Complete Metastasectomy Research Articles

Oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases

Background: The oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases (SLLM) and the significance of the time to surgical failure (TSF) in such patients are unknown. Methods: Patients undergoing hepatectomy from 2005 to 2016 as an initial treatment for colorectal liver metastases (CLM) in a single tertiary hospital were divided into three groups: patients with isolated CLM undergoing complete resection (Group 1, n = 317), SLLM undergoing complete metastasectomy (Group 2, n = 33), and SLLM undergoing complete hepatectomy but incomplete lung resection (Group 3, n = 20). Upfront surgery was performed for patients with initially resectable disease. A staged strategy (hepatectomy followed by lung resection) without interval chemotherapy was mainly applied for SLLM as long as the lung metastases were resectable. Clinical characteristics and prognoses were compared among the groups. Results: The 5-year overall survival rate of Group 2 was significantly better than that of Group 3 (70.3% vs. 11.9%, <.001) and similar to that of Group 1 (63.5%, “P” = .859). The 5-year disease-free survival rate was significantly worse in Group 2 than 1 (22.1% vs. 34.6%, =.048), while the 5-year TSF was similar (52.9% vs. 49.9%, =.991). On multivariable analysis, a carcinoembryonic antigen level of >200 ng/ml was the sole predictor of incomplete resection of lung metastases (odds ratio, 13.8; 95% confidence interval, 1.75–298; =.011). Conclusion: The prognosis in patients with SLLM who achieve complete metastasectomy is acceptable and might be improved by a carcinoembryonic antigen level of ≤200 ng/ml, appropriate selection based on operative indications, and aggressive repeat resection.

Molecular Subtypes of Clear-cell Renal Cell Carcinoma are Prognostic for Outcome After Complete Metastasectomy

BackgroundMetastasectomy is routinely performed in selected patients with metastatic clear-cell renal cell carcinoma (ccRCC) as an alternative to systemic therapy. In the absence of randomized trials, the benefit and best way of patient selection remain unclear. Earlier, we described four molecular ccRCC-subtypes (ccrcc1–4) that have a prognostic and predictive value upon first-line sunitinib or pazopanib. ObjectiveAssess the prognostic value of ccrcc1–4 subtypes after complete metastasectomy. (1) Compare outcomes of good-prognosis ccrccc2&3-tumors with intermediate/poor-prognosis ccrcc1&4-tumors. (2) Compare outcomes of the four subtypes separately. Design, setting, and participantsSingle-center retrospective study (1995–2017), assessing 43 ccRCC patients undergoing complete metastasectomy without systemic treatment. InterventionMolecular subtype determined with established 35-gene expression classifier. Outcome measurements and statistical analysisMedian disease-free survival (DFS), time to systemic therapy, cancer-specific (CSS) and overall survival (OS) from metastasectomy, estimated with Kaplan-Meier method and tested against other predictors with multivariable Cox regression. Results and limitationsMedian DFS was 23 mo for ccrcc2&3-tumors versus 9 mo for ccrcc1&4-tumors (p=0.011, hazard ratio [HR]=2.6). Median time to systemic therapy was 92 mo versus 28 mo (p=0.003, HR=3.3). Median CSS was 133 mo versus 50 mo (p<0.001, HR=2.7). Median OS was 127 mo versus 50 mo (p=0.011, HR=2.5). The classification remained independent upon multivariable analysis. Outcomes remained significantly different when comparing four subtypes separately. The intrinsic heterogeneity of expression profiles is a limitation of this approach. ConclusionEven after clinical patient selection, patients with a ccrcc1- or ccrcc4-tumor are at a higher risk of relapse after complete metastasectomy. Patients with a ccrcc2- or ccrcc3-tumor usually experience a long DFS. These results need validation in a larger cohort to establish the subtypes as prognostic marker. Patient summaryMetastasectomy is recommended for some patients with metastatic clear-cell kidney cancer; however, we do not know who will benefit the most. We show that molecular subtypes increase the possibility to predict which patients are at risk for early relapse after metastasectomy and who may benefit more from other treatment options.

