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According to a recent article published in the New England Journal of Medicine, clinical trial evidence suggests that patients with advanced renal cell carcinoma (RCC) may live longer with a combination of surgery (nephrectomy) and interferon versus interferon alone.

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. Advanced (metastatic) RCC 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.

Radical nephrectomy, removal of the involved kidney, is a standard surgical procedure for RCC 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. Advanced RCC is difficult to treat since it is unpredictable and resistant to chemotherapy. One standard approach for the treatment of advanced RCC typically includes interferon. Interferon is 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.

Researchers in the Southwest Oncology Group (SWOG) recently conducted a multicenter clinical trial examining the efficacy of surgery and interferon versus interferon alone for patients with advanced RCC. In the study, approximately 200 patients with advanced RCC were treated with either a radical nephrectomy prior to interferon treatment or interferon treatment alone. One year following treatment, 50% of patients treated with surgery and interferon were alive, compared to only 37% of patients treated with interferon only. The average duration of survival of patients that were treated with a combination of surgery and interferon was 11.1 months. For the patients treated with interferon alone, the average survival was 8.1 months.

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Although surgery as part of treatment for patients with advanced renal cell carcinoma has been a controversial issue, the results from this trial correlate with other recent trials indicating an improvement in survival duration for patients with advanced RCC treated with surgery prior to interferon, compared with interferon alone. Future clinical trials further evaluating this treatment regimen are warranted for patients with this disease and the risks of surgery versus the added duration of survival must be examined.

Patients with advanced RCC may wish to speak with their physician about the risks and benefits of treatment including nephrectomy plus interferon or the participation in a clinical trial evaluating this treatment regimen or other promising therapies.

New England Journal of Medicine, Vol 345, No 23, pp 1655-1659, 2001)

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