Aggressive Treatment of Metastatic Renal Cancer

Golimbu, Mircea; Al‐Askari, Salah; Tessler, Arthur N.; Morales, Pablo

doi:10.1016/s0022-5347(17)45085-3

Cited by 74 publications

(21 citation statements)

References 8 publications

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“…Minervini et al (2001) did not observe different 5-year-survival rates in 167 patients undergoing either radical tumor nephrectomy alone or in combination with extensive lymph node dissection. These findings are in line with previous reports by Bassil et al (1985) and Golimbu et al (1986). In contrast, observations by Schafhauser et al (1999) in more than 1000 patients with renal cancer suggest a survival benefit for patients after extensive lymph node dissection.…”

Section: Lymph Node Metastasessupporting

confidence: 93%

Nephron sparing surgery in renal cancer - individual decision or standard procedure?

Schmitz‐Dräger

Beiche

Fischer

et al. 2003

Actas Urológicas Españolas

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A lo largo de la última década, la cirugía conservadora del órgano ha alcanzado reconocimiento generalizado dentro de la comunidad urológica internacional. En consecuencia, la cuestión de la cirugía radical frente a la cirugía conservadora del órgano está siendo cada vez más debatida de forma polémica. A día de hoy, incluso los defensores de la nefrectomía radical deben admitir que los resultados a largo plazo obtenidos con la cirugía conservadora de la nefrona son excelentes. Por consiguiente, la heminefrectomía se ha convertido en un tratamiento habitual en pacientes con función renal comprometida. Sin embargo, en pacientes cuyo riñón contralateral es normal, las directrices nacionales e internacionales siguen mostrándose favorables a la nefrectomía radical. El aumento de la morbilidad y las dudas sobre la eficacia de la heminefrectomía en relación con el control tumoral son los motivos clave tras esta estrategia. Como parte de este análisis, los autores destacan la hipó-tesis de que las diferencias actuales entre cirugía conservadora del órgano y nefrectomía radical en relación con la supervivencia son marginales siempre que se cumplan los requisitos para la heminefrectomía. Así pues, la polémica actual parece basarse sobre todo en suposiciones y convicciones más que en hechos reales. Para responder definitivamente a esta pregunta se ha sugerido la realización de un ensayo clínico prospectivo y aleatorizado, aunque sin subestimar los problemas que conlleva dicho estudio.PALABRAS CLAVE: Cáncer de riñón. Heminefrectomía. Preservación del órgano. ABSTRACT "NEPHRON SPARING SURGERY IN RENAL CANCER -INDIVIDUAL DECISION OR STANDARD PROCEDURE?"Organ-preserving surgery has gained widespread acceptance within the international urological community through the last decade. In consequence, the question of radical vs. nephron sparing surgery for the treatment of renal cancer is increasingly discussed in a controversial way. Today, even advocates of a radical nephrectomy must admit that long-term results obtained through nephron sparing surgery are excellent. In consequence, heminephrectomy has become a standard treatment in patients with impaired renal function. However, in patients with a normal contralateral kidney, national and international guidelines still favor radical nephrectomy. An increased morbidity and doubts on the efficacy of heminephrectomy concerning tumor control are the key reasons behind this strategy. Within this analysis the authors stress the hypothesis that the actual differences between organ-preserving surgery and radical nephrectomy concerning survival are marginal if the requirements for heminephrectomy are met. Therefore, the actual controversy appears to be rather based upon assumptions and convictions than on actual facts. To definitively answer this question a prospective randomized trial is suggested, however, the problems of this study may not be underestimated.

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Section: Lymph Node Metastasessupporting

confidence: 93%

Nephron sparing surgery in renal cancer - individual decision or standard procedure?

Schmitz‐Dräger

Beiche

Fischer

et al. 2003

Actas Urológicas Españolas

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“…Besides the 'classical' prognostic factors identified by From 1977 to 1995, 79 patients (54 men and 25 women) underwent surgery in the Urology Department, Golimbu et al [2], others reported that the diagnosis of a Hannover Medical School, for RCC with propagation of a tumour thrombus into the IVC. Sixty-three patients Accepted for publication 11 March 1997 presented with a VCT bordering the infrahepatic section (36%) were diagnosed as having distant metastases during routine pre-operative tumour staging, five of of the IVC caudal to the hepatic veins and 16 superior to the hepatic veins, above the diaphragm or in the whom showed more than one area of tumour (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…These surprisingly the long-term survival of patients with RCC but no VCT. The prognostic importance of propagation of tumour positive results can be compared with the 5-year survival rate reported in the study by Golimbu et al [2], in which thrombus into the IVC and cranial extension was investigated and correlated with other tumour characteristics, 326 patients with RCC were investigated, where the longterm survival rate was 88% for those presenting with both by univariate and multivariate analyses, to assess the value of intracaval extension as a possible indepenearly stages of hypernephroma. The survival rates for those with additional tumour characteristics were 67% dent prognostic factor for patients with RCC.…”

