Patients with advanced renal cancer who had the surgery followed by interferon chemotherapy lived an average of 11.1 months, compared with 8.1 months for those who had interferon treatment alone, says a report in the Dec. 6 issue of The New England Journal of Medicine.
"It certainly is not as wonderful a long-lasting result as we hoped," but it does increase time of survival, says study leader Dr. Robert C. Flanigan, professor and chairman of the department of urology at Loyola University Chicago's medical center. The study, funded by the National Cancer Institute, involved patients in 80 institutions around the country.The results are better for some patients in relatively good shape with no other disease, he says. "They probably live another five or six months on average," he says.
As word of the result spreads, the medical community is changing the way it treats these patients, Flanigan says. "We are seeing many more patients with advanced cancer who are referred to us for surgery," he says.
There will be 30,800 new cases of kidney cancer in the United States this year, with 12,100 deaths, the American Cancer Society estimates.
Most doctors have been reluctant to perform surgery on patients with advanced cancer, on the grounds that the benefits were not great enough to outweigh possible adverse effects.
"In the past, in general, most people felt it shouldn't be done," says Dr. Ian F. Tannock, professor of medical oncology at Princess Margaret Hospital, in Toronto and author of an accompanying editorial. "If it was a big tumor with small metastases [colonies that have spread outside the original site of the cancer], there would be a clinical decision to take it out, but most of the time it would not be done."
It's not exactly clear why surgery produces a survival benefit, Tannock says. "I don't buy the idea that it allows interferon to work better. Perhaps just removing the bulk may reduce the output of molecules that cause local symptoms, such as pain or bleeding," he says.
Flanigan says the results might be better if surgery is combined with more advanced chemotherapeutic drugs, such as interleukin-2. Other studies have shown improved survival with more aggressive therapy without surgery, he says.
The finding also has implications for patients with advanced forms of other cancers, Flanigan says. "We do think it is worthy of exploration," he says.
Tannock says, "There are sufficient grounds to do other appropriate trials," though he says he knows of no specific plans for such studies.
What To Do
Patients with metastatic renal cancer, and their families, should discuss the value of surgery with their physicians.