title: Liver directed therapy for renal cell carcinoma.
abstract: BACKGROUND
  Metastatic renal cell carcinoma (RCC) to the liver portrays a poor prognosis and liver directed therapy remains controversial. We aimed to determine potential selection criteria for patients who might benefit from this strategy.
  
  
  METHODS
  We evaluated 247 consecutive patients with RCC metastatic to the liver from a prospectively maintained database.
  
  
  RESULTS
  Eighteen patients received liver directed therapy (18/247, 7%). Ten patients underwent liver resection (10/247, 4%) and eight patients underwent radiofrequency ablation (RFA, 8/247, 3%). All were rendered free of disease in the liver. Five had synchronous liver disease and underwent synchronous resections with their primary. Mortality was 0%. Fourteen had single (surgery 7, RFA 7) and four (surgery 3, RFA 1) had multiple liver lesions, respectively. Median size of lesions was 5cm (0.5 - 10cm) and 2.5cm (1 - 6cm) in the surgery and RFA groups, respectively. Median DFI was 10 months, and no difference was observed in those with a longer vs. shorter than median DFI (p = 0.95); liver specific progression free survival for the surgery and RFA groups were 4 and 6 months, respectively (p= 0.93). 1, 3 and 5-year actuarial survivals for the whole group were 89%, 40%, 27%. Median survival for the surgery group was 24 (3 to 254+) months, and for the RFA group 15.6 (7-56+) months (p = 0.56). Metachronous liver disease was associated with prolonged survival (p = 0.02).
  
  
  CONCLUSIONS
  Liver directed therapy for RCC is safe. For highly selected patients with metachronous liver RCC metastases, liver directed therapy should be considered in a multidisciplinary manner.
authors.affiliation: 1. Surgery Branch, Center for Cancer Research, National Cancer Institute, NIH, Bethesda, MD, USA.
authors.forename: Russell C
authors.initials: RC
authors.lastname: Langan
authors.forename: R Taylor
authors.initials: RT
authors.lastname: Ripley
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Davis
authors.forename: Peter A
authors.initials: PA
authors.lastname: Prieto
authors.forename: Nicole
authors.initials: N
authors.lastname: Datrice
authors.forename: Seth M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Gennady
authors.initials: G
authors.lastname: Bratslavsky
authors.forename: Udo
authors.initials: U
authors.lastname: Rudloff
authors.forename: Udai S
authors.initials: US
authors.lastname: Kammula
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Itzhak
authors.initials: I
authors.lastname: Avital