Debulking nephrectomy followed by a "watch and wait" approach in metastatic renal cell carcinoma.
OBJECTIVE
Debulking nephrectomy has been shown to improve survival in metastatic renal cell carcinoma and is now a standard procedure. However, it remains controversial if debulking nephrectomy should routinely be followed by interferon. We report on the clinical course of metastatic renal cell carcinoma patients after debulking nephrectomy who did not receive routine systemic anticancer therapy.


METHODS
Fifteen consecutive metastatic renal cell carcinoma patients were put on a "watch and wait" protocol after debulking nephrectomy. This included regular computer tomographic scans done at 6 to 8 weeks after debulking nephrectomy, and subsequently 3 to 4 monthly. Systemic treatment was instituted only after disease progression.


RESULTS
At a median follow-up of 18 months, 80% of patients had progressed. However, a third of the patients had at least 6 months of progression-free interval, and 3 of 15 patients had not progressed at prolonged follow-up durations of 18, 23, and 46 months. A third of the patients remained alive and the median survival for the cohort was 25 months. Preoperative predictive factors for nonprogression after debulking nephrectomy included absence of abnormal laboratory indices, single organ system metastases, and good performance status.


CONCLUSIONS
There is a subset of metastatic renal cell carcinoma patients who will have an indolent course after debulking nephrectomy. Toxic systemic therapies may be avoided in such patients for a significant period of time.
Wong
Alvin S
AS
Department of Hematology Oncology, National University Hospital, Singapore. Alvin_SC_WONG@nuh.com.sg
Chong
Kian-Tai
KT
Heng
Chin-Tiong
CT
Consigliere
David T
DT
Esuvaranathan
Kesavan
K
Toh
Khai-Lee
KL
Chuah
Benjamin
B
Lim
Robert
R
Tan
James
J
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009392:Nephrectomy / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014572:Urology / Q000379:methods*