Cytoreductive nephrectomy preceding adjuvant: Immunotherapy for metastatic renal cell carcinoma: 8 years' experience in a UK tertiary referral centre

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 - 2011/5

Y1 - 2011/5

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 - https://www.scopus.com/pages/publications/84998183746

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 -