MP64-13 NON-METASTATIC RENAL CANCERS OF MODERATE TO HIGH COMPLEXITY ARE AMENABLE TO PARTIAL NEPHRECTOMY AFTER NEOADJUVANT SUNITINIB

You have accessJournal of UrologyKidney Cancer: Localized V1 Apr 2014MP64-13 NON-METASTATIC RENAL CANCERS OF MODERATE TO HIGH COMPLEXITY ARE AMENABLE TO PARTIAL NEPHRECTOMY AFTER NEOADJUVANT SUNITINIB Cesar Ercole, Brian Lane, Hyung Kim, Ithaar Derweesh, Rebecca O'Malley, Joseph Klink, Kerrin Palazzi, Brian Rini, and Steven Campbell Cesar ErcoleCesar Ercole More articles by this author , Brian LaneBrian Lane More articles by this author , Hyung KimHyung Kim More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Rebecca O'MalleyRebecca O'Malley More articles by this author , Joseph KlinkJoseph Klink More articles by this author , Kerrin PalazziKerrin Palazzi More articles by this author , Brian RiniBrian Rini More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1930AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Systemic therapy with sunitinib has been shown to facilitate surgery with unresectable renal cell carcinoma (RCC). We sought to evaluate the effect of sunitinib on moderate- to high-complexity RCC in efforts to determine tumor characteristics that favor the conversion of a mass not initially readily amenable to partial nephrectomy (PN) to one that may be managed successfully with systemic therapy and a subsequent PN. METHODS Patient information at 4 institutions was reviewed to assess outcomes of radical nephrectomy (RN) or PN after sunitinib therapy for localized RCC. Data were collected for pre- and post-treatment characteristics of the primary renal mass (e.g. size, RENAL score, venous involvement), renal function, and surgical outcomes. Patient who completed presurgical sunitinib therapy with the intent for subsequent surgical intervention were included in this analysis. RESULTS Of 83 patients treated with presurgical sunitinib, 43 patients presented with moderate- to high-complexity renal masses (median clinical size: 7.2cm, interquartile range(IQR): 5.2-8.2; median RENAL score: 10, IQR: 9-11), in the absence of clinical evidence of lymph node or distant metastases. Absolute indications for PN included 9 patients with solitary kidney, 8 with bilateral RCC, and 27 patients with preoperative GFR<60. Following a median of 2 cycles of sunitinib (range: 2-5), median tumor size was 5.1cm (IQR: 4.1-7) and RENAL was 9 (IQR: 8-10). A total of 49 kidneys met criteria for this analysis and surgery was performed in 48 (98%) as one patient was deemed unfit for surgery. PN was completed successfully for 36 tumors (75%), including 10 using a minimally-invasive approach. A reduction in tumor area was observed in 94% (median decrease: 32.5%,IQR 19.5– 46.5%) and reduction in RENAL score was determined in 74% (26 by 1 point, 10 by 2 points). Main sunitinib side effects were fatigue related. Surgical complications of Grade ≥3 occurred in 5% of PN, where one patient required attention for a wound hernia and another patient required embolization for an AV fistula presenting with gross hematuria. CONCLUSIONS PN can be safely performed after sunitinib, including for some tumors not considered amenable to PN at initial presentation. We feel that presurgical sunitinib therapy for biopsy-proven clear cell RCC for which PN is not deemed feasible is a reasonable approach in select patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e705 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Cesar Ercole More articles by this author Brian Lane More articles by this author Hyung Kim More articles by this author Ithaar Derweesh More articles by this author Rebecca O'Malley More articles by this author Joseph Klink More articles by this author Kerrin Palazzi More articles by this author Brian Rini More articles by this author Steven Campbell More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...