Long-term survival in patients with metastatic renal cell carcinoma managed with conservative therapy: a report of two cases

Case 1. A 58-year-old man underwent radical nephrectomy due to a tumor in the left kidney (renal cell carcinoma, clear cell subtype, G3, pT1bpN0) in 1988. Thirteen years later, he underwent surgical resection of metastases to lung and cerebrum and gamma ray knife resection of two other sites of metastases to cerebrum in 2001. He had no evidence of disease in April, 2003. Case 2. A 53-year-old man underwent radical nephrectomy due to a tumor in the right kidney (renal cell carcinoma, clear cell type, pT1apN0) in 1987. From 1996 to 2001, irradiation therapy to multiple metastases to thoracic vertebrae (50 Gy), rib (50 Gy), para-aorta lymph nodes (40 Gy), sacrum (44 Gy) and sternum (44 Gy), and surgical resection of dermal metastasis were performed. Paraplegia occurred due to regrowth of thoracic bone metastasis in December, 2001. In February, 2002, he died of septic shock caused by infection of decubitus. Surgical resection and palliative therapy of recurrent metastatic foci was useful to improve the quality of life and probably prognosis.     

Successful interferon-alpha therapy of renal cell carcinoma with lung metastasis: a case report

A 67-year-old man was admitted with a chief complaint of dyspnea. Computed tomography (CT) revealed a left renal tumor, 12 cm in diameter, with tumor thrombus in the left renal vein, multiple lung metastases, right pleural effusion, and para-aortic lymph node metastases. Because of poor condition in respiratory status, nephrectomy was considered to be impossible and the patient was administered 6×10? IU of interferon-alpha daily. Then, 6×10? IU was also administered three times a week. At 14 months after interferon-alpha therapy, CT scan showed complete remission of lung, pleura metastases and right pleural effusion, and the left renal tumor was markedly reduced in size. Because of improvement of general condition, nephrectomy of the left kidney was performed. Twenty-seven months after the start of interferon-alpha therapy, the patient is alive without evidence of disease.     

Synergetic responses after administration of interleukin-2 and Interferon-alpha combined with gamma knife radiosurgery in a patient with multiple lung and brain metastases: a case report

A 51-year-old man with left renal tumor and multiple lung metastases was admitted to our hospital for treatment. Left nephrectomy was performed, and pathological diagnosis was renal cell carcinoma (clear cell carcinoma, G2, pT3a). Initially, Interferon-alpha (IFN-alpha) therapy was started for lung metastases. About 40 days after surgery, head magnetic resonance imaging revealed brain metastases, and therefore gamma knife radiosurgery(GKS) was performed. Since chest computed tomography showed no change in lung metastases, we tried a combination of interleukin-2 (IL-2) and IFN-alpha therapy to elininate those metastases. As a result, neither lung nor brain metastases could be detected at the 4th month follow-up examination. At 5 months after the IL-2 and IFN-alpha therapy, the patient attempted suicide. Therefore, the IL-2 and IFN-alpha therapy was stopped and an antidepressant was prescribed. Now 11 months after withdrawal of the IL-2 and IFN-alpha, the patient's mental condition remains stable. No recurrence of the cancer has been detected by CT.     

A case of renal cell carcinoma with multiple lung metastases refractory to interferon-α showing complete remission by interleukin-2 monotherapy

We report a case in which a regimen of interleukin-2 (IL-2) achieved pathologically complete remission against renal cell carcinoma with multiple lung metastases. A 63-year-old man was admitted to the Osaka University Hospital with a right renal tumor and multiple lung metastases. Right radical nephrectomy was performed and the histological diagnosis was clear cell carcinoma, G3 > G2, INFbeta, pT3a, pN0. Postoperatively, despite treatment with interferon-alpha, the lung metastases progressed. Consequently, intravenous administration of IL-2 was started at a dose of 70 x 10(4) JRU/day five times per week. After 16 weeks of IL-2 therapy, most of the multiple lung metastases completely vanished and the largest metastatic lung mass was reduced in size. Resection of this residual lung mass was performed and pathological examination revealed no viable cancer cells.     

