[A case of advanced renal cell carcinoma with inferior vena cava thrombus treated with sunitinib as neoadjuvant...

A 70 year old woman had a right renal tumor with vena cava thrombus up to right atrium. We started medical treatment with sunitinib at a dose of 50 mg as neoadjuvant therapy. In 2 months, the vena cava thrombus shrank to the same level of the diaphragm. After stopping sunitinib for 2 weeks, a nephrectomy and thrombectomy was performed with extracorporeal circulation. Pathological diagnosis was clear cell carcinoma, G2. The TNM stage was pT3bN0M0. There were no viable cells at the tip of the thrombus. There is no recurrence during 9 months after the operation. Although we had to stop medication due to thrombocytopenia, it was possible to continue to take sunitinib for 3 months and achieved the operation. Because of down-staging of the tumor thrombus, we didn't have to do thoracic surgery. These results suggest that neoadjuvant therapy with molecular target drug may reduce surgical invasion.