title: Local salvage therapy for late (≥2 years) metastatic and local relapse of renal cell cancer is a potentially curative treatment irrespective of the site of recurrence.
abstract: OBJECTIVE
  The primary treatment approach to locoregional renal cell carcinoma (RCC) is surgical resection. Most relapses occur within the first 2 years but some patients experience late recurrences. Surgical resection of oligometastatic disease may be considered a curative option for relapsed RCC. However, limited data are available of long-term follow-up of late relapse regarding treatment choice.
  
  
  METHODS
  We identified 104 patients with RCC from our database, who relapsed after≥2 years from resection of their primary tumor. Median age at primary diagnosis was 61 years and sex distribution was F:M = 40:64. Histology was clear cell, n = 103 and papillary, n = 1. Sites of relapse were local, n = 14 (13.4%); lung only, n = 25 (24.0%); or extrapulmonary, n = 65 (62.5%). Treatment at first relapse was local therapy (LT) in n = 60 (57.7%) patients, of these, n = 55 patients had surgery done and n = 5 patients had underwent radiotherapy. Systemic therapy was used in n = 9 (8.7%) patients. Overall, 35 patients received best supportive care (33.7%).
  
  
  RESULTS
  We found a median overall survival (OS) of 49.8 months (95% CI: 29.3-70.2) and a progression-free survival (PFS) of 21.6 months (95% CI: 12.6-30.5) for all patients. Patients receiving LT had a median OS of 99.9 months (95% CI: 77.2-122.6) and a PFS of 31.1 months (95% CI: 21.5-40.7). Patients treated with systemic therapy, in turn, had an OS of 21.1 months (95% CI: 8.4-33.8) and a PFS of 4 months (95% CI: 1.0-6.2). Patients who received best supportive care had an OS of 10 months (95% CI: 1.3-18.7). This difference was highly significant (log rank for PFS: P<0.001; log rank for OS: P<0.003). Subgroup analysis of the LT group showed a superior outcome for local relapses (OS: not reached, PFS: 61.4mo [95% CI: 28.5-9.2]) compared to visceral relapses (OS: 35.5mo [95% CI: 17.9-53.1], PFS: 21.1mo [95% CI: 19.2-22.9]).
  
  
  CONCLUSIONS
  Local salvage therapy should be considered the first therapeutic option in late relapse of RCC irrespective of the site of relapse.
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: carsten.gruellich@med.uni-heidelberg.de.
authors.forename: Carsten
authors.initials: C
authors.lastname: Grüllich
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Sonia
authors.initials: S
authors.lastname: Vallet
authors.affiliation: Department of Urology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hecht
authors.affiliation: Section of Molecular Urooncology, Department of Urology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Duensing
authors.affiliation: Department of Urology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hadaschik
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Jäger
authors.affiliation: Department of Urology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: Department of Urology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D013997:Time Factors
keywords: Late relapse; Local salvage; Renal cell cancer