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Spontaneous regression of metastatic renal cell carcinoma: case report
© Lekanidi et al; licensee BioMed Central Ltd. 2007
Received: 18 June 2007
Accepted: 18 September 2007
Published: 18 September 2007
Spontaneous regression of metastatic renal cell carcinoma is rarely observed. A case of suspected spontaneous regression of pulmonary metastases following nephrectomy for histologically proven renal cell carcinoma without systemic treatment is presented along with a brief review of the literature.
Renal cell cancer accounts for 2% of all cancers and its incidence is steadily rising. It usually presents in late adult life and is more common in males than females. Although they are associated with Von Hippel-Lindau disease, adult polycystic kidney disease and multicystic nephroma, most renal cell cancers develop spontaneously .
The patient may present with urological symptoms such as haematuria or flank pain or with an abdominal mass or alternatively with systemic manifestations, such as anaemia and fever, or symptoms of metastatic disease and other rare phenomena .
Approximately 20% to 30% of patients with renal cell carcinoma present with metastatic disease, and 20% to 40% of patients undergoing nephrectomy for clinically localized disease will develop metastasis . If the tumor cannot be completely resected, the course is generally relentlessly progressive, with median survival of 12 to 18 months after metastasis. 85% of relapses occur in the first three years .
However, a group of patients with advanced disease have experienced improvements in survival, which is partly related to the introduction of immunotherapeutic approaches and a better understanding of the role and timing of cytoreductive nephrectomy. Although the benefits of immunotherapy have been displayed repeatedly by several studies, controversy has existed as to the need for adjunctive nephrectomy in treating metastatic patients. Removal of the malignant kidney may be of palliative benefit in some settings of metastatic renal cell carcinoma . There have been studies to demonstrate that the benefits of nephrectomy are in addition to and probably greater than the benefit resulting from the interferon-alpha that all patients would receive. Others argue that immunotherapy as a modality has had disappointingly little proven impact on the survival of patients with advanced renal cell carcinoma compared to a variety of other options with less toxicity .
Bumpus described the first reported case of spontaneous regression of metastatic renal cell carcinoma in 1928 . Metastatic sites include brain, bone, hilar adenopathy and most commonly pulmonary metastases. The clinical pattern of the improvement is not uncommonly the complete disappearance of disease, and often the regression is long-lasting. Many of these cases are associated with surgical removal of the primary tumor, but regression can also occur in association to radiation or embolization of the primary tumor .
The rarity of the observation and the heterogeneity of the clinical circumstances in which spontaneous regression of disease occurs do not provide the opportunity for insight into the pathophysiologic mechanism or into the capability for the identification of potential candidates for regression. Although no single mechanism can completely account for this phenomenon, it can be speculated that resection of the primary tumour may result in removal of a prometastatic or growth factor secreted by the tumour and/or promotion of apoptosis might be involved. Immunologic factors almost certainly play a role in some cases of spontaneous tumour regression and perhaps removal of bulk tumour enables or stimulates the immune system to control residual disease. Other theories include hormonal changes, trauma and changes in blood supply (via inhibition of angiogenesis by cytokines) .
It is important to recognize the existence of this clinical entity, which, although rare, might provide another argument in favour of surgical intervention or immunological treatment of metastatic renal cancer. The observation itself should also provide encouragement and drive to pursue immunologic as well as other investigations of the disease.
- Motzer RJ, Bander NH, Nanus DM: Renal-cell carcinoma. N Engl J Med. 1996, 335: 865-875. 10.1056/NEJM199609193351207.View ArticlePubMedGoogle Scholar
- Hamid Y, Poller DN: Spontaneous regression of renal cell carcinoma: a pitfall in diagnosis of renal lesions. Journal of Clinical Pathology. 1998, 51 (4): 334-337.View ArticlePubMedPubMed CentralGoogle Scholar
- Lam JS, Shvarts O, Leppert JT, Figlin RA, Belldegrun AS: Renal Cell Carcinoma 2005: new frontiers in staging, prognostication and targeted molecular therapy. J Urol. 2005, 173: 1853-1862. 10.1097/01.ju.0000165693.68449.c3.View ArticlePubMedGoogle Scholar
- Rabinovitch RA, Zelefsky MJ, Gaynor JJ, Fuks Z: Patterns of failure following surgical resection of renal cell carcinoma: implications of adjuvant local and systemic therapy. J Clin Oncol. 1994, 12: 206-212.PubMedGoogle Scholar
- Lam JS, Brenda A, Belldegrun AS: Evolving principles of surgical management and prognostic factors for outcome in renal cell carcinoma. J Clin Oncol. 2006, 24 (35): 5565-5575. 10.1200/JCO.2006.08.1794.View ArticlePubMedGoogle Scholar
- Coppin C, Porzsolt F, Awa A, Kumpf J, Goldman A, Wilt T: Immunotherapy for advanced renal cell cancer. Cochrane database of systematic reviews. 2004, Art. No: CD001425.-3Google Scholar
- Bumpus HC: The apparent disappearance of pulmonary metastasis in a case of hypernephroma following nephrectomy. J Urol. 1928, 20: 185-191.Google Scholar
- Lokich J: Spontaneous regression of metastatic renal cancer: case report and literature review. Am J Clin Oncol. 1997, 20 (4): 416-418. 10.1097/00000421-199708000-00020.View ArticlePubMedGoogle Scholar
- Papac RJ: Spontaneous regression of cancer. Cancer Treat Rev. 1996, 22: 395-423. 10.1016/S0305-7372(96)90023-7.View ArticlePubMedGoogle Scholar
- Nakajima T, Suzuki M, Ando S, Iida T, Araki A, Fujisawa T, Kimura H: Spontaneous regression of bone metastasis from renal cell carcinoma; a case report. BMC Cancer. 2006, 6: 11-10.1186/1471-2407-6-11.View ArticlePubMedPubMed CentralGoogle Scholar
- Hammad AM, Paris GR, Van Heuven WA, Thompson IM, Fitzsimmons TD: Spontaneous regression of choroidal metastasis from renal cell carcinoma. American Journal of Ophthalmology. 2003, 135 (6): 911-3. 10.1016/S0002-9394(02)01973-6.View ArticlePubMedGoogle Scholar
- Wyczólkowski M, Klima W, Bieda W, Walas K: Spontaneous regression of hepatic metastases after nephrectomy and metastasectomy of renal cell carcinoma. Urologia Internationalis. 2001, 66 (2): 119-20. 10.1159/000056586.View ArticlePubMedGoogle Scholar
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