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Published in Renal Cell Carcinoma

Expert Opinion / Cases · March 08, 2015

Post-nephrectomy Patient With Spinal Metastasis

Written by
Sylvia Richey MD


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  • Andrew Fintel

    Apr 07, 2015

    We chose to treat this patient with Cyberknife radiation which she tolerated well. Although no randomized prospective trials exist in regards to systemic treatment following metastasectomy, we decided to offer her systemic therapy given that she is young and that there are restrospective studies showing improved progression free survival benefit. No overall survival benefit is known at this time for systemic therapy in this situation.  

  • Eric Wiedower

    Apr 14, 2015

    Which systemic therapy did you offer? The case had stated that she was working as a nurse at time of diagnosis. If she had insisted on working, I would consider pazopanib based on the more favorable QOL measures and noninferior PFS when compared to sunitinib. Does the retrospective data favor one targeted agent in this setting?

  • Andrew Fintel

    Apr 21, 2015

    We chose to treat her with Sunitinib. If she had more extensive metastases then and not just the one site of relapse that was able to be treated by local Cyberknife then I believe pazapanib may be a better choice for the reasons you listed above. At the time of this patients treatment, Sunitinib was being used extrapolating data from Adjuvant trials, but now based on the ASSURE trial there is no role for adjuvant Sunitinib. 

  • Nov 28, 2023

    Pending Moderator approval.

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