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A radical nephrectomy prior to treatment with interferon appears to significantly delay cancer progression and improve survival over interferon alone for patients with metastatic renal cell cancer, according to a recent article published in The Lancet.

The kidneys are a pair of bean shaped organs located on each side of the spine. The kidneys filter the blood and eliminate waste in the urine through a complex system of filtration tubules. All of the blood in the body passes through the kidneys approximately 20 times an hour. Renal cell cancer is an uncommon form of cancer that is most often characterized by the presence of cancer cells in the lining of the filtration tubules of the kidney. Metastatic renal cell cancer refers to cancer that has spread outside the kidneys to distant locations in the body. The prognosis for patients with metastatic renal cell cancer following standard therapy is poor and novel treatment strategies are being evaluated to establish optimal care.

A radical nephrectomy, or complete removal of the involved kidney, is a standard surgical procedure for renal cancer that is confined to the kidney. However, physicians’ opinions differ on whether this procedure is beneficial in patients whose cancer has already spread outside the kidney to distant sites in the body. Standard treatment for metastatic renal cell cancer typically includes interferon, a substance naturally produced in the body that stimulates the immune system to initiate an attack against foreign substances, such as bacteria or cancer cells.

A recent multi-institutional clinical trial was conducted to further evaluate the efficacy of treatment involving a radical nephrectomy prior to interferon in 85 patients with metastatic renal cell cancer. In this trial, half of the patients were treated with a radical nephrectomy prior to interferon and the other half were treated with interferon alone. Following treatment, the average time to the progression of cancer was 5 months for patients treated with a radical nephrectomy plus interferon, compared with 3 months in the group of patients treated with interferon alone. The average survival time following treatment was 17 months in the group patients treated with surgery, compared with only 7 months for patients treated with interferon only. Five patients who were treated with surgery and interferon achieved a complete disappearance of their cancer, compared with one patient treated only with interferon.

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Although this is a controversial issue, the results from this small trial indicate a significant improvement in survival duration for patients with metastatic renal cell cancer treated with a radical nephrectomy prior to interferon, compared with interferon alone. Future clinical trials further evaluating this treatment regimen are warranted for patients with this disease. Patients with metastatic renal cell cancer may wish to speak with their physician about the risks and benefits of treatment including a radical nephrectomy plus interferon or the participation in a clinical trial evaluating this treatment regimen or other promising therapies. (The Lancet, Vol 358, No 9286, pp 966-970, 2001)

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