Neoadjuvant targeted therapy in a primary metastasized renal cell cancer patient leads to down-staging of inferior vena cava thrombus (IVC) enabling a cardiopulmonary bypass-free tumor nephrectomy: a case report.

Abstract:

BACKGROUND:We report on a 62-year-old gentleman presenting at our urological department with an advanced renal cell cancer of the right kidney (10 cm in diameter), with an extensive caval vein thrombus (level IV) and bilateral pulmonary metastases. Another suspicious lesion at the left hemithorax was radiologically described. METHOD:A presurgical, neoadjuvant systemic therapy with sunitinib, a tyrosine kinase inhibitor, was initiated for 4 cycles in total (50 mg/day; 4 weeks on/2 weeks off). The cytoreductive nephrectomy was performed following the fourth cycle of sunitinib and after a 14-day break. Transesophageal echocardiography was used for intraoperative monitoring of the caval vein thrombus. Systemic treatment with sunitinib was continued 4 weeks after surgery. RESULTS:A significant reduction in tumor size, metastatic sites and down-staging of IVC from level IV to level III according to Novick classification was achieved. CONCLUSION:Significant down-staging of the tumor caval vein thrombus which initially reached the right atrium enabled us to perform surgery limited to the abdominal cavity without extracorporeal circulation nor hypothermia.

journal_name

World J Urol

journal_title

World journal of urology

authors

Peters I,Winkler M,Jüttner B,Teebken OE,Herrmann TR,von Klot C,Kramer M,Reichelt A,Abbas M,Kuczyk MA,Merseburger AS

doi

10.1007/s00345-012-0955-5

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

245-8

issue

1

eissn

0724-4983

issn

1433-8726

journal_volume

32

pub_type

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