Successful treatment for renal cell carcinoma with lung metastases by interleukin-2 and interferon-alfa: a case report

We report a case in which a regimen of interleukin-2 (IL-2) and interferon alfa (IFN-alpha) was effective against renal cell carcinoma with lung metastases. A 69-year-old man diagnosed with right renal tumor had not received treatment for 28 months. He was admitted to our hospital for treatment. Computed tomographic (CT) findings showed a right renal tumor 11.5 cm in diameter and multiple lung metastases. Right nephrectomy was performed, and pathological examination was renal cell carcinoma (clear cell carcinoma, G2, pT3a). A regimen of IL-2 and IFN-alpha was selected as an adjuvant therapy. He received 70 x 10(4) JRU/day of IL-2 (div) 5 times a week, and 600 x 10(4) IU/day of IFN-alpha intramuscularly 3 times a week for 8 weeks. Thereafter, both treatments were continued 3 times a week. CT scan showed a complete response on lung metastases 12 months and no recurrence has been observed on CT scan for 16 months after operation.     

Surgically treated pancoast tumor

A 40-year-old male was detected his right apical lung tumor by roentgenographic screening on January 1997, but he did not refer to a hospital since he had no symptom. He went a orthopedics because of his right chest, back, and arm pain on October 1997, and he received traction and physical therapy. He went roentgenographic screening again on January 1998 and he was pointed out that the tumor increased. He admitted our hospital. Biopsy using bronchofiberscopy revealed adenocarcinoma and induction radiotherapy (40 Gy) was performed. Right upper lobectomy with chest wall resection and lymph node dissection was performed under hook approach. This approach was useful to dissect the tumor from the invaded plexus brachialis. Postoperative radio-chemotherapy was added but the patient died 7-postoperative months because of multiple metastases. Early detection should be led to early starting of the therapy.     

Primitive neuroectodermal tumor with Wilms' tumor. Case report]

Occurrence of embryonal kidney tumors in patients with primitive neuroectodermal tumors, so-called central nervous system-renal neoplasia has been reported. An infant who presented with masses in the right lateral ventricle and the cerebellar vermis is reported. Histological examination showed primitive neuroectodermal tumors. Further investigation revealed tumors in the bilateral kidneys, which were removed subtotally and pathologically shown to be Wilms' tumors. The patient was then treated with anticancer drugs and irradiation. However, he developed lung metastases from the renal tumors and expired. At autopsy, a small tumor was found in the inferior horn of the left lateral ventricle. Histological finding showed a primitive neuroectodermal tumor. Also, bilateral large masses of recurrent Wilms' tumors, multiple metastases to the lungs and peritoneal dissemination were found. There is no evidence that this association is based on the selective neoplastic transformation of embryonal cells of similar histogenetic or cytogenetic origin. Several reports demonstrate the presence of embryonal cells in the nervous tissue which could imply a neuroepithelial origin for Wilms' tumors.     

Laparoscopic nephroureterectomy for Wilms' tumor: oncologic considerations

Wilms' tumor is the most common malignant renal tumor of childhood. Surgical resection is an important aspect of therapy and is traditionally performed through an open transabdominal approach. The advent of advanced laparoscopic techniques for benign renal lesions has led to interest in applying a minimally invasive approach to Wilms' tumors in children. We describe a 2-year-old girl who presented with a right renal mass measuring 18 × 13 cm with peritoneal seeding and pulmonary metastatic disease. Wilms' tumor was confirmed on open biopsy. After neoadjuvant chemotherapy, a laparoscopic resection of the tumor with right radical nephroureterectomy, retroperitoneal lymph node dissection, and resection of peritoneal metastases was achieved using one 12-mm and four 5-mm ports. The specimens were removed in an endoscopic retrieval bag through a small Pfannenstiel incision by extending the 12-mm port site. The patient had an uncomplicated recovery and was discharged on the fifth post-operative day. She remains disease free at 19 months postoperatively. Minimally invasive techniques may be considered for resection of Wilms' tumor provided oncologic principles are carefully followed.     

多靶点药物治疗晚期肾癌肾功能改善的临床观察

目的 总结多靶点药物治疗1例晚期双肾癌患者肾功能改善的效果. 方法 晚期双肾癌患者1例,男,60岁.腰痛1个月.B超及CT检查提示双肾癌.左肾肿瘤11.0 cm×9.4 cm×8.5 cm,右肾肿瘤3.5 cm×4.3 cm×4.1 cm,肾穿刺活检诊断为肾透明细胞癌.X线检查示肝及右下肺转移灶.实验室检查:左肾肾小球滤过率(GFR)20.39 ml/min,右肾25.40 ml/min.予多靶点药物索拉非尼400 mg,1～2次/d口服,共治疗12周. 结果 经索拉非尼治疗12周后.CT检查示左肾肿瘤缩小至9.0 cm×8.5 cm×7.4 cm,右肾肿瘤缩小至3.0 cm×3.6 cm×4.0 cm,病灶内部见液化坏死,未见新的转移灶.总肾GFR由治疗前45.79 ml/min升至71.38 ml/min,左肾GFR 31.57ml/min,较治疗前提高11.18 ml/min,右肾GFR 39.81 ml/min,较治疗前提高14.41 ml/min. 结论 多靶点药物治疗晚期肾癌可使肿瘤缩小,并改善肾功能.     

