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Surgery following response to interferon-alpha-based therapy for residual renal cell carcinoma
1Department of Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Abstract:
The role of aggressive surgery for metastatic renal cancer in the era of biological therapy is not clear. Therefore, we reviewed 17 patients who, between February 1987 and August 1990, underwent surgical resection of residual masses following initial response to interferon-alpha-based therapy. Viable tumor persisted in 15 patients (88%), whereas only inflammatory response was detected in 2. Of the patients 11 (65%) remained disease-free at a median of 12 months postoperatively (range 5 to 29), with an overall median survival of 26 months (range 6 to 34) from treatment initiation. These data suggest that surgery may be of therapeutic benefit in select patients with renal cell carcinoma who do not meet traditional criteria for surgical resection. Prospective trials are being performed to determine whether there is a role for aggressive surgical resection of persistent disease in patients with advanced renal cell carcinoma who have previously responded to interferon-alpha-based therapy.
Insights
Aggressive surgery for metastatic renal cancer may benefit select patients after biological therapy. Many patients remained disease-free, suggesting a therapeutic role for surgical resection of persistent tumors.
Area of Science:
- Oncology
- Surgical Oncology
- Nephrology
Background:
- The efficacy of aggressive surgical resection for metastatic renal cell carcinoma (RCC) in the context of modern biological therapies remains uncertain.
- Interferon-alpha based therapies have been used for advanced RCC, but the role of subsequent surgery for residual disease is not well-defined.
Purpose of the Study:
- To evaluate the therapeutic benefit of aggressive surgical resection of residual masses in patients with advanced renal cell carcinoma (RCC) following initial response to interferon-alpha based therapy.
- To assess disease-free survival and overall survival rates in patients undergoing such surgical intervention.
Main Methods:
- Retrospective review of 17 patients with metastatic RCC who underwent surgical resection of residual masses between February 1987 and August 1990.
- Patients had received prior interferon-alpha based therapy and showed initial response before surgical intervention.
Main Results:
- Viable tumor was found in 15 out of 17 patients (88%) at the time of surgery; only inflammatory response was detected in 2 patients.
- 11 patients (65%) remained disease-free for a median of 12 months (range 5-29 months) post-surgery.
- The overall median survival was 26 months (range 6-34 months) from the initiation of treatment.
Conclusions:
- Aggressive surgical resection may offer therapeutic advantages for carefully selected patients with advanced renal cell carcinoma (RCC) who have residual disease after biological therapy.
- These findings support the potential role of surgery in managing advanced RCC, even in cases not traditionally meeting surgical criteria.
- Further prospective trials are warranted to confirm the role of aggressive surgical resection in advanced RCC patients responding to interferon-alpha therapy.