title: Timely delivery of biological therapy after cytoreductive nephrectomy in carefully selected patients with metastatic renal cell carcinoma.
abstract: OBJECTIVE
  We determine whether cytoreductive surgery delays or precludes the administration of systemic biological therapy in patients with previously untreated metastatic renal cell carcinoma.
  
  
  METHODS
  We evaluated 79 patients 22 to 73 years old with untreated renal cell carcinoma for possible cytoreductive surgery before the administration of systemic biological therapy. Based on performance status, overall disease burden and subjective clinical assessment 13 patients were referred for initial systemic biological therapy and 66 underwent cytoreductive surgery as initial treatment. We evaluated patient ability to receive postoperative biological therapy, time to therapy, surgical complications and mortality.
  
  
  RESULTS
  Cytoreductive surgery had a minimal impact on the administration of timely systemic biological therapy in these carefully selected patients. Of the 66 patients 54 (82%) received postoperative systemic biological therapy beginning a median of 40 days after nephrectomy. Two patients (3%) died postoperatively (within 30 days) and in 1 (1.5%) postoperative deterioration in performance status precluded the administration of systemic therapy. The other 9 patients did not have measurable residual disease postoperatively, did not need or refused systemic therapy, or were followed elsewhere.
  
  
  CONCLUSIONS
  Systemic biological therapy can be administered in a timely manner (median 40 days) to the majority of patients (82% treated) after cytoreductive surgery. Surgery alone does not preclude the administration of systemic biological therapy in carefully selected patients.
authors.affiliation: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Levy
authors.forename: D A
authors.initials: DA
authors.lastname: Swanson
authors.forename: J W
authors.initials: JW
authors.lastname: Slaton
authors.forename: J
authors.initials: J
authors.lastname: Ellerhorst
authors.forename: C P
authors.initials: CP
authors.lastname: Dinney
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D018579:Patient Selection; D013997:Time Factors