Spontaneous disappearance of multiple lung metastases after nephroureterectomy from sarcomatoid carcinoma of the renal pelvis: A case report

We report a case in which lung metastases disappeared spontaneously after nephroureterectomy from sarcomatoid carcinoma of the renal pelvis. A 58-year-old man presented with gross hematuria. Computed tomography (CT) revealed a left renal tumor and multiple lung metastases. Intravenous pyelography revealed a filling defect in the upper renal calyx. Urine cytology was positive. Left renal pelvic cancer was diagnosed and nephroureterectomy performed. The resected specimen was diagnosed pathologically as sarcomatoid carcinoma of the renal pelvis. Approximately 5 months later, CT revealed that the lung metastases had disappeared. There has been no evidence of disease for 46 months postoperatively.     

Case of bilateral renal cell carcinoma with the tumor thrombus in the inferior vena cava

We describe a case of bilateral renal cell carcinoma with the tumor thrombus in the inferior vena cava. A 71-year-old male was admitted to our department for, careful examination of bilateral renal tumors. Abdominal computed tomography (CT) revealed bilateral solid enhanced renal masses with the tumor thrombus in the inferior vena cava (IVC) and the left renal vein. The renal tumor did not reveal distant metastatic lesions. We enforced two-term operation for bilateral renal tumor. First, right nephrectomy and tumor thrombectomy in the IVC were performed. On the 32th day after the first operation, we performed left nephrectomy. On the second day after the last operation, the patient received hemodialysis. The histopathological diagnosis revealed bilateral renal cell carcinomas. At 9 months after the last operation, the patient had multiple bone metastases, multiple liver metastases and multiple lung metastases.     

经支气管动脉化疗栓塞联合射频消融术治疗>5 cm肺癌

目的探讨经支气管动脉化疗栓塞（TACE）联合射频消融术（RFA）对较大肺癌局部肿块的灭活作用。方法2008年5-11月我科共收治4例肺癌患者（肿瘤最大径均〉5 cm,最大肿瘤为10 cm×8 cm×8 cm）。所有肿瘤均经病理活检证实为低分化腺癌。4例患者中2例介入治疗前曾接受系统化疗＋靶向治疗（NP方案＋恩度）,2例曾接受普通化疗,均因无法耐受化疗反应转而寻求介入治疗。对4例患者均先经支气管动脉行病灶侧TACE,术后3～7天给予CT引导下RFA治疗,均于局麻联合静脉强化麻醉下完成。术后1个月增强CT扫描评价疗效,如有不同程度的肿瘤组织残留或复发征象则再次行TACE＋RFA治疗。所有患者均定期影像随访至本研究结束。结果4例患者均接受2次TACE＋RFA联合治疗,第1次联合治疗后1个月CT增强扫描示均有不同程度的肿瘤组织残留征象;第2次联合治疗后1个月CT增强扫描均未见残存肿瘤组织征象。经2次TACE＋RFA联合治疗后随访至本研究结束6～12个月,影像学随访示局部射频灶均有不同程度的缩小,未见残存或复发征象。结论TACE＋RFA联合治疗可以有效地灭活直径〉5 cm肺癌局部病灶,近期疗效较好,远期疗效有待于长期随访。     

