UroToday.com - Bone, lung, pleural and liver metastases from renal cell carcinoma (RCC) are common sites. Sometime surgical resection is recommended in cases in which the metastasis is resectable and the patient's performance status is good. However, most of patients are treated with immunotherapy or/and molecular target drugs. Recently bisphosphonate zoledronic acid (ZA) has become widely accepted as a standard treatment for bone pain caused by bone metastasis from RCC as well as other many cancers. In this article we reported the case in which ZA was extremely effective in treating not only multiple bone metastases but also lung, pleural and liver metastases from RCC. ⁽¹⁾

The patient was a 37-year-old woman diagnosed as having right RCC, who was treated by radical right nephrectomy for cancer of the right kidney (cT2, N0, M0). Two months after the surgery, lung metastases were detected bilaterally on chest CT. Since we were not generally able to use molecular target drugs until the autumn of 2008 in Japan, interferon α (IFN-α) therapy, complete resection of lung metastasis, and interleukin 2 (IL-2) were performed. However, chest CT revealed an appearance of multiple lung metastases less than 1 cm at at least 18 sites and aggravation of metastases to pleura with left pleural effusion several months later. She refused active treatments afterward and hoped for only conservative treatment.

Several months later, she felt bone pain at left ankle. Bone scintigraphy identified multiple bone metastases including the left ankle from RCC. Therefore, we have begun to use ZA, at first, in expectation of improvement of the bone pain due to bone metastases. Marked improvement of bone metastasis was observed following treatment with ZA at the dose of 4 mg administered once every 4 weeks. Surprisingly, lung, plural and liver metastases also diminished markedly in size in response to the treatment. The metastases have shown no progression for 21 months since starting the ZA treatment.

We are continuing administration of ZA every 4 weeks. We believe that present report is the first report that ZA monotherapy is effective for lung, pleural and liver metastases from RCC.

References

1. Miwa S, Mizokami A, Konaka H, Izumi K, Nohara T, Namiki M. A Case of Bone, Lung, Pleural and Liver Metastases from Renal Cell Carcinoma Which Responded Remarkably Well to Zoledronic Acid Monotherapy. Jpn J Clin Oncol 2009.

Written by Atsushi Mizokami, MD, et al. as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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