Cytoreductive RFA before sunitinib improves the OS

[Olga]

We discussed in the past that we feel that cytoreductive procedures - resections or ablations of the ASPS tumors, primary especially and bulky metastases also - improves the overall response to the chemotherapy treatments, so we would advocate having the primary and other tumors removed before starting these treatments. There are now some articles that support this hypothesis.
The study was done in the patients with metastatic RCC, this disease often behaves similar to ASPS.
Cytoreductive radiofrequency ablation in patients with metastatic renal cell carcinoma (RCC) with small primary tumours treated with sunitinib or interferon-α.
http://www.ncbi.nlm.nih.gov/pubmed/23746142
they found that a cytoreductive RFA
OS (overall survival) was significantly longer in the cRFA/sunitinib group compared with the sunitinib-alone. Patients received cRFA followed by sunitinib had their hazard ratio index reduced to HR = 0.71 comparing to sunitinib alone.
Of interest is that the study was done byTsimafeyeu I, Zart JS, Chung B, Kidney Cancer Research Bureau, Moscow, Russian Federation. I would advocate use this article as a starting conversation point for our patients in Russia and elsewhere when the patient is diagnosed in advanced ASPS metastatic state with the widespread metastases and any other local treatments (surgeries, ablations or radiosurgeries) besides systemic sunitinib or pazopanib are considered to be excessive. The article clearly demonstrates that a prior cytoreduction does improve the overall survival (OS) by at least 30% in RCC, and we expect that the result would be even better in the slow growing ASPS.