Postmetastasis survival in high‐grade extremity osteosarcoma: A retrospective analysis of prognostic factors in 126 patients

Prognostic factors predictive of postmetastasis survival (PMS) in metastatic osteosarcoma are poorly understood. Our aims were to evaluate PMS in patients with high-grade osteosarcoma in extremities, and to identify prognostic factors related to PMS. A retrospective review of data for 126 patients with metastatic osteosarcoma was conducted. The study population consisted of 70 men and 56 women, with a mean age of 21 years (range: 4-75 years). The mean postmetastasis follow-up period was 37 months (range: 1-245 months). The 5-year PMS rate was 31% and median PMS duration was 22 months. In the multivariate analyses, no metastasectomy (P < 0.001), local recurrence prior to metastasis (P = 0.016), extrapulmonary metastasis (P = 0.006), and poor histologic response to preoperative chemotherapy (P = 0.047) were significant poor prognostic factors. The 5-year PMS without any negative prognostic factor was 60.2%; with one factor, 31.6%; and with more than two factors, 3.6%. PMS in osteosarcoma patients was influenced by primary tumor-related factors such as histologic response to chemotherapy, as well as metastasis-related factors such as complete metastasectomy and metastasis site. A certain group of patients without such poor prognostic factors could be cured even after the development of metastasis.

Utilization of targeted near-infrared molecular imaging to improve pulmonary metastasectomy of osteosarcomas.

Pulmonary metastasectomy for osteosarcoma provides a select group of patients an opportunity for long-term survival and possible cure. Unfortunately, a complete metastasectomy is challenging due an inability to accurately identify lesions that lay below the threshold of preoperative imaging or intraoperative visual and tactile inspection. Growing evidence suggests that osteosarcomas express a number of unique molecular markers, including the folate receptor alpha. In this case report, we describe the application of a folate receptor-targeted, near-infrared optical contrast agent (OTL38) to improve osteosarcoma localization during minimally invasive pulmonary resection. In addition to localizing preoperatively identified lesions, this technology helped identify additional disease that was undetected on preoperative imaging or with traditional intraoperative techniques. This report marks the first successful utilization of a molecular imaging probe useful for osteosarcomas. This technology may provide a unique approach to improve pulmonary metastasectomy of osteosarcomas.

Survival of renal cell carcinoma metastatic to nonthyroid head and neck region: A systematic review.

Metastasis of renal cell carcinoma to nonthyroid head and neck region is rare. Survival benefit for complete metastasectomy of more common renal cell foci has been reported in the literature. It is uncertain whether metastasectomy in nonthyroid head and neck region would provide a similar benefit. We conducted a retrospective review of all renal cell metastases to the head and neck region treated in the past 15 years at an academic hospital, and a systematic review of all relevant reports with survival data in the literature between 1960 and 2016. An analysis of pooled data was performed to estimate overall survival. Six cases from our institution and 260 independent cases reported in the literature were included in the survival analyses (n = 266). The median follow-up time was 12 months (range 0-180 months). The overall median survival was 36 months (95% confidence interval [CI] 23.7-48.3). The median survival for those who underwent complete metastasectomy in the head and neck was significantly higher at 60 months (95% CI 41.1-78.9) than those who had incomplete or no metastasectomy (12 months, 95% CI 9.5-14.5). Multivariable Cox proportional hazards model estimated that, after controlling for potential confounders, complete metastasectomy remained associated with reduced risk of death (hazard ratio 0.44, 95% CI 0.29-0.69). Complete metastasectomy was associated with 4-year longer median overall survival than incomplete metastasectomy or no metastasectomy. Laryngoscope, 128:889-895, 2018.

