BERKELEY, CA (UroToday.com) - The patient in our case report is young and has been on treatment with pazopanib for three years. Currently there are no radiological signs of disease progression. In such patients, a viable treatment option may be to discuss with the treating surgeon the possibility of metastasectomy. The complete removal of the metastasis helps to improve the prognosis of patients with metastatic renal cell carcinoma. A recent retrospective case series (Alt et al. Cancer 2011) has shown a benefit in terms of cancer specific survival (CSS) in favor of complete resection of distant metastases from RCC regardless of the sites of disease and from the time of onset. For patients undergoing pulmonary metastasectomy there was a 5-year CSS of 73.6% after complete resection of pulmonary metastases and 19% after incomplete resection of the same; for patients with multiple metastases in other sites the 5-year CSS was found to be 32.5% with complete resection and 12.4% with incomplete resection. The advantage, even if lower, persists in the presence of more than three distant metastasis and in case of asynchronous multiple metastases.
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Currently we have no randomized trials designed to gain additional information on terms and timing of multimodal strategy, but experts suggest to draw the individual treatment algorithm, based on the results, in favor of radical surgery. In the case of complete response after metastasectomy, there is another question: stop or continue treatment with pazopanib? At the moment, we have no answer. We await further studies that may indicate the optimal duration with the new drugs available.
Elisa Biasco as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Unit of Medical Oncology, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori Pisa, Pisa, Italy