1. Does the embolization of the tumor, prior to radical nephrectomy, prologs the life of patients with renal cell carcinoma * Department of Urology Regional Specialistic Hospital, Wroclaw ** Clinic of Urology Medical Academy, Wroclaw L. Świebocki*, J. Lorenz**,

2. Patients  Cohort of 441 patients with RCC  178 women and 263 men  embolizing patients - group E: 180 (W- 68, M-112)  82/180 -embolization was the treatment of last resort  98/180 -radical nephrectomy done after embolization

3. Patients  98 - nephrectomised after embolization compared  261 - control group 110 - women and 151 - men nephrectomised during last 10 years Group K Group E

4. 38% 62% WomenMen 68 112 Both groups were statistically equal according to sex 42% 58% Group K 110 151 chi-square test - group E and K chi-square test - group E and K Comparison of groups E and K according to sex

5. U Mann-Whitney’s test Both groups were statistically equal according to age Comparison of groups E and K according to age

6. Distant metastases

7. Comparison of groups E and K according to tumor grade Both groups were statistically equal according to tumor stage chi-square test - group E and K chi-square test - group E and K

8. Tumor stage - TNM classification

9. Both groups were not equal statistically according do tumor stage chi-square test - group E and K chi-square test - group E and K

10. Groups of patients chosen for statistic analysis  Group E - from 97 embolized and nephrectomised patients, 91 with complete follow-up were separate  Group K - from 261 nephrectomised patients, 91 patients with the same: tumor stage, lymph node status, metastases and tumor grade were chosen

11. Comparison of new groups E and K according to age Both groups were statistically equal

12. Embolizing agents:  Ethanol - 134 cases  Ethanol + Gelfoam- 32 cases  Ethanol + Gianturco coil - 4 cases  Gianturco coil + gel foam- 2 cases  Gelfoam- 8 cases

13. Mechanism of alcohol ablation  perivascular necrosis  sluding of erythrocytes in small arteries  small artery spasms  endothelial damage and sloughing leading to occlusion  denaturation of blood proteins and injuries of the vascular endothelium inciting an intense thrombosis

14. Delay nephrectomy:  Varied from 3 to 273 days  75% of patients were nephrectomised before 47 day

15. Influence of delaying surgical treatment for better survival rate Group 1 time of delay until 30 days Group 2 time of delay 30-60 days Group 3 time of delay over 60 days

16. Comparison of general survival rate Kaplan-Meier’s curves Survival rate for E group patients was better, statistically significant p < 0,01

17. Comparison of 5-year survival rate - I 5

18. Comparison of 10-year survival rate - I 10

19. Influence of delaying surgical treatment for better survival rate Kaplan-Meier’s curves and F Cox - test, apparent difference in the median survival time

20. Impact of embolization on the general condition of the patients in stage IV RCC  Most of the patients within the study group had advanced cancer. Their general conditions at the time of diagnosis were very poor.  Together with general weakness, symptoms of circulatory insufficiency were also often present. These were: easily fatigability, peripheral edema.  The effect of embolization on half of all patients with unfavorable clinical symptoms resulting from the presence of advanced cancer, made it possible to undertake further surgical treatment.

21. Haematuria Percentage of patients with haematuria after embolization was significantly lower p < 0,0001

22. Loss of weight Percentage of patients with loss of weight after embolization was significantly lower, p < 0,0001

23. Loss of apetite Percentage of patients with loss of appetite after embolization was significantly lower

24. Anemia Percentage of patients with anemia after embolization was significantly lower p < 0,0001

25. Conclusions:  Embolization prior to nephrectomy performed in not infiltrating tumors prolongs the life of patients  Delaying of nephrectomy for 30-60 days after embolization provides to improve survival rate  Embolization performed in infiltrating kidney tumors didn’t prolong the life but was of value in improving the clinical status of patients