MP16-14 CLINICAL IMPLICATION OF METASTASECTOMY IN METACHRONOUS METASTATIC RENAL CELL CARCINOMA IN THE ERA OF TARGETED THERAPY

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II1 Apr 2017MP16-14 CLINICAL IMPLICATION OF METASTASECTOMY IN METACHRONOUS METASTATIC RENAL CELL CARCINOMA IN THE ERA OF TARGETED THERAPY Jong Won Kim, Jongsoo Lee, Jae Yong Jeong, Sung Ku Kang, Jang Hee Han, Seung Hwan Lee, Won Sik Ham, Koon Ho Rha, Young Deuk Choi, Sung Joon Hong, Young Eun Yoon, and Woong Kyu Han Jong Won KimJong Won Kim More articles by this author , Jongsoo LeeJongsoo Lee More articles by this author , Jae Yong JeongJae Yong Jeong More articles by this author , Sung Ku KangSung Ku Kang More articles by this author , Jang Hee HanJang Hee Han More articles by this author , Seung Hwan LeeSeung Hwan Lee More articles by this author , Won Sik HamWon Sik Ham More articles by this author , Koon Ho RhaKoon Ho Rha More articles by this author , Young Deuk ChoiYoung Deuk Choi More articles by this author , Sung Joon HongSung Joon Hong More articles by this author , Young Eun YoonYoung Eun Yoon More articles by this author , and Woong Kyu HanWoong Kyu Han More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.520AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the clinical implication of complete and incomplete metastasectomy in the patients having metachronous metastatic RCC (mRCC). METHODS We retrospectively reviewed metachronous mRCC treated at our institute between January 2005 and December 2015. Metachronous mRCC was defined as those diagnosed of metastatic disease >3month after initial nephrectomy. Patients were classified into three groups; A. targeted therapy for metachronouc mRCC without additional surgical treatment. B. complete metastasectomy and adjuvant targeted therapy. C. incomplete metastasectomy and adjuvant targeted therapy. Cox proportional hazard regression analysis was performed to determine if complete and incomplete metastasectomy prolongs overall survival (OS) for the metachronous mRCC. RESULTS Total of 101 patients were enrolled and followed up for 41.9 months in this study. 22 patients (21.8%) underwent complete metastasectomy, while 17 patients (16.8%) underwent incomplete metastasectomy. Most commonly performed metastasectomy was lung wedge resection (n=14, 13.9%), followed by bone excision (n=9, 8.9%), and local recur resection (n=6, 5.9%). Overall, incomplete metastasectomy and complete metastasectomy prolonged OS (HR 0.608, 0.318, p=0.042, respectively). Complete and incomplete lung wedge resection both prolonged overall survival significantly (p<0.05). Metastasectomy for bone and retroperitoneum recurred mass both did not show survival benefit (p=0.590 and 0.133, respectively). For the other metastasis, we labeled them as soft tissue metastasis, and soft tissue metastasectomy prolonged OS (p=0.036). Incomplete metastasectomy for soft tissue prolonged OS (p=0.016) CONCLUSIONS Metastasectomy could prolong OS in metachronous mRCC. Except for metastasectomy for bone and retroperitoneum recurred mass, incomplete metastasectomy also could play a role as OS prolongation. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e185 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jong Won Kim More articles by this author Jongsoo Lee More articles by this author Jae Yong Jeong More articles by this author Sung Ku Kang More articles by this author Jang Hee Han More articles by this author Seung Hwan Lee More articles by this author Won Sik Ham More articles by this author Koon Ho Rha More articles by this author Young Deuk Choi More articles by this author Sung Joon Hong More articles by this author Young Eun Yoon More articles by this author Woong Kyu Han More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Metastasis therapies for renal cancer.

