Cytoreduction Nephrectomy in Metastatic Renal Cancer: The Results of
Southwest Oncology Group Trial 8949
James Metz, MD
OncoLink Associate Editor
Last Modified: May 22, 2000
Presenter: Robert Charles Flanigan
Affiliation: Southwest Oncology Group
Metastatic renal cancer has a poor prognisis and is
resistant to chemotherapy. A number of case series
have reported a
benefit to neprhectomy in patients with metastatic
renal cancer. This
prospective randomized trial was designed to
nephrectomy prior to systemic therapy with
interferon prolongs survival
Materials and Methods:
- 246 patients with operable metstatic renal
carcinoma and SWOG
performance status 0 - 1 were randomized to one of
1. Neprhectomy plus alpha interferon
2. Alpha interferon without nephrectomy.
- Interferon 5 Million Units was administered Q M-
W-F and continued
- The study was well balanced between arms for age,
gender and race.
However, there were more patients with better
performance status in the
- Median survival was 12.5 months vs. 8.1 months in
favor of the
nephrectomy group (p = 0.006)
- The 1-year actuarial survival was 50% vs. 37%,
again in favor of
- There was a poor response rate from interferon in
both arms (3% in
- There is a clear survival advantage to
nephrectomy prior to biologic
therapy based on the results of this trial.
- This represents a new algorithm for the
management of metastatic renal
call carcinoma in patients with good performance
- This study shows a greater than 50% improvement
in survival for
patients with metastatic disease who undergo
- The performance status can have a great imact on
survival, and the
imbalance between the two arms of this trial may
have contributed to the
differences in outcome.
- Fortunately, a recent EORTC trial with similar
design (presented last
month at the American Urologic Association meeting)
showed a survival
advantage also in favor of nephrectomy.
- Based on these two trials, surgery can be
considered in select
patients with good performance status when they
present with metastatic
- Further evaluation of appropriate systemic
therapy is warranted.
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