Suppression of primary tumor growth in a mouse model of human neuroblastoma

BACKGROUND/PURPOSE: Neuroblastoma is the most common tumor of the abdomen in children. Consistently effective treatments are lacking for aggressive disease. The authors previously reported that therapy with anti-vascular endothelial growth factor (VEGF) antibodies suppresses both growth and metastasis in an experimental model of Wilms' tumor. The authors hypothesized that, in a parallel model of neuroblastoma, anti-VEGF treatment would inhibit (1) growth and (2) metastasis. METHODS: Primary tumors were established in the kidneys of nude mice. In cohort 1 (n = 42), mice were killed at 3 time-points, and tissues were evaluated histologically. Tumors were assayed for VEGF. In cohort 2 (n = 28), anti-VEGF antibody or vehicle was administered. Tumor weights and the incidence of metastases in the 2 groups were compared. VEGF deposition was evaluated by immunohistochemistry. RESULTS: Mice displayed large tumors with liver and lung metastases. VEGF levels in tumors increased over time. Antibody-treated animals displayed significantly smaller tumors, but incidence and size of metastases were unaffected. VEGF was localized to tumor stroma immunohistochemically, with no difference in pattern observed in control and antibody-treated tumors. CONCLUSIONS: Anti-VEGF antibodies inhibit primary tumor growth in experimental neuroblastoma, but not metastasis. This may contrast with the effect of the same antibody in a parallel model of Wilms' tumor.     

A case of CEA-producing renal pelvic and ureteral cancer

We report a case of carcinoembryonic antigen (CEA)-producing renal pelvic and ureteral cancer. A 62-year-old man consulted a local hospital with the chief complaint of right flank pain. On ultrasonography and CT scan, right hydronephrosis with the renal pelvis and ureteral tumor were detected, and he was referred to our hospital. Both serum levels of CEA and CA19-9 were elevated to 36.9 ng/ml and 119 u/ml, respectively. Close examination of the gastro-intestinal tract did not detect any sign of digestive tumor. Right nephro-ureterectomy was performed, and the tumor was histologically diagnosed as TCC G2 > G3 pT3, and CEA was positive in the tumor cells immunohistochemically. CA19-9 was also positive both in the tumor cells and normal epithelium of the renal tubules. Postoperatively, multiple lung metastases developed despite chemotherapy and the patient died 4 months after surgery. CA19-9 had immediately decreased to the normal range after preoperative percutaneous nephrostomy. CEA had transiently decreased postoperatively, but then increased with lung metastases, apparently related to the state of cancer.     

A combined treatment of interferon-alpha, 8 MHz radiofrequency hyperthermia and/or irradiation in a patient with advanced renal cancer

A combined treatment of alpha interferon (INF), 8 MHz radiofrequency (RF) hyperthermia using Thermotron-RF Model 8 and/or irradiation was performed on a patient with advanced renal cancer. The patient was a 52-year-old male, who had received arterial embolization with a gelatin sponge and 60 mg of adriamycin for the right renal tumor in January, 1985. He was referred to our clinic in April, 1985. Computed tomography showed a right renal tumor, 120 x 105 x 80 mm. Histological examination revealed clear cell carcinoma of the right kidney. The tumor was unresectable because of the huge tumor size, invasion into the right lobe of the liver, multiple pulmonary metastases and severe dysproteinemia. From the beginning of May, 1985, administration of 3 x 10(6) units interferon-alpha (INF) daily and radiofrequency (RF)hyperthermia for one hour twice a week were started. By June 11, 1985, 10 sessions of RF-hyperthermia were performed. Thereafter, hyperthermia for the renal tumor was maintained once a week until June, 1986. From the middle of June, 1985, a gradual improvement of dysproteinemia and appetite loss, and a decrease of the right renal tumor size as well as disappearance of febrile attacks were attained. In November, 1985, mediastinal lymph node swelling developed. A combined therapy of RF-hyperthermia twice a week and irradiation with 2.0 Gy daily 5 times a week was started. A total of 14 sessions of RF-hyperthermia and 30 Gy of irradiation were delivered until January, 1986. Intratumoral temperature of the renal tumor reached 44.0 degrees C during the heating.(ABSTRACT TRUNCATED AT 250 WORDS)     

Small cell carcinoma of the prostate: a case report

A 76-year-old man had been treated with maximum androgen blockade therapy for a poorly-differentiated prostate adenocarcinoma (T3cN1M0, prostate specific antigen (PSA) 65 ng/ml, Gleason Score 4+5=9) since September 2002. By August 2003, his serum PSA levels were undetectable and the lymph node swelling had vanished. However, in December 2004, his serum PSA levels started rising gradually up to 0.66 ng/ml. Radiation therapy on the prostate was then performed (66 Gy). At that time, no metastasis was detected by computed tomography and bone scintigraphy. In August 2005, multiple bone metastases were detected. Immunohistochemical examination of a biopsy specimen from the bone lesion revealed a small cell carcinoma/neuroendocrine cell carcinoma. He died with undetectable PSA levels (less than 0.008 ng/ml) in December 2005. The autopsy showed multiple organ metastases including bone, liver, lungs and others. The immunohistochemical examination revealed pure small cell carcinoma in all metastatic lesions. A precise histological examination of the lungs using a 1 cm serial section could not reveal any tumors compatible with primary lung cancer. We concluded from the clinical history and autopsy findings that his initial poorly-differentiated adenocarcinoma of the prostate dedifferentiated into a pure small cell carcinoma with neuroendocrine differentiation.     