Although novel targeted therapies for metastatic renal cell carcinoma (RCC) are emerging, metastasectomy still remains the only potentially curable intervention and plays an important role both in disease control, cancer-specific survival (CSS) and overall survival (OS). A systematic review was conducted in 2014 by the European Association of Urology RCC guidelines panel to summarize evidence on the subject at hand. The purpose of this review is to update the current evidence base. A total of 17-19% of initially nonmetastatic patients with later RCC metastasis are potentially curable. Complete metastasectomy still remains the sole curative option, continues to show improved OS and CSS and is suggested to defer time to palliative targeted therapy. Resectability, long time to recurrence, good performance status and oligometastatic disease have better benefit of metastasectomy. Stereotactic radiotherapy remains an excellent option for local tumor control and symptom control in patients with RCC brain and bone metastases. Minimal-invasive options such as thermal ablation are evolving, albeit the evidence base is small. Novel trials are investigating sequencing of metastasectomy and targeted therapy with results pending. Metastasectomy continues to be supported as beneficial for OS, CSS and progression-free survival in patients with good prognostic factors.

A 20-year retrospective analysis of CT-based pre-operative identification of pulmonary metastases in patients with osteosarcoma: A single-center review

PurposeCooperative studies support complete metastasectomy in osteosarcoma (OS). Pre-operative CT is used to identify and quantify metastases and can facilitate minimally invasive techniques. Here we assess the accuracy of pre-operative CT compared to findings at thoracotomy and its change over time. MethodsWe reviewed OS thoracotomies performed at our institution from 1996 to 2015. The number of metastases identified on pre-operative chest CT was compared to the number of metastases seen on pathology (both metastases with viable cells and non-viable, osteoid-only metastases). ResultsEighty-eight patients underwent 161 thoracotomies with a median of 14days (range, 1–85) between CT and surgery, a median of 2 CT-identified lesions (range, 0–15), and a median of 4 resected lesions (range, 1–25). In 56 (34.8%) cases, more metastases were found surgically than were seen on CT, and among these, 34 (21.1%) had a greater number of viable metastases. There was poor overall correlation between CT and pathology findings (Kendall Tau-b=0.506), regardless of CT slice thickness, decade of thoracotomy, or total number of CT-identified lesions. ConclusionsCT accuracy in pre-operatively quantifying OS pulmonary metastases has not improved in recent decades. Consequently, we recommend an open technique with direct lung palpation for complete identification and resection of OS pulmonary metastases. Level of evidenceLevel IV, retrospective study with no comparison group.

Impact of metastasectomy on prognosis in patients treated with targeted therapy for metastatic renal cell carcinoma

We evaluated the value of metastasectomy in patients treated with targeted therapy for metastatic renal cell carcinoma (mRCC). The medical records of 325 patients who presented with mRCC were reviewed; among these patients, 33 underwent complete metastasectomy followed by targeted therapy (complete metastasectomy group), 29 underwent incomplete metastasectomy followed by targeted therapy (incomplete metastasectomy group), and 263 treated with targeted therapy alone (non-metastasectomy group). We estimated progression-free and overall survivals using Kaplan-Meier curves. A Cox proportional hazards regression model was used to estimate the prognostic significance of metastasectomy. Clinicopathological variables did not differ among the three groups except for age, history of nephrectomy, type of metastasis, the International Metastatic Renal Cell Carcinoma Database Consortium risk groups, histology, and bone metastasis. The median progression-free survivals were 29.5, 18.8, and 14.8months in the complete, incomplete, and non-metastasectomy groups (p<0.001). Complete metastasectomy (hazard ratio 0.431, p=0.001) was an independent predictor of disease progression, along with targeted agents, risk groups, sarcomatoid feature, and number of metastatic sites. The median overall survivals were 92.5, 29.6, and 23.5months in the complete, incomplete, and non-metastasectomy groups (p<0.001). Complete metastasectomy (hazard ratio 0.378, p=0.001) was an independent predictor of overall survival, along with targeted agents, type of metastasis, risk groups, sarcomatoid feature, and number of metastatic sites. Complete metastasectomy performed before targeted therapy might improve progression-free and overall survivals in patients with mRCC.

Efficacy of incomplete metastasectomy with targeted therapy in patients with metastatic renal cell carcinoma.

e16117Background: Complete metastasectomy in patients with potentially surgically resectable metastases have an important role in the management of metastatic renal cell carcinoma (mRCC).Clinical b...

