.

Methods

Patients who underwent metastasectomy for RCC recurrence in our institution between 2001–2011 were identified through a clinical database that was cross-referenced with a pathology database and multi-disciplinary team records.

Patient characteristics N= 36 %
Male/Female 25/11 70/30
Median Age (range 44-85) 65 NA
Primary tumour pT2 or less 4 10
Radical nephrectomy 31 97*
Clear cell histology 20 100**
Median time to metastasectomy months (range) 24 5-230
Number of metastases 1 27 77
2-3 7 20
3+ 1 3
Site of metastases Lung 12
Adrenal 7
Bone 4
Other*** 4
Upper GI 2
Liver 2
Minimum Heng risk score at time of metastasectomy Favourable 21
Intermediate 11
Poor 1

Results

*evaluable patients n= 32, **n = 20 *** includes chest wall, ovary, thyroid, contralateral kidney Median time to first progression from surgery was 21 months (range 0-50). On progression 17/18 patients had repeat metastasectomy with 10/17 relapsing at a site different to the original surgery. To date 11/36 have received additional therapy including tyrosine kinase inhibitors (n = 7), radiotherapy (n = 3) and interferon (n = 1). Median overall survival from first metastasectomy has not been reached at mean follow up of 27 months. 27 patients are alive at last follow up with 14 disease free. Of the 13 evaluable patients, none are free from recurrence at 5 years.

Discussion

Despite limitations of retrospective design, selection bias and size, this data shows that metastasectomy is feasible in selected patients with mRCC. Our patients included a group with characteristics that have previously been described as less favourable for resection. Despite this preliminary overall survival data is encouraging.

Conclusion

Metastatectomy is an important treatment option for selected patients with metastatic renal cell carcinoma. All patients should be managed in a multi-disciplinary manner to ensure that patients are considered for metastasectomy when appropriate.

Disclosure

All authors have declared no conflicts of interest.