A62: Neo-adjuvant sunitinib to facilitate nephron sparing surgery in patients with renal cell carcinoma (RCC) in a solitary kidney.
1University Hospital Birmingham, Birmingham, UK,2Heart of England NHS Trust, Birmingham, UK
Patients with RCC in a solitary kidney will require renal replacement therapy if curative resection necessitates a radical nephrectomy. Nephron Sparing Surgery (NSS) represents an alternative to nephrectomy in early stage tumours but may not be feasible in locally advanced tumours. Tyrosine kinase inhibitors may have a role in the neoadjuvant setting to downstage the tumour and facilitate curative NSS. We report our institution's experience in this setting.
Records of patients with RCC in a solitary kidney considered for treatment with neoadjuvant sunitinib followed by NSS were reviewed. Patients were treated at Queen Elizabeth Hospital (UK) between 30/01/2007 and 10/12/2011. Multi-disciplinary team review of radiological staging and pathology confirmed curative therapy would involve radical nephrectomy. Response to treatment was assessed by CT every 2 cycles using RECIST criteria. If sufficient downstaging was achieved NSS was attempted. Time free from renal replacement therapy (Time to dialysis') was calculated from date of surgery.
6 patients with RCC in a solitary kidney considered for treatment with neo-adjuvant sunitinib prior to NSS were identified. Mean cycles of sunitinib received was 2.8. NSS was feasible in 3 patients. 1 patient remains free from dialysis after surgery. Another patient developed renal failure requiring long term dialysis 20 months after NSS. 1 patient was free of dialysis for 11 months.
Neoadjuvant TKIs may still be a potential option in selected cases of locally advanced RCC in a solitary kidney. Further studies are required to fully assess its efficacy.