UroToday - Two late breaking development papers were presented in the field of renal cancer.

"Surgical morbidity associated with administration of targeted molecular therapies prior to cytoreductive nephrectomy for metastatic renal cell carcinoma"

Dr. Vitaly Marguilis presented the concept of cytoreductive nephrectomy (CRN) as defined with INF-alpha to CRN prior to targeted therapies. One benefit is that patients who are benefiting from targeted therapy go on to surgery and those who are not would likely not benefit from surgery. Patients studied underwent CRN prior to treatment with bevacizumab, sorafenib, or sunitinib on clinical trials. These patients were compared to traditional CRN patients receiving neoadjuvant systemic therapy. Surgical parameters and complication rates were the same. In summary, bevacizumab stopped 30 days prior to surgery and TKI inhibitors stopped 1 day prior to surgery did not lead to increased complications.

"Metastatic renal cell carcinoma with venous extension undergoing radical nephrectomy and thrombectomy: prognostic implications"

Dr. Juan Martinez-Salamanca analyzed the impact of presence of metastasis at the time of diagnosis in a group of patients treated by surgery. They were stratified by sites of metastasis and evaluated for survival. A total of 671 patients from 8 international institutions were studied. Clinical and pathologic variables were included. The median followup was 43.5 months. There were 510 stage M0 patients and 141 stage M1 patients of whom 60 had lung metastases only and the remaining 81 had numerous sites of metastasis. The 5 year M0 survival was 52% compared to 18% for several mets and 23% for lung-only mets. There was no difference between the lung-only mets and several mets groups. The conclusion is that the decision for surgery should be based upon the presence of mets, not the number of locations. However, the nodal staging was not included in the analysis and could significantly influence the outcome. Also, the selection criteria for surgery were not defined.

Presented at the 8th Annual Meeting of the Society of Urologic Oncology (SUO) - November 29 - December 1, 2007. Natcher Conference Center, National Institutes of Health - Bethesda, Maryland.

Reported by UroToday Contributing Editor Christopher P. Evans, MD

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