"Overview of Surgical Issues in the Treatment of Renal Cell Carcinoma"
David Swanson, MD

Speaker

Dr. David Swanson, MD is Professor of Urology at the U. of Texas MD Anderson Cancer Center, Houston, TX, where he has worked for more than 25 years. He earned his medical degree from the U. of Pennsylvania and trained in general surgery at UCLA-Harbor General Hospital. After serving two years in the US Army Medical Corps (including one year in Vietnam), he completed his urologic residency at the U. of California Davis and a fellowship at MD Anderson. He has published over 100 papers and book chapters.

Talk

SURGERY

In describing surgical treatment practiced at MD Anderson, Dr. Swanson indicated that:

  1. They do not routinely biopsy. They consider a high risk of false negatives.
  2. They do staging before treatment.
  3. They utilize helical CT with bolus contrast, which gives better resolution than traditional CT.
  4. They utilize Magnetic Resonance Angiography - described as excellent for visualizing IVC thrombus (vena cava involvement)
  5. He considers nephrectomy options to be open partial vs. laparoscopic radical.

ADJUVANT THERAPY

For patients who have No Evidence of Disease following nephrectomy, he listed the following adjuvant therapy options. He stressed that he felt these therapies should ONLY be practiced in a clinical trial setting.

  1. Autolymphocyte Therapy
  2. Interferon-alpha + 5-FU
  3. Interleukin-2
  4. Heat Shock Protein Vaccine
  5. Thalidomide

For this group of patients he gave the stage-specific follow up schedule for scans as that published by Levy, et al (and previously cited here on the KIDNEY-ONC list)

METASTASIS PRESENT WITH NEW RCC DIAGNOSIS

For these patients Dr. Swanson talked about the debate about when to remove the kidney. He said since the 1980's, MDA has started IFN-alpha first, then operated on positive responders. He talked about a study by Walther in 1977 at NCI, and said that randomized trials showed delayed progression and improved survival for nephrectomy first vs. biologic treatment only. "The jury is still out."

TREATMENT OF RESIDUAL RCC AFTER NEPHRECTOMY

He gave the following as reasons for surgical excision:

  1. Excision of mass [my notes are unclear here as to whether it referred to reduction of tumor mass or harvesting cells for vaccine therapy]
  2. Treat localized recurrence
  3. Solitary metastasis (as in lungs or brain)

For recurrence in the renal fossa (the kidney bed), Dr. Swanson recommends biological therapy first and then surgery. He said surgery could be palliative to address symptoms without being curative.

SUMMARY

Dr. Swanson stressed development of a game plan. Steps:

  1. Evaluate patient status and make plan
  2. Consider standard and new options
  3. Do the Nephrectomy despite presence of mets if:
    1. Clinical trial protocol requires tumor tissue
    2. Patient agrees to follow surgery with biological therapy later
    3. Patient has already had a good response to a biological therapy


This Kidney Cancer FAQ Page By PJ Boyle. Copyright 2001 PJ Boyle
Last Updated August 5, 2001