TY - JOUR
T1 - Cytoreductive nephrectomy preceding adjuvant
T2 - Immunotherapy for metastatic renal cell carcinoma: 8 years' experience in a UK tertiary referral centre
AU - Martenstein, Christian
AU - Phipps, Simon
AU - Nabi, Ghulam
AU - Riddick, Anthony
AU - Mclaren, Duncan
AU - Mcneill, Alan
PY - 2011/1/1
Y1 - 2011/1/1
N2 - We report a tertiary referral centre's experience of cytoreductive nephrectomy (CN) combined with immunotherapy as part of multimodality treatment for metastatic renal cell cancer (mRCC) over a period of 8 years. Patients who underwent CN as part of multimodality treatment for mRCC were identified from our nephrectomy database. Demographic characteristics, oncological outcome, reasons for failure to start or to complete immunotherapy, pathological findings and a comparison between open and laparo-scopic CN were evaluated. Forty patients underwent CN for mRCC preceding immunotherapy. 26 (65%) failed to receive immunotherapy. This was most commonly due to poor performance status postoperatively (12/26, 46%). 14 patients (35%) received immunotherapy following surgery and 9 (23%) patients completed treatment. Laparoscopic CN was associated with a significantly lower blood loss, shorter hospital stay and lower rate of transfusion than the open approach. Patients are at significant risk of failure to proceed to adjuvant immunotherapy following CN for mRCC, most commonly due to poor performance status postoperatively. Laparoscopic CN is shown to be safe and effective in well-selected patients. As new targeted treatments for mRCC emerge and their use in combination with CN is evaluated, a detailed and multidisciplinary approach to selection of these patients will continue to be crucial.
AB - We report a tertiary referral centre's experience of cytoreductive nephrectomy (CN) combined with immunotherapy as part of multimodality treatment for metastatic renal cell cancer (mRCC) over a period of 8 years. Patients who underwent CN as part of multimodality treatment for mRCC were identified from our nephrectomy database. Demographic characteristics, oncological outcome, reasons for failure to start or to complete immunotherapy, pathological findings and a comparison between open and laparo-scopic CN were evaluated. Forty patients underwent CN for mRCC preceding immunotherapy. 26 (65%) failed to receive immunotherapy. This was most commonly due to poor performance status postoperatively (12/26, 46%). 14 patients (35%) received immunotherapy following surgery and 9 (23%) patients completed treatment. Laparoscopic CN was associated with a significantly lower blood loss, shorter hospital stay and lower rate of transfusion than the open approach. Patients are at significant risk of failure to proceed to adjuvant immunotherapy following CN for mRCC, most commonly due to poor performance status postoperatively. Laparoscopic CN is shown to be safe and effective in well-selected patients. As new targeted treatments for mRCC emerge and their use in combination with CN is evaluated, a detailed and multidisciplinary approach to selection of these patients will continue to be crucial.
KW - Cytoreductive nephrectomy
KW - Immunotherapy
KW - Interferon-α
KW - Performance status
KW - Treatment failure
KW - Tyrosine kinase inhibitor
UR - http://www.scopus.com/inward/record.url?scp=84998183746&partnerID=8YFLogxK
U2 - 10.1016/j.bjmsu.2010.08.001
DO - 10.1016/j.bjmsu.2010.08.001
M3 - Article
AN - SCOPUS:84998183746
SN - 2051-4158
VL - 4
SP - 101
EP - 107
JO - Journal of Clinical Urology
JF - Journal of Clinical Urology
IS - 3
ER -