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Metastasectomy

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Kidney Cancer

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Abstract

Metastasis from renal cell carcinoma (RCC) may be present at diagnosis or develop after nephrectomy. Most of these patients are candidates for systemic therapy rather than metastasectomy. Surgical resection has been the preferred approach for metastasectomy, but recent data suggest a role for stereotactic radiosurgery (SRS) or body radiotherapy (SBRT) as a valid noninvasive alternative. The decision to resect metastases is depending on a number of clinical factors such as the TNM classification, performance status, prognostic risk factors, the length of the disease-free interval, synchronous or metachronous metastasis, as well as the burden of metastatic disease and the number and location of sites involved. The best outcome is reported for patients with solitary metastases after a long disease-free interval, which could be completely resected. Pulmonary metastasectomy is associated with a longer survival when compared to other sites even when multiple lung metastases are present. However, almost all available data on metastasectomy in RCC are biased by the retrospective nature of the studies, which were mostly conducted before the advent of targeted therapy. For most metastatic sites, definite guidelines cannot be established but a pattern emerges. To guide decision making, the available evidence for common metastatic sites will be presented including the recent advances of metastasectomy following targeted therapy.

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Authors and Affiliations

  1. Department of Urology, Skåne University Hospital, Jan Waldenstöms Gata 7, Malmö, 20502, Sweden

    Saeed Dabestani

  2. Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, CX, 1066, The Netherlands

    Axel Bex MD

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  1. Saeed Dabestani
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Correspondence to Axel Bex MD .

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  1. Department of Internal Medicine, Division of Hematology - Oncology, University of California Davis, School of Medicine UC Davis Comprehensive Cancer center, Sacramento, California, USA

    Primo N. Lara

  2. Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Eric Jonasch

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Dabestani, S., Bex, A. (2015). Metastasectomy. In: Lara, P., Jonasch, E. (eds) Kidney Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-17903-2_11

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