Pulmonary metastasectomy from renal cell carcinoma including 3 cases with sarcomatoid component.

Usefulness of complete metastasectomy against pulmonary metastases from renal cell carcinoma (RCC) is well known. We examined the efficacy of surgical resection of pulmonary metastases from RCC performed in Shikoku Cancer Center. Between January 2004 and December 2014, 11 patients with pulmonary metastases from RCC underwent thoracic resection in our institution. We examined disease-free interval (DFI) and overall survival of these patients after pulmonary metastasectomy. Patients included 9 men and 2 women with a mean age of 63.2 years. The median number of metastases was 1 (range 1-6). Overall, 5 patients had a single metastasis (45.5%), 8 patients had unilateral metastases (72.7%), and 3 patients received immunotherapy or chemotherapy in the interval between radical nephrectomy and pulmonary metastasectomy. We performed complete pulmonary metastasectomy in these patients. The median observation period was 43 months (range 5-82), median DFI was 5 months (range 2-17), and 3-year overall survival rate was 86%. In the 3 patients who had primary or metastatic tumors with sarcomatoid (SA) component, their median DFI tended to be shorter than that of 8 patients without it (2 vs. 8 months, p = 0.07). The pulmonary metastasectomy for RCC is a treatment option, while the indication for RCC with SA component should be carefully considered.

Metastasectomy for Stage IV Melanoma in the Era of Effective Systemic Agents.

There is an increasing body of literature that strongly suggests that complete metastasectomy for stage IV melanoma can improve overall survival. Before 2011, the efficacy of systemic therapy for melanoma was poor, making surgical resection the mainstay for treatment and the only realistic chance for cure. Now, in just a short time span (2011-2014), we have six Food & Drug Administration (FDA)-approved drugs for patients with stage IV metastatic melanoma. In the absence of prospective clinical trials evaluating the most advantageous sequence and timing for systemic therapy and surgical resection in the setting of stage IV melanoma, the treating surgical and medical oncologists must jointly devise individual treatment plans that take into account the advantages and disadvantages of each modality. This multidisciplinary approach gives the patient the best chance for prolonged survival. This article briefly reviews the FDA-approved systemic therapy options, discusses the data for site-specific metastasectomy, critiques the previous stage IV metastasectomy trials, and presents a view for moving forward with a multidisciplinary approach in mind.

Complete metastasectomy after high-dose interleukin-2 (HD IL-2) therapy for melanoma

Meeting abstracts Our aim was to describe our experience with surgery after High-dose Interleukin-2 (HD IL-2) therapy in patients who were eligible for complete metastasectomy after treatment. A retrospective chart review was performed on patients with metastatic melanoma seen at Saint Louis

Surgical Treatment of Lung Metastases of Colorectal Carcinoma – Survival and Prognostic Factors

Colorectal carcinoma has the third highest incidence of all tumor diseases in the world. In the long term, Slovak republic is among countries with highest occurrence of this disease. About 25% of patients have distant metastases at the time of diagnosis, and about 50% of patients progress. The first possibility of colorectal carcinoma lung metastases treatment is metastasectomy which may have a curative character. In this paper, the authors retrospectively evaluated 50 patients who had undergone surgical treatment to establish the diagnosis of colorectal carcinoma lung metastases at the Clinic of thoracic surgery of JLF UK and UH Martin between 2003 and 2014. Altogether, 27 men and 23 women were operated (average age: 62 and 61 years). 52% of patients had solitary metastasis.We chose thoracotomy as a surgical access for majority of the surgeries (76%), and the most common type of surgical procedure was a wedge resection (74%). 3-year survival of patients after complete metastasectomy was 55.5%, and 5-year survival was 31.8% with a median survival of 42 months. We did not record any statistically significant influence of number of metastases (p = 0.3297) and length of disease-free interval (p = 0.4423) on the long-term survival, but we confirmed a significant difference of survival in different prognostic groups according to the International registry of lung metastases (p = 0.049). A surgical removal of colorectal carcinoma lung metastases in selected patients is an important curative modality that might prolongsurvival, improve the prognosis and at the same time have minimum complications. The results show that the strongest predicative indicator of prognosis is incorporation of the patients to the prognostic groups determined by the International Registry of Lung Metastases.

