Zusammenfassung
Hintergrund
Es existieren vielfache Hinweise auf den kurativen Effekt der Resektion sich metachron entwickelnder Metastasen beim Nierenzellkarzinom (NZK) als Alternative zur Systemtherapie. Hier stellt sich die Frage, ob auch Patienten mit primär oligometastasiertem NZK von einem rein chirurgischen Behandlungskonzept als Alternative zu einer mit einer Resektion des Primärtumortumors kombinierten hocheffektiven systemischen Behandlung profitieren können.
Material und Methoden
Es erfolgte eine unstrukturierte Literaturrecherche in PubMed und die Bewertung der Publikationen, inklusive systemischer Reviews und Metaanalysen durch die Autoren. Die Arbeiten wurden in den klinischen Kontext gesetzt.
Ergebnisse und Diskussion
Beim NZK existiert keine einheitliche Definition einer Oligometastasierung. Daten zur Metastasektomie, die häufig gute Langzeitergebnisse beschreiben, beziehen sich oftmals auf die metachrone Metastasierung. So oder so gilt es in der primären Oligometastasierung, die vorherige zytoreduktive Nephrektomie kritisch zu evaluieren. Bei Metastasierung in Lunge, Knochen, zentralem Nervensystem (ZNS), Leber, Nebenniere und Schilddrüse scheint eine primär chirurgische Strategie in der primär oligometastasierten Situation eine wichtige Therapiesäule darstellen zu können. Die systemischen Kombinationstherapien haben bei der primären Behandlung einer Oligometastasierung im Vergleich zum primär chirurgischen Vorgehen bei einem ideal definierten Patienten noch keine „prime time“, dies könnte sich je nach Verfügbarkeit randomisierter Studien möglicherweise ändern. Gegenwärtig kann die therapeutische Entscheidung nur aus einem v. a. auch die Patientenpräferenz berücksichtigenden multidisziplinären Konsens resultieren.
Abstract
Background
Long-term remission can be achieved by surgery in patients with metastatic renal cell carcinoma (mRCC), without chronic toxicity due to systemic treatment. Data on metastasectomy are mostly based on observations of metachronous metastasis. However, it is unclear whether patients with synchronous oligometastasis may also benefit from surgery alone as an alternative to highly effective systemic treatment combined with resection of the primary tumor.
Materials and methods
The authors performed an unstructured literature search in PubMed including systematic reviews and meta-analyses. Results are discussed in regard of the current data and clinical practice.
Results and discussion
Although there is no uniform definition for oligometastasis in mRCC, cytoreductive nephrectomy in selected patients seems to be mandatory before metastasectomy is performed in primary oligometastatic RCC. In particular, in those patients with oligometastasis of the lung, bone, central nervous system, liver, adrenal gland, and thyroid, metastasectomy appears to be an important therapeutic option. Ultimately, among the therapeutic options, surgery is also an important therapeutic approach in primary oligometastatic mRCC. A balanced consideration between surgery, other local therapies, and modern systemic treatment demands interdisciplinary decision-making that takes into account the patients’ preference.
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P. Ivanyi: Honorare und Berater und Studientätigkeit: BMS, Ipsen, Bayer, EUSA, EISAI, ROCHE, Merck Serono. MSD. M. Kuczyk gibt an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Ivanyi, P., Kuczyk, M. Primär oligometastasiertes Nierenzellkarzinom – Welchen Stellenwert hat heutzutage die Chirurgie?. Urologe 60, 1546–1554 (2021). https://doi.org/10.1007/s00120-021-01700-8
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DOI: https://doi.org/10.1007/s00120-021-01700-8