Objective: to develop an effective and safe surgical technique for the treatment of patients with renal cell carcinoma with invasive tumor venous thrombosis of the inferior vena cava (IVC).Materials and methods. The study included 75 patients underwent surgical treatment at the N.N. Blokhin Russian Cancer Research Center between 1995 and 2017. The median age of patients was 57 years (range: 32–72 years). All patients were diagnosed with RCC with invasive tumor venous thrombosis levels II–IV; of them, 55 patients (73.3 %) had complete IVC obstruction and mature venous collaterals. Twenty- seven patients (26.0 %) were diagnosed with regional, 37 (49.3 %) – with distant metastases. Prior nephrectomy was performed in 5 (6.7 %) cases. Surgical treatment included nephrectomy (n = 70; 93.3 %), thrombectomy with IVC resection (n = 75; 100 %), and metastasectomy in solitary distant lesions (n = 11; 14.7 %). Partial IVC resection was demanded in 18 patients (24.0 %): with infrarenal IVC plication – 14 (18.7 %), with reconstruction of IVC with synthetic patch – 4 (5.3 %). Fifty-seven patients (76.0 %) underwent circular IVC resection (with left renal vein (LRV) ligation – 35 (46.7 %)). The IVC was replaced with ePTFE grafts in 4 (5.3 %) patients, IVC reconstruction was not required in 53 (70.7 %) patients. IVC grafting was considered to be justified in patients without mature venous collaterals. Twenty-two patients (29.3 %) received systemic antitumor therapy. Median follow-up was 32.3 months (range: 1–226 months).Results. Median operative time was 237.5 min (range: 135–580 min); median blood loss – 7000 mL (range: 1200–27 000 mL). The post- operative complications rate was 52.1 % (grades III–V – 31.5 %). Hospital mortality was 13.3 % (10 of 75 patients). Thirty-two months overall, cancer-specific, and recurrence-free survival were 42.4 %, 49.5 %, and 61.2 % respectively. At 19 months all prosthesis were patent. None of the patients had glomerular filtration rate <60 ml/min/1.73 m2 after LRV ligation. No patients developed disabling chronic venous insufficiency of the lower limbs after IVC ligation/resection without grafting.Conclusion. Nephrectomy, thrombectomy, and IVC resection is the only effective method of treatment for RCC with invasive tumor venous thrombosis. The development of IVC and LRV venous collaterals allows performing circular IVC resection with LRV ligation without graft replacement.
Administration of 4 cycles of induction CT (4BEP or 3BEP + 1EP) in patients with metastatic seminoma who have LDH level ≥ 2.25 ULN, and/or retroperitoneal lymph nodes >5 cm and/or pulmonary metastases results in decreased disease progression rate and significant gain in OS.
e16063 Background: Cisplatin- and etoposide-based CT allows curing the majority of patients (pts) with metastatic germ cell tumor. There are limited data concerning the importance of maintenance of DI during iCT. In the retrospective study we analyzed the role of DI of iCT on metastatic NSGCT. Methods: 589 chemotherapy-naïve pts with advanced NSGCT received induction iCT from 1987 to 2006 in our center. We compared data of all pts who relapsed after iCT (147 pts) with data of 159 randomly sampled pts without relapses. During iCT all pts received classical E500P (24%) or BE500P (76%) regimens. Median follow-up time was 49 (range, 3–218) months. Eighty four (27.5%) of 306 pts, 107 (35%) and 115 (37.5%) were from good, intermediate and poor prognostic groups, respectively. DI was calculated for every drug and expressed in mg/m2 per week. Multivariate Cox stepwise regression analysis was performed to determine independent prognostic factors in each IGCCCG prognostic group. Progression free survival was used as endpoint of the analysis. Results: Multivariate analysis revealed the following negative prognostic factors as independent: in pts of the IGCCCG good prognostic group: retroperitoneal lymph nodes >5 cm (HR 3.53, 95% Cl 1.66–7.51). In pts with the intermediate prognosis: DI of etoposide <80% (HR 4.73; 95 % CI 4.85–25.04) and presence of pulmonary metastases (HR 0.45, 95% Cl 0.203–0.977). In IGCCCG poor prognostic group: DI of etoposide <80% (HR 1.82, 95% Cl 1.143–2.913). Conclusions: Maintaining a DI of greater then 80% of etoposide during iCT, for the treatment metastatic NSGCT, is one of the crucial factors for pts outcome, particularly in intermediate and poor IGCCCG prognostic groups. No significant financial relationships to disclose.
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