THE IMPACT OF ADJUVANT NEPHRECTOMY ON MULTIMODALITY TREATMENT OF METASTATIC RENAL-CELL CARCINOMA

Multimodality treatment of metastatic renal cell carcinoma with biolog ical response modifiers and cytoreductive surgery has produced durable responses. The timing and impact of cytoreductive surgery on the succ ess of immunotherapy require further study. We reviewed the treatment of 62 patients with metastatic renal cell carcinoma and primary tumors in place who qualified for multimodality treatment comprising adjuvan t nephrectomy and biological response modifier protocols at our instit ution between 1987 and 1992. Of the patients 37 were scheduled to unde rgo initial adjuvant nephrectomy followed by biological response modif ier therapy. A total of 25 patients underwent initial biological respo nse modifier therapy with planned delayed adjuvant nephrectomy if a re sponse to treatment was demonstrated. Of the 37 patients undergoing in itial adjuvant nephrectomy, 8 (22%) were unable to enter induction of immunotherapy because of perioperative complications (1), medical cont raindications (2), tumor progression (4) or death (1). Three patients in the initial adjuvant nephrectomy group (8%) had a partial response and the median survival in this group was 12 months (range 1 to 57). I n the initial biological response modifier group 3 patients (12%) with an objective response (2 complete and 1 partial) to biological respon se modifier therapy underwent nephrectomy. The median survival for the initial biological response modifier group was 14 months (range 1 to 48). These results add to our understanding of the impact of adjuvant nephrectomy on patients with metastatic renal cell carcinoma considere d for immunotherapy protocols.