title: Downsizing a thrombus of advanced renal cell carcinoma in a presurgical setting with sorafenib.
abstract: A 53-year-old man presented with fever, 15 kg weight loss, ECOG performance status 0, and 12 × 9.5 cm renal tumor with an associated level II (near level III) tumor thrombus extending into the vena cava. We offered a presurgical targeted therapy to downsize the thrombus and primary tumor, which may reduce the extent of the surgery and operative risk. The patient accepted this approach with administration of sorafenib, resulting in a marked reduction of the primary renal tumor and 43% regression in tumor thrombus. Tumor shrinkage and regression of the thrombus allowed resection of the left kidney. Pathological findings revealed that part of the tumor was necrotic tissue. Two years after initiation of presurgical sorafenib therapy, the patient remains alive without evidence of disease progression.
authors.affiliation: Department of Urology, Tosei General Hospital, Seto, Japan. spy3038@yahoo.co.jp
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takeda
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Nakano
authors.forename: Yuhta
authors.initials: Y
authors.lastname: Kashiwagi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshino
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D000077157:Sorafenib; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology*; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib