Saeed Dabestani1, Lorenzo Marconi, Axel Bex. 1. aDepartment of Urology, Skåne University Hospital, Malmö, Sweden bDepartment of Urology, Coimbra University Hospital, Coimbra, Portugal cDivision of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, The Netherlands.
Abstract
PURPOSE OF REVIEW: Although novel targeted therapies for metastatic renal cell carcinoma (RCC) are emerging, metastasectomy still remains the only potentially curable intervention and plays an important role both in disease control, cancer-specific survival (CSS) and overall survival (OS). A systematic review was conducted in 2014 by the European Association of Urology RCC guidelines panel to summarize evidence on the subject at hand. The purpose of this review is to update the current evidence base. RECENT FINDINGS: A total of 17-19% of initially nonmetastatic patients with later RCC metastasis are potentially curable. Complete metastasectomy still remains the sole curative option, continues to show improved OS and CSS and is suggested to defer time to palliative targeted therapy. Resectability, long time to recurrence, good performance status and oligometastatic disease have better benefit of metastasectomy. Stereotactic radiotherapy remains an excellent option for local tumor control and symptom control in patients with RCC brain and bone metastases. Minimal-invasive options such as thermal ablation are evolving, albeit the evidence base is small. Novel trials are investigating sequencing of metastasectomy and targeted therapy with results pending. SUMMARY: Metastasectomy continues to be supported as beneficial for OS, CSS and progression-free survival in patients with good prognostic factors.
PURPOSE OF REVIEW: Although novel targeted therapies for metastatic renal cell carcinoma (RCC) are emerging, metastasectomy still remains the only potentially curable intervention and plays an important role both in disease control, cancer-specific survival (CSS) and overall survival (OS). A systematic review was conducted in 2014 by the European Association of Urology RCC guidelines panel to summarize evidence on the subject at hand. The purpose of this review is to update the current evidence base. RECENT FINDINGS: A total of 17-19% of initially nonmetastatic patients with later RCC metastasis are potentially curable. Complete metastasectomy still remains the sole curative option, continues to show improved OS and CSS and is suggested to defer time to palliative targeted therapy. Resectability, long time to recurrence, good performance status and oligometastatic disease have better benefit of metastasectomy. Stereotactic radiotherapy remains an excellent option for local tumor control and symptom control in patients with RCC brain and bone metastases. Minimal-invasive options such as thermal ablation are evolving, albeit the evidence base is small. Novel trials are investigating sequencing of metastasectomy and targeted therapy with results pending. SUMMARY: Metastasectomy continues to be supported as beneficial for OS, CSS and progression-free survival in patients with good prognostic factors.
Authors: Pawel Wiechno; Jakub Kucharz; Malgorzata Sadowska; Wojciech Michalski; Bozena Sikora-Kupis; Joanna Jonska-Gmyrek; Grazyna Poniatowska; Karol Nietupski; Krzysztof Ossolinski; Tomasz Demkow Journal: Med Oncol Date: 2018-10-27 Impact factor: 3.064