Neoadjuvant targeted therapy in a primary metastasized renal cell cancer patient leads to down-staging of inferior vena cava thrombus (IVC) enabling a cardiopulmonary bypass-free tumor nephrectomy: a case report.
BACKGROUND
We report on a 62-year-old gentleman presenting at our urological department with an advanced renal cell cancer of the right kidney (10 cm in diameter), with an extensive caval vein thrombus (level IV) and bilateral pulmonary metastases. Another suspicious lesion at the left hemithorax was radiologically described.


METHODS
A presurgical, neoadjuvant systemic therapy with sunitinib, a tyrosine kinase inhibitor, was initiated for 4 cycles in total (50 mg/day; 4 weeks on/2 weeks off). The cytoreductive nephrectomy was performed following the fourth cycle of sunitinib and after a 14-day break. Transesophageal echocardiography was used for intraoperative monitoring of the caval vein thrombus. Systemic treatment with sunitinib was continued 4 weeks after surgery.


RESULTS
A significant reduction in tumor size, metastatic sites and down-staging of IVC from level IV to level III according to Novick classification was achieved.


CONCLUSIONS
Significant down-staging of the tumor caval vein thrombus which initially reached the right atrium enabled us to perform surgery limited to the abdominal cavity without extracorporeal circulation nor hypothermia.
Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Inga
I
Peters
Michael
M
Winkler
Björn
B
Jüttner
Omke E
OE
Teebken
T R
TR
Herrmann
Christoph
C
von Klot
Mario
M
Kramer
Angela
A
Reichelt
Mahmoud
M
Abbas
Markus A
MA
Kuczyk
Axel S
AS
Merseburger
D000970:Antineoplastic Agents / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000628:therapy; D002315:Cardiopulmonary Bypass; D000075202:Contraindications; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000628:therapy*; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D009392:Nephrectomy; D011758:Pyrroles / Q000627:therapeutic use; D000077210:Sunitinib; D017131:Thrombectomy; D013927:Thrombosis / Q000601:surgery*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior
D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib