Downsizing a Tumor Thrombus of Advanced Renal Cell Carcinoma with Neoadjuvant Systemic Therapy and Resulting Histopathological Effects

Background: We report a treatment option in surgical therapy of locally advanced renal cell carcinoma (RCC). Method: A 63-year-old patient with locally advanced RCC including an atrial thrombus underwent 2 cycles of neoadjuvant therapy (Sutent® 50 mg daily for 4 weeks followed by 2 weeks off) and then tumor surgery. Primary surgical therapy had to be delayed because of suspected bronchial carcinoma and additional diagnostics. After neoadjuvant therapy to downsize the tumor thrombus and exclusion of any additional malignant tumors, operation was done via abdominal access; no sternotomy was necessary. Results: Histopathological examinations of the primary tumor after tyrosine kinase inhibitor therapy were evaluated and compared to tumor biopsy material taken before therapy. Conclusion: Neoadjuvant therapy with Sutent® may represent a favorable treatment option in cases of locally advanced clear-cell RCC with extended tumor thrombus.