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Modeling Spontaneous Metastatic Renal Cell Carcinoma mRCC in Mice Following Nephrectomy
Published on: April 29, 2014
Surgical management of metastatic renal cell carcinoma
1Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
Abstract:
Despite advances in systemic therapy for metastatic renal cell carcinoma, durable responses remain rare and surgical management remains a mainstay of treatment for many patients with metastatic disease. Management of the primary tumor in metastatic patients can occur as 1) palliative nephrectomy for symptomatic patients in whom cure is not achievable, 2) cytoreductive nephrectomy before systemic therapy, or 3) consolidative nephrectomy after systemic therapy. Palliative nephrectomy is rarely performed in centers where angioembolization is available. The evidence for cytoreductive nephrectomy is based on randomized trials in the cytokine era and retrospective studies in the more recent targeted therapy era. Consolidative nephrectomy is utilized after systemic therapy for intermediate- and poor-risk patients or in patients with potentially unresectable disease based on retrospective evidence. Resection of metastatic lesions, or metastasectomy, is utilized in select patients, with efficacy predicated on the organs involved and the extent of resection that is achievable, based on retrospective data. Herein, the evidence for surgical management of both the primary tumor and metastatic lesions in patients with metastatic renal cell carcinoma is reviewed.
Insights
Surgery remains crucial for metastatic renal cell carcinoma (mRCC). This review examines evidence for primary tumor and metastatic lesion resection in mRCC patients when systemic therapies offer limited durable responses.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Metastatic renal cell carcinoma (mRCC) has limited durable responses to systemic therapies.
- Surgical management of the primary tumor and metastatic lesions is a key treatment modality for mRCC.
Purpose of the Study:
- To review the evidence for surgical management of the primary tumor and metastatic lesions in patients with mRCC.
- To evaluate the roles of palliative, cytoreductive, and consolidative nephrectomy.
- To assess the efficacy of metastasectomy for mRCC.
Main Methods:
- Review of evidence for surgical management in metastatic renal cell carcinoma.
- Analysis of data from randomized trials and retrospective studies.
- Evaluation of palliative, cytoreductive, and consolidative nephrectomy strategies.
- Assessment of metastasectomy based on organ involvement and resection extent.
Main Results:
- Palliative nephrectomy is less common with angioembolization availability.
- Cytoreductive nephrectomy evidence stems from the cytokine and targeted therapy eras.
- Consolidative nephrectomy is used post-systemic therapy for specific risk groups.
- Metastasectomy efficacy depends on organ site and resection completeness.
Conclusions:
- Surgical intervention remains a cornerstone in managing metastatic renal cell carcinoma.
- Evidence for different surgical approaches (nephrectomy types, metastasectomy) is primarily based on retrospective data.
- Further research is needed to optimize surgical roles in the evolving mRCC treatment landscape.
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