title: Metastasectomy after targeted therapy in patients with advanced renal cell carcinoma.
abstract: OBJECTIVE
  Metastasectomy is often incorporated in overall treatment in patients with metastatic renal cell carcinoma. While this approach was studied in the immunotherapy era, only a few cases have been described in the targeted therapy era. Thus, we evaluated the role of metastasectomy in patients with metastatic renal cell carcinoma who received prior targeted therapy.
  
  
  METHODS
  We retrospectively evaluated the records of patients who underwent consolidative metastasectomy after targeted therapy at 3 institutions from 2004 to 2009. All patients received at least 1 cycle of targeted therapy before surgical resection of all visible disease.
  
  
  RESULTS
  We identified 22 patients. Metastasectomy sites included the retroperitoneum in 12 patients, lung in 6, adrenal gland in 2, bowel in 2, and mediastinum, bone, brain and inferior venal caval thrombus in 1 each. A total of 6 postoperative complications were observed in 4 patients within 12 weeks after surgery, which resolved with appropriate management. Postoperatively 9 patients received at least 1 targeted therapy. In 11 patients recurrence developed a median of 42 weeks after metastasectomy and another 11 experienced no recurrence at a median of 43 weeks. At a median followup of 109 weeks 21 patients were alive and 1 died of renal cell carcinoma 105 weeks after metastasectomy.
  
  
  CONCLUSIONS
  In a cohort of select patients with a limited tumor burden after treatment with targeted agents consolidative metastasectomy is feasible with acceptable morbidity. Significant time off targeted therapy and long-term tumor-free status are possible with this approach.
authors.affiliation: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Jose A
authors.initials: JA
authors.lastname: Karam
authors.forename: Brian I
authors.initials: BI
authors.lastname: Rini
authors.forename: Leticia
authors.initials: L
authors.lastname: Varella
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Garcia
authors.forename: Robert
authors.initials: R
authors.lastname: Dreicer
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.forename: Surena F
authors.initials: SF
authors.lastname: Matin
authors.forename: Steven C
authors.initials: SC
authors.lastname: Campbell
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Tannir
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome