title: Long-term survival following multidisciplinary treatment of metastatic sarcomatoid renal cell carcinoma: a case report.
abstract: BACKGROUND
  We report the case of a 62-year-old woman diagnosed with sarcomatoid renal cell carcinoma.
  
  
  METHODS
  A 62-year-old Asian woman presented with macroscopic hematuria. A histological and immunohistochemical study of a tumor biopsy specimen led to a suspected diagnosis of sarcomatoid renal cell carcinoma. She underwent surgical tumor resection that included her left kidney. A histological and immunohistochemical study of the resected tumor confirmed the diagnosis of sarcomatoid renal cell carcinoma. The pathological stage was pT3bpN2, and multiple lung metastases were detected (pT3bpN2cM1; stage IV). Our patient was classified as "poor risk" according to the Memorial Sloan Kettering Cancer Center risk criteria. Interferon-α was administered as adjuvant therapy, and her lung metastases remained stable. However, a computed tomography scan and bone scintigraphy 2 years later revealed multiple bone metastases. External beam radiotherapy was performed for the bone metastases. Despite continuing interferon-α during radiotherapy, multiple skull and liver metastases appeared. Oral administration of the tyrosine kinase inhibitor axitinib was initiated as a second-line therapy, and our patient achieved a stable state for 11 months. As the liver metastases progressed and meningeal dissemination newly appeared, oral administration of the mammalian target of rapamycin inhibitor everolimus was initiated as a third-line therapy. Our patient remains alive 71 months after diagnosis and has maintained a comparatively good quality of life.
  
  
  CONCLUSIONS
  A literature review revealed that metastatic sarcomatoid renal cell carcinoma has very poor prognosis, with a survival of <1 year despite systemic therapy. Our patient in this present case achieved long-term survival, a rare incidence worthy of report.
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. hiroshining@hotmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yaegashi
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Izumi
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konaka
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Mizokami
authors.affiliation: Department of Integrative Cancer Therapy and Urology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Namiki
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077784:Axitinib; D001706:Biopsy; D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D000068338:Everolimus / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D007191:Indazoles / Q000627:therapeutic use; D016898:Interferon-alpha / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D011878:Radiotherapy; D017741:Survivors; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D007093:Imidazoles; D007191:Indazoles; D016898:Interferon-alpha; D047428:Protein Kinase Inhibitors; D000068338:Everolimus; D000077784:Axitinib