Renal cell carcinoma accounts for about 2-3% of all malignancies. It is characterized by a high frequency of metastases, which are most often observed in the lungs, bones, liver, brain and regional lymph nodes. Literature highlights the rare occurrence of renal cancer metastases to the head and neck, even though it is the third most common cancer that metastasizes to the head and neck. Below we present a case report of metastases of clear cell carcinoma from a kidney to the organs of the head and neck. The analysis was carried out retrospectively based on medical records of a patient hospitalized at the Department of Otorhinolaryngology, Head and Neck Surgery of the Medical University of Warsaw in the years 2009-2019. We describe an 81-year-old man after left-sided nephrectomy due to clear cell carcinoma, with numerous distant metastases, who was diagnosed with metastases to the left submandibular salivary gland 8 years after primary surgery, followed by a diagnosis of metastasis to the right submandibular salivary gland 3 years later. The patient underwent 2 radical procedures to remove the submandibular salivary glands. Due to the presence of lung metastases, treatment with a tyrosine kinase inhibitor was also implemented.
Objective: Results of second-line everolimus treatment in clear cell renal carcinoma. Material and methods: Clinical data of 32 patients of the Clinic of Systemic and Metastatic Malignancies, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute (Krakow Branch) treated with second-line everolimus between 2011 and 2016 were analysed. Results: Median progression-free survival was 7 months. Stable disease was observed in 24 cases. Adverse events occurred in 59% of all patients, and the majority were mild and moderate (G1 and G2) according to CTCAE. The most frequent adverse events included anaemia, stomatitis, rash and fatigue. Conclusion: Molecularly targeted drugs offer the only effective and available therapy in Poland, which can be administered in patients with advanced renal cell carcinoma. Second-line everolimus is a valuable therapeutic option in the above mentioned group (following progression on first-line TKI therapy), especially when it is necessary to avoid the accumulation of similar adverse events after TKI treatment (different toxicity profiles).
Cabozantinib, the latest available in Poland medication for the treatment of renal cell carcinoma, registered in this indication by the European Medicines Agency (EMA) in September 2016, has been available in several cancer centers in Poland since November 2016 as part of the expanded access program. Primary hypothyroidism is a common complication during thyrosine kinase inhibitors (TKI) treatment, although there are few reports of its occurrence during treatment with cabozantinib, which belongs to this medication group. We present a case of rapid development of clinically apparent hypothyroidism after cabozantinib treatment and report data on this complication in the group of our patients.
The purpose of this article is to discuss the use of therapeutic options for the first-line systemic treatment of patients with advanced renal cell carcinoma under the B.10 drug program effective in Poland as of May 2022 - with a focus on intermediate and high-risk patient populations according to the IMDC. The specific situation created by reimbursement conditions with the exclusion of regimens combined with a tyrosine kinase inhibitor and immune checkpoint inhibitors along with the marginalisation of the use of an mTOr inhibitor necessitates a choice between two-drug immunotherapy or an antian giogenic drug in monotherapy. In this context, choosing the right treatment in the context of specific clinical situations is a challenge.
A 64-year-old woman presented with contralateral right adrenal metastasis with adrenal vein thrombus, which was diagnosed many years after left nephrectomy with adrenalectomy due to renal cell cancer. The patient underwent right adrenalectomy with adrenal vein tumor thrombectomy for treatment. The pathologic examination confirmed metastatic clear cell carcinoma. The remote but existing risk of developing contralateral adrenal metastasis (CAM) after primary radical nephrectomy supports the idea of sparing the adrenal gland in suitable patients who undergo radical nephrectomy. Contralateral adrenal metastasis from RCC is a rare finding with the potential benefit of cure after resection. Care must be taken in preoperative diagnostics, as this metastasis is capable of causing inferior vena cava tumor thrombus via the suprarenal venous route. According to our knowledge, our case is the second similar entity described in literature so far.
PL
U 64-letniej chorej stwierdzono przerzut do przeciwległego nadnercza wraz z obecnością czopu nowotworowego w żyle nadnerczowej, który został rozpoznany wiele lat po lewostronnej nefrektomii wraz z adrenalektomią, wykonanej z powodu raka nerkowokomórkowego. Pacjentka została poddana prawostronnej adrenalektomii z usunięciem czopa nowotworowego z żyły nadnerczowej. W badaniu histopatologicznym potwierdzono przerzut raka jasnokomórkowego. Ryzyko wystąpienia przerzutu do przeciwległego nadnercza po pierwotnej radykalnej nefrektomii istnieje, choć jest niewielkie, dlatego zasadne wydaje się zachowanie nadnercza w wybranej grupie chorych poddawanych radykalnej nefrektomii. Występowanie zmian wtórnych raka nerkowokomórkowego w przeciwległym nadnerczu jest rzadko spotykane, natomiast resekcja guza wiąże się z możliwością wyleczenia. Konieczna jest staranna diagnostyka przedoperacyjna w związku ze zdolnością przerzutu raka nerkowokomórkowego do tworzenia czopa nowotworowego w żyle głównej dolnej drogą żył nadnerczowych. Wedle wiedzy autorów niniejszy przypadek jest drugim tego rodzaju opisywanym dotąd w literaturze przedmiotu.
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