Outcome analysis of treatment of local recurrences of renal cell carcinoma

Purpose: to evaluate results of treatment of local recurrences of renal cell carcinoma (RCC).
Material and methods: a retrospective analysis of 119 consecutive patients with local recurrence of RCC after nephrectomy treated from 1975 to 2007 at Cancer Research Center was performed. Mean age of the patients was 52.2 (19—75) years. A male to female ratio was 1.3:1. Local recurrences were localized in the renal fossa in 49 (41.2%), in retroperitoneal lymph nodes - in 46 (38.7%), in both renal fossa and retroperitoneal lymph nodes — in 24 (20.1%) cases. The tumor invaded neighboring organs in 59 (49.6%) of 119 patients. Metastases in the postoperative scar were diagnosed in 27 (22.7%), distant secondaries — in 38 (31.9%) cases. Surgery was performed in 78 (65.5%) cases (complete — 60 (76.9%), incomplete — 13 (16.7%), exploratory — 5 (6.4%)), 41 (34.5%) patients received conservative treatment. Neoadjuvant and/or adjuvant immunotherapy and/or chemotherapy were used in 14 (17.9%) of 78 patients treated with surgery. Of 41 (34.5%) patients receiving conservative treatment immunotherapy was administered in 25 (61.0%), chemotherapy — in 1 (2.4%), immunochemotherapy - in 11 (26.8%), hormonotherapy — in 4 (9.8%) (tamoxifen). Median follow-up was 23.3 (1—126) months.
Results: Local recurrences were diagnosed a median of 33.0 (1-151) months after nephrectomy. Progression was registered in 33 (55.0%) of 60 patients following a complete removal of the relapse a median of 23.7 months after surgery (local — 10, distant metastases — 13, both local and distant metastases — 10). Four (12.1%) patients underwent repeat removal of the recurrent tumors, 29 (87.8%) received conservative treatment with no response. One-, 3- and 5 -year disease-specific survival of 119 patients was 72.6%, 41.4% and 30.5% respectively (median — 25.7±5.9 months). In the univariate analysis survival was affected by complete removal of the relapse (p=0.001), number of recurrent nodes (p=0.006), distant metastases (p=0.013) and presence of clinical symptoms (p=0.004). In the multivariate analysis the only factors affected survival significantly were radical surgery (p 0.005) and clinical symptoms of the relapse (p 0.024).
Conclusion: Surgery is the only effective method of treatment in isolated recurrence of RCC following nephrectomy.