Resection of metastasis and local recurrences of renal cell carcinoma after presurgical targeted therapy: probability of complete local control and outcome.

PURPOSE: To analyse probability of complete local control and outcome in patients with metastases and local recurrences who have a high probability of failure of local therapy and who were treated with presurgical targeted therapy with the intention to reconsider complete resection or other local therapies such as radiotherapy or ablation.
METHOD: From two institutional databases, patients with metastatic or locally recurrent RCC were retrospectively identified who received targeted therapy based on a multidisciplinary tumour board decision because of high probability of failure of local control.
RESULTS: From January 2007 until November 2014, 34 patients were treated and included in the analysis. Five patients underwent no local therapy due to insufficient downsizing to attempt resection. The probability of proceeding to local therapy was 85.3 %. Median overall survival of 29 patients with local therapy after pretreatment was 67 months (range 9-173, 95 % CI 90.87) with a median disease-free survival of 12 months (range 0-147 months). The probability to achieve complete local therapy and discontinue targeted therapy was 73.5 % (25 of 34 patients). Median time without systemic therapy was 12 months.
CONCLUSION: In a retrospective series of patients with a high probability of failure of local therapy, neoadjuvant targeted therapy was associated with successful complete local treatment in approximately 70 % of patients with a time off targeted therapy of ≥1 year in 50 %. Only number of metastatic sites and the disease-free interval after treatment were associated with outcome.