Adrenalectomy for Metastatic Melanoma: Current Role in the Age of Nonsurgical Treatments

Surgical resection of metastases to the adrenal gland can improve overall survival of patients with stage IV melanoma, but its relative value with respect to current nonsurgical therapies is unknown. We hypothesized that surgery remains an optimal first-line treatment approach for resectable adrenal metastases. A search of our institution's prospectively collected melanoma database identified stage IV patients treated for adrenal metastases between January 1, 2000, and August 11, 2014. The 91 study patients had a mean age of 60.3 years at diagnosis of adrenal metastasis and 24 had undergone adrenalectomy. Improved survival was associated with an unknown primary lesion, surgical resection, and nonsurgical therapies. Median overall survival from diagnosis of adrenal metastases was 29.2 months with adrenalectomy versus 9.4 months with nonoperative treatment. Adrenalectomy, either as complete metastasectomy or targeted to lesions resistant to systemic therapy, is associated with improved long-term survival in metastatic melanoma.

Role of metastasectomy in metastatic renal cell carcinoma.

Management of patients with metastatic renal cell carcinoma is challenging and continues to be delivered in a multidisciplinary context. Even with the advent of systemic targeted therapy, complete remission with these new agents is rare using systemic therapy alone. Surgical resection of the primary tumor and metastatic deposits continues to play an important role in managing patients with metastatic renal cell carcinoma when aiming for complete remissions. To date, despite the lack of level 1 evidence, metastasectomy appears to prolong survival and achieve long-term cure in carefully selected patients. This review examines current evidence for the role of metastasectomy in renal cell carcinoma. Studies continue to consistently support a benefit of complete metastasectomy for overall and cancer-specific survival at most sites for resection, with the exception of brain and bone, which tend to perform for symptomatic relief and palliation. Metastasectomy has not yet been examined in a randomized setting. The debate of survival benefit because of selection bias of patients or differences in tumor biology is relevant and has yet to be resolved in the literature. Clearly, careful patient selection remains paramount in optimizing survival benefit from metastasectomy. Patients with isolated surgically resectable metastatic disease, with long disease-free intervals, and with good performance status are likely to benefit the most from metastasectomy.

MP69-14 PERIOPERATIVE AND RENAL FUNCTIONAL OUTCOMES OF PARTIAL NEPHRECTOMY FOR COMPLEX RENAL SCORE WITH OR WITHOUT PRE-SURGICAL SUNITINIB: A MULTICENTER ANALYSIS

lymphadenopathy (HR 1.82, P < 0.001), number of metastatic sites (HR 1.69, P 1⁄4 0.001), hemoglobin (HR 1.47, P 1⁄4 0.017), neutrophil (HR 1.78, P1⁄4 0.033), corrected calcium (HR 1.96, P1⁄4 0.022), and time from diagnosis to treatment (HR 1.68, P 1⁄4 0.005). CONCLUSIONS: We found that complete metastasectomy performed before targeted therapy significantly increased overall survival in patients with mRCC. If surgically resectable, aggressive metastasectomy should be considered.

The Significance of Metastasectomy in Patients with Metastatic Renal Cell Carcinoma in the Era of Targeted Therapy.