mentioning

confidence: 99%

Prognostic relevance of intracaval neoplastic extension for patients with renal cell cancer

Kuczyk

Bokemeyer

Kohn

et al. 1997

British Journal of Urology

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Objective To assess the diagnosis of vena caval throm-0.158) were identified as having any prognostic value during univariate or multivariate statistical analysis. bosis (VCT) in patients with renal cell carcinoma (RCC) as an independent indicator of prognostic impor-The presence of regional lymph node (P<0.001) or distant metastases (P=0.009) was an independent tance and when combined with additional tumour characteristics in a controlled multivariate analysis.prognostic variable for patients with RCC, with a significant decrease in long-term survival (13 and 14 Patients and methods The clinical course of 53 patients (41 men and 12 women, mean age 60 years, range months for patients with lymph node and distant metastases, respectively). 35-79) with RCC and VCT was compared with that of a control group of 47 patients (37 men and 10Conclusion A radical surgical approach is essential as standard therapy for the treatment of patients with women, mean age 57 years, range 32-76) with RCC but no neoplastic extension into the vena cava.RCC and neoplastic extension into the vena cava. Because they have a significantly decreased life expectResults With a follow-up of 1-154 months and a mean long-term survival of 32 and 35 months, respectively, ancy, asymptomatic patients with lymph node or distant metastases should be treated conservatively. for patients with and without VCT, neither the propagation of the tumour into the vena cava (P=0.391)Keywords Renal cell carcinoma, intracaval thrombus, prognostic value, multivariate analysis nor the cranial extension of the thrombosis (P= VCT or extensive cranial propagation also decreased the

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“…Renal cell carcinomas (RCC) generally have a poor prognosis since, once the diagnosis is made, metastases are already present in 30% of the cases while 50% of the patients develop them at a later date [5,13]. At present there is no efficient systemic treatment for metastatic RCC, since neither radiation nor chemotherapy has been very effective [4,6,12].…”

Section: Introductionmentioning

confidence: 99%

Immunoscintigraphic localization of renal tumours in an extracorporeal perfusion model with a monoclonal antibody against γ-glutamyltransferase

Fischer

Baüm

Tauber

et al. 1992

Cancer Immunol Immunother

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Monoclonal antibody 138H11 against human gamma-glutamyltransferase has been shown to react immunohistochemically with 98% of all tested clear-cell type and chromophilic renal cell carcinomas, but not with renal chromophobic carcinomas, Duct-Bellini carcinomas or oncocytomas. In normal kidney the target epitopes of mAb 138H11 are located in the luminal brush-border membrane of proximal tubule cells, whereas in renal carcinomas the epitopes are found surrounding the whole tumour cells. These results form the basis of the present immunoscintigraphic study designed to evaluate mAb 138H11 in an extracorporeal perfusion model. Immediately after nephrectomy, human tumour-bearing kidneys were perfused with 99mTc-labelled mAb 138H11 in Euro-Collins solution. High specific uptake in 4/4 renal clear cell carcinomas could be demonstrated by planar immunoscintigraphy and single-photon-emission computed tomography, "regions of interest" investigation and immunohistochemistry. In contrast, a perfused oncocytoma showed up as an unlabelled lesion. The results indicate a possible use for mAb 138H11 in immunoscintigraphy or even therapy, provided high tumour uptake can be confirmed in patients.

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Aggressive Treatment of Metastatic Renal Cancer

Cited by 74 publications

References 8 publications

Nephron sparing surgery in renal cancer - individual decision or standard procedure?

Nephron sparing surgery in renal cancer - individual decision or standard procedure?

Prognostic relevance of intracaval neoplastic extension for patients with renal cell cancer

Immunoscintigraphic localization of renal tumours in an extracorporeal perfusion model with a monoclonal antibody against γ-glutamyltransferase

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