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CASE REPORT: RENAL CARCINOMA WITH LUNG METASTASIS TREATED WITH INTERFERON ALFA IN THE ERA OF TARGETED THERAPY AND IMMUNOTHERAPY
Apresentação do caso
A 64 year old male presenting hematuria seen mass in the upper two thirds of the left kidney. Underwent left nephrectomy in another service. Referred to our service for oncologic follow-up. Anatomopathology (AP): renal cell carcinoma clear cell type grade 3 nuclear, free surgical margins pT1b. Chest tomography (CT) showed a solid nodule in the left lower lobe (LLL). Nodulectomy was performed in LLL, with AP: metastatic adenocarcinoma in lung compatible with renal clear cell carcinoma. Performed treatment with interferon alpha (IFN-α) 3 times a week, 13 cycles. A restaging chest CT, nodule was remain in LLL and lobectomy was performed. AP: metastatic clear cell carcinoma in lung with free margins. Restarted IFN-α 30 days after surgery, 11 cycles, no evidence of active disease after restaging exams. Suspended IFN-α and maintained exclusive follow-up until the present moment with no evidence of disease recurrence (58 months since diagnosis).
Renal cell carcinoma (RCC) accounts for about 4% of all solid tumors. In about one third of patients RCC is diagnosed at an advanced stage; metastatic disease occurs in approximately 30% of cases after primary surgery. Metastases from RCC are often multifocal, commonly involving the lungs (45%), bones, lymph nodes, liver, brain and (more rarely) the other viscera and endocrine organs. The cytokine era introduced IFN-α as a therapy for RCC. Early studies demonstrated overall survival gain with cytoreductive nephrectomy in patients with metastatic disease, treated with IFN-α. Currently, anti-VEGF molecular target therapy and more recently the introduction of immunotherapy have been widely used in first and second-line treatment, with IFN-α only used in selected patients. Local treatment of oligometastases in RCC, such as lung surgery, has been shown to be safe and offer survival benefits. Indication for surgery is based on respiratory function, extent of lung damage and control of the primary tumor.
The reported case exemplifies a patient with renal malignancy with lung metastasis treated with surgery and IFN-α, with good results and no evidence of disease to date.
renal cancer, oligometastasis, interferon
PETRIANE ROCHA MENDES CHAVES, MAYSA LEMOS SIMOSONO, TALITA SPOSITO