Port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy: a case report

We report a case of port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy. A 76-year-old woman was admitted to our hospital with a complaint of anorexia, general malaise and left abdominal distension. Computed tomography revealed severe hydronephrosis in the left kidney. Laboratory examination revealed a high serum level of CA19-9 (155 U/ml). However, antegrade and retrograde pyelography revealed no filling defects and urine cytopathology for renal pelvis showed no malignancy. Thus, on the suspicion of a ureteropelvic junction stenosis, a laparoscopic nephrectomy was performed. There were some papillary tumors in the renal pelvis and a histopathological examination of the tumor revealed a papillary adenocarcinoma. Twelve months after nephrectomy, left iliopsoas muscle metastasis was found. Thus irradiation therapy with a total of 30 Gy was performed. However, 3 months later, the patient developed metastasis at the trocar site and the serum level of CA19-9 elevated to 6,720 U/ml. She died of multiple metastases from adenocarcinoma of the renal pelvis 4 months after port site metastasis.     

Stereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma.

The aim of this study was to analyse treatment effects after stereotactic radiosurgery (SRS) without whole brain radiation therapy (WBRT) as primary treatment for patients harboring brain metastases of renal cell carcinoma (RCC). During an 8-year period, 85 patients with 376 brain metastases from RCC underwent 134 outpatient SRS procedures. 65 % of all patients had multiple brain metastases. The median tumor volume was 1.2 cm (3) (range: 0.1 - 14.2 cm (3)). Mean prescribed tumor dose was 21.2 (+/- 3.2) Gy. Local/distant tumor recurrences were treated by additional SRS in cases of stable systemic disease. Overall median survival was 11.1 months after SRS. The local tumor control rate after SRS was 94 %. Most patients (78 %) died because of systemically progressing cancer. A KPS > 70 and RTOG class I were related to prolonged survival time. Patients of the RTOG groups I, II and III survived for 24.2 months, 9.2 months and 7.5 months, respectively. There was no permanent morbidity after SRS. 11 patients (12.9 %) showed transient radiogenic complications and 3 patients (3.5 %) died because of intratumoral bleedings after SRS. Stereotactic radiosurgery alone achieves excellent local tumor control rates for patients with small brain metastases from renal cell carcinoma.     

Treatment of bilateral Wilms' tumor: comparison of initial biopsy and chemotherapy to initial surgical resection in the preservation of renal mass and function.

The National Wilms' Tumor Study 3 (NWTS-3) recommended treatment of bilateral Wilms' tumor with initial biopsy followed by chemotherapy with subsequent operation to resect the remaining tumor. This study was performed to determine if this approach preserves renal mass and function when compared with initial surgical resection followed by chemotherapy. Over a 20-year period (1970 to 1990), 15 patients with synchronous bilateral Wilms' tumor were treated at the Childrens Hospital of Los Angeles. Eight patients in the surgical group underwent initial unilateral nephrectomy with contralateral biopsy, wedge resection, or partial nephrectomy and subsequent chemotherapy. The seven patients in the chemotherapy group underwent bilateral tumor biopsy, followed by chemotherapy and subsequent tumor resection. Patients were assigned to each group in a nonrandomized manner according to the preference of the attending oncologist and surgeon. Comparison of the two groups showed no significant differences in sex distribution, initial renal function, tumor histology, dose and field of radiotherapy, presence or absence of positive surgical margins, and local recurrence rates. Patients in the surgery group were slightly older than those in the chemotherapy group: 3.6 +/- 2.2 versus 2.3 +/- 2.2 years. The percent of renal mass involved by tumor for the surgery group was 52 +/- 12 versus 73 +/- 16 for the chemotherapy group (P = .03). The percent of renal mass preserved following all operations, local recurrence rates, incidence of metastases, and survival was nearly identical between the two groups. There were three cases of renal failure in the surgery group and one case of renal failure in the chemotherapy group.(ABSTRACT TRUNCATED AT 250 WORDS)