転移を有する腎細胞癌の治療

Abstract

Eighty-one renal cell carcinomas were experienced during 22 years period, 1953 to 1974, and 13 of them showed distant metastases. Six of 13 patients already had multiple distant metastases at the time of their initial hospital visit. All of six patients were treated by radiation and chemotherapy, and 3 of them had nephrectomy additionally. All of six patients died within two years regardless renal surgery. Nephrectomy seemed to have improved their survival very little except one in whom severe pain in the flank disappeared resulting in improvement of appetite. Of seven cases with solitary metastsis, 4 already had the lesion on their first hospital visit and 3 developed after nephrectomy. All of these 7 cases underwent nephrectomy followed by surgical excision of the metastatic lesion in 4 cases and radiation therapy in 3. As to survival, 5 of 7 patients are still alive 2 years to 3 years and seven months after nephrectomy associated with treatment on the metastatic lesion. This fact teaches us that renal cell carcinoma with solitary metastasis is well treated by nephrectomy and positive treatment upon the metastaic lesion. From above experience, we established our principle of the tretament of renal cell carcinoma. Nephrectomy should be considered whenever possible even in the cases with distant metastasis, but it should be carefully chosen in the cases with multiple metastatic foci because of operation mortality reaching 4.3%.