METASTASES OF RENAL-CELL CARCINOMA

The prognosis of renal cell carcinoma (RCC) is related to the initial staging, assessed by nephrectomy. Metastases are present at the time of diagnosis in 30% of cases. Solitary metastases are rare. The most common metastatic sites include lungs, lymph nodes and bones. Anatomical pathways as well as local events in the secondary sites are responsible for the site specificity of the tumor spread. Patients with disseminated disease have a 5 years survival rate of less than 10 %. RCC is intrinsically chemoresistant. Vinblastine leads to a global response rate (RR) of 15 %. In view of the lack of effective chemotherapeutic agents, interest has been directed towards the potential value of biological response modifiers (BRM). Response rates are about 15 % with IFN-alpha. Significant synergy between IFN-alpha and vinblastine has not been proved. Interleukin-2 (IL-2) with or without Lymphokine Activated Killer (LAK) cells leads to a RR of 20 %. Some durable complete remissions have been reported. Ideal doses and schedules remain to be determined.