Resection of Renal Tumors Invading the Vena Cava

Wotkowicz, Chad; Wszolek, Matthew F.; Libertino, John A.

doi:10.1016/j.ucl.2008.07.013

Cited by 73 publications

(55 citation statements)

References 51 publications

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“…8,13 Progressing IVC-TT can lead to significant and lifethreatening morbidity including pulmonary embolus or BuddChiari syndrome. 36 There has not been any report of the application of SABR for the treatment of RCC IVC-TT to our knowledge. Conventionally fractionated RT has been used for the treatment of HCC portal vein TT showing favorable response rates in multiple early phase clinical trials.…”

Section: Discussionmentioning

confidence: 95%

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Hannan

Margulis

Chun

et al. 2015

Cancer Biology & Therapy

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Renal Cell Carcinoma (RCC) is a common malignancy world-wide that is rising in incidence. Up to 10% of RCC patients present with inferior vena cava (IVC) tumor thrombus (IVC-TT). Although surgery is the only treatment with proven efficacy for IVC-TT, the surgical management of advanced (level III and IV) IVC-TT is difficult with high morbidity and mortality, and offers a poor survival outcome. Currently, there are no treatment options in the setting of recurrent or unresectable RCC IVC-TT. Even though RCC may be resistant to conventionally fractionated radiation therapy, hypofractionated radiation has shown excellent control rates for both primary and metastatic RCC. We report our experience treating 2 RCC patients with Level IV IVC-TT -one recurrent and the other unresectable-with stereotactic ablative radiation therapy (SABR). The first patient is a 75-year-old gentleman with a level IV RCC IVC-TT who presented 9 months after his radical nephrectomy and thrombectomy with a growing level IV IVC-TT that became refractory to 4 targeted agents. He received SABR of 50Gy in 5 fractions and at 2-year follow-up is doing well with a significant decrease in the enhancement and size of the IVC-TT. The second patient is an 83-year-old gentleman who presented with metastatic RCC and level IV IVC-TT but was not a surgical candidate. After progression on temsirolimus, he received SABR of 36Gy in 4 fractions to his IVC-TT and survived 18 months post-SABR. Both patients improved symptomatically and did not experience any acute or late treatment-related toxicity. Their survival of 24 months and 18 months are comparable to the reported median survival of 20 months in patients with level IV IVC-TT that underwent surgical resection. Therefore, SABR can be a potentially safe treatment option in the unresectable setting for RCC patients with IVC-TT and should be further evaluated in prospective trials.

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Section: Discussionmentioning

confidence: 95%

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Hannan

Margulis

Chun

et al. 2015

Cancer Biology & Therapy

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“…Despite advances in radiation, chemotherapy, and immunotherapy, surgical resection is still the standard treatment for RCC with tumor thrombus (2). However, the range of 5-year survival rates for RCC patients with venous tumor thrombus treated with radical nephrectomy and tumor thrombectomy is only 35% -45% despite the developments in surgical techniques and perioperative care (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

et al. 2013

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Purpose: To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus. Materials and Methods: A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors. Results: The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5-and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence. Conclusions: Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival.

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“…However, tumors with level III and IV IVC thrombus (retrohepatic and subdiaphragmatic) needs CPB for its complete removal as in our patient. 6 The use of CPB can reduce the amount of blood loss, minimizes the chances of pulmonary embolism and ensure adequate removal of the tumor from RA and IVC. In some cases hypothermic circulatory arrest allows complete resection of the tumor in a virtually bloodless field albeit some systemic complications.…”

Section: Discussionmentioning

confidence: 99%

Renal Cell Carcinoma presenting as a Right Atrial Mass

Subramanian¹,

Choudhary²,

Chowdhary³

2014

Journal of Perioperative Echocardiography

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Renal cell carcinoma (RCC) has a tendency to invade the renal vein and thereby reach the right heart through inferior vena cava (IVC). This may necessitate a combined surgical procedure usually under cardiopulmonary bypass (CPB). In the following discussion, we shall present a case of right RCC extending into the right atrium. The patient underwent a radical nephrectomy followed by removal of the tumor from right atrium, IVC and hepatic vein under CPB.

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Resection of Renal Tumors Invading the Vena Cava

Cited by 73 publications

References 51 publications

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Renal Cell Carcinoma presenting as a Right Atrial Mass

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