Objective. To investigate the efficacy of surgery in the treatment of metastatic renal cell carcinoma (mRCC) and to identify prognostic factors. Methods. A single center retrospective study of 96 patients with mRCC from December 2004 to August 2013. Results. The median follow-up time was 45 months. Thirty-one (32.3%) of the patients received complete resection of metastatic sites, 11 (11.5%) of the patients underwent incomplete resection of metastatic sites, and 54 (56.3%) of the patients received no surgery. In the univariate Kaplan-Meier analysis, the median overall survival times of the three groups were 52 months, 16 months, and 22 months, respectively (p < 0.001). The difference in the overall survival time was statistically significant between complete resection and no surgery groups (HR = 0.43, p = 0.009), while there was no significant difference between the incomplete metastasectomy and no surgery groups (HR = 1.80, p = 0.102). According to the multivariate Cox regression analysis, complete metastasectomy (HR = 0.49, p = 0.033), T stage > 3 (HR = 1.88, p = 0.015), disease free interval <12 months (HR = 2.34, p = 0.003), and multiorgan involvement (HR = 2.00, p = 0.011) were significant prognostic factors. Conclusion. In the era of targeted therapy, complete metastasectomy can improve overall survival. Complete metastasectomy, T stage > 3, disease free interval <12 months, and multiorgan involvement are independent prognostic factors.

Targeted therapy after complete resection of metastatic lesions in metastatic renal cell carcinoma.

To evaluate the efficacy of targeted therapy after complete resection of metastatic lesions in patients with metastatic renal cell carcinoma. We retrospectively reviewed the medical records of 53 patients with metastatic renal cell carcinoma who underwent complete surgical resection of metastatic lesions between January 2006 and December 2012. Immediate postoperative targeted therapy was given to a subgroup of patients. Progression-free survival and cancer-specific survival were assessed. All patients underwent curative surgery for a primary tumor. A total of 13 patients (24.5%) had metastatic disease at initial diagnosis, and 49 (92.5%) had single-organ involvement at the time of first metastasis. None of the patients met the poor-risk criteria. Of the 19 patients who received immediate postoperative targeted therapy, five (26.3%) experienced relapse. Of the 34 patients who did not receive immediate postoperative targeted therapy, 27 (79.4%) experienced disease recurrence. Targeted therapy was restarted in 30 patients (93.8%) after relapse with excellent disease control rates (complete response: 3.3%, partial response: 36.7%, stable disease: 46.7%). Immediate postoperative targeted therapy was associated with better median progression-free survival (not reached vs 20.0 months; P = 0.017), but not better cancer-specific survival. Postoperative targeted therapy after complete metastasectomy seems to be associated with better progression-free survival in patients with metastatic renal cell carcinoma, but not with cancer-specific survival.

Response to preoperative chemotherapy in patients undergoing resection of pulmonary metastasis from soft tissue sarcoma – a predictor of outcome?

Approximately 50% of patients with high-grade soft tissue sarcoma (STS) will develop pulmonary metastasis. This is the most frequent cause of death and improving treatment is warranted. Preoperative chemotherapy is used for selected patients, usually those with less favorable prognosis and mainly outside clinical trials. The predicted value of histological and radiological response to preoperative chemotherapy on outcome was the main focus for this investigation.Patients and methods. This retrospective study comprises 93 patients with metachronous lung metastasis from STS who underwent complete metastasectomy alone (n = 41) or metastasectomy following preoperative chemotherapy (n = 52). Clinical data, histological and radiological responses to chemotherapy were recorded and survival analyses performed.Results. The time from initial STS diagnosis to the appearance of metastasis was shorter in the preoperative chemotherapy group than in those treated with surgery alone (p = 0.02). However, no statistical differences in post-metastasis disease-specific survival (DSS) or progression-free survival (PFS) between the groups were demonstrated. Patients in the preoperative chemotherapy group with good (complete) histological response had improved PFS compared with poor responders (p = 0.04). Radiological partial response was an independent, favorable prognostic factor for improved PFS and DSS (p = 0.003).Conclusion. Despite having unfavorable disease characteristics, some patients may benefit from preoperative chemotherapy. Both histological and radiological responses to preoperative chemotherapy seem to be prognostic in STS patients undergoing complete pulmonary metastasectomy.