2
|
Josephides E, Rodriguez-Vida A, Galazi M, Chowdhury S, Suder A. The role of metastasectomy in renal cell carcinoma. Expert Rev Anticancer Ther 2014; 13:1363-71. [PMID: 24236818 DOI: 10.1586/14737140.2013.856762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite significant advances in the systemic treatment of metastatic renal cell carcinoma, long-term survival remains low. A potential way to improve outcomes in selected cases is the use of metastasectomy, which is part of the multimodal treatment of this disease. Although the evidence supporting this approach is limited, we believe it is a reasonable option for certain patients. This review summarizes the evidence supporting this approach.
Collapse
Affiliation(s)
- Eleni Josephides
- Department of Medical Oncology, Guy's Hospital, London, SE1 9RT, UK
| | | | | | | | | |
Collapse
|
3
|
Gutenberg A, Nischwitz MD, Gunawan B, Enders C, Jung K, Bergmann M, Feiden W, Egensperger R, Keyvani K, Stolke D, Sure U, Schroeder HWS, Warzok R, Schober R, Meixensberger J, Paulus W, Wassmann H, Stummer W, Blumcke I, Buchfelder M, van Landeghem FKH, Vajkoczy P, Günther M, Bedke J, Giese A, Rohde V, Brück W, Füzesi L, Sander B. Predictive chromosomal clusters of synchronous and metachronous brain metastases in clear cell renal cell carcinoma. Cancer Genet 2014; 207:206-13. [PMID: 25027636 DOI: 10.1016/j.cancergen.2014.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/01/2014] [Accepted: 05/10/2014] [Indexed: 01/21/2023]
Abstract
Synchronous (early) and metachronous (late) brain metastasis (BM) events of sporadic clear cell renal cell carcinoma (ccRCC) (n = 148) were retrospectively analyzed using comparative genomic hybridization (CGH). Using oncogenetic tree models and cluster analyses, chromosomal imbalances related to recurrence-free survival until BM (RFS-BM) were analyzed. Losses at 9p and 9q appeared to be hallmarks of metachronous BM events, whereas an absence of detectable chromosomal changes at 3p was often associated with synchronous BM events. Correspondingly, k-means clustering showed that cluster 1 cases generally exhibited low copy number chromosomal changes that did not involve 3p. Cluster 2 cases had a high occurrence of -9p/-9q (94-98%) deletions, whereas cluster 3 cases had a higher frequency of copy number changes, including loss at chromosome 14 (80%). The higher number of synchronous cases in cluster 1 was also associated with a significantly shorter RFS-BM compared with clusters 2 and 3 (P = 0.02). Conversely, a significantly longer RFS-BM was observed for cluster 2 versus clusters 1 and 3 (P = 0.02). Taken together, these data suggest that metachronous BM events of ccRCC are characterized by loss of chromosome 9, whereas synchronous BM events may form independently of detectable genetic changes at chromosomes 9 and 3p.
Collapse
Affiliation(s)
- Angelika Gutenberg
- Department of Neurosurgery, Georg August University, Göttingen, Germany; Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany.
| | - Martin D Nischwitz
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Bastian Gunawan
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Christina Enders
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Klaus Jung
- Department of Medical Statistics, Georg August University, Göttingen, Germany
| | - Markus Bergmann
- Department of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Wolfgang Feiden
- Departments of Gastroenteropathology and Neuropathology, University of the Saarland, Homburg, Germany
| | - Rupert Egensperger
- Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany
| | - Dietmar Stolke
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University of Duisburg-Essen, Essen, Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany
| | - Rolf Warzok
- Department of Neuropathology, Ernst Moritz Arndt University, Greifswald, Germany
| | - Ralf Schober
- Department of Neuropathology, University of Leipzig, Leipzig, Germany
| | | | - Werner Paulus
- Department of Neuropathology, Westphalian Wilhelm University, Münster, Germany
| | - Hansdetlef Wassmann
- Department of Neurosurgery, Westphalian Wilhelm University, Münster, Germany
| | - Wolfgang Stummer
- Department of Neurosurgery, Westphalian Wilhelm University, Münster, Germany
| | - Ingmar Blumcke
- Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Frank K H van Landeghem
- Department of Neuropathology, Charité University Medicine, Berlin, Germany; Department of Neuropathology, University of Alberta, Edmonton, Canada
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Marlis Günther
- Department of Pathology, Health Care Center Brandenburg, Brandenburg, Germany
| | - Jens Bedke
- Department of Urology, Eberhard Karls University, Tübingen, Germany
| | - Alf Giese
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg August University, Göttingen, Germany
| | - Wolfgang Brück
- Department of Neuropathology, Georg August University, Göttingen, Germany
| | - Laszlo Füzesi
- Department of Gastroenteropathology, Georg August University, Göttingen, Germany
| | - Bjoern Sander
- Stereology and Electron Microscopy Laboratory, Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
Syrios J, Kechagias G, Tsavaris N. Prolonged survival after sequential multimodal treatment in metastatic renal cell carcinoma: two case reports and a review of the literature. J Med Case Rep 2012; 6:303. [PMID: 22978809 PMCID: PMC3459787 DOI: 10.1186/1752-1947-6-303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 07/23/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In this case series and short review of the literature, we underline the impact of nephrectomy combined with sequential therapy based on cytokines, antiangiogenic factors, and mammalian target of rapamycin inhibitors along with metastasectomy on overall survival and quality of life in patients with metastatic clear cell renal carcinoma. CASE PRESENTATION In the first of two cases reported here, a 53-year-old Caucasian man underwent a radical left nephrectomy for renal cell cancer and relapsed with a bone metastasis in his right humerus. He was treated with closed nailing and cytokine-based chemotherapy. For 5 years, the disease was stable and he had great improvement in quality of life. Subsequently, the disease relapsed in his lymph nodes, lung, and thorax soft tissue. He was then treated with antiangiogenic factors and mammalian target of rapamycin inhibitors. The disease progressed until September 2009, when he died of allergic shock during a blood transfusion, 9 years after the initial diagnosis of renal cell cancer.In the second case, a 54-year-old Caucasian man underwent a radical left nephrectomy for renal cell cancer. A year later, the disease progressed to his neck lymph nodes, and cytokine-based chemotherapy was initiated. While he was on cytokines, a solitary pulmonary nodule appeared and he underwent a metastasectomy. Nine months later, magnetic resonance imaging of his brain revealed a focal right occipitoparietal lesion, which was resected. After two years of active surveillance, the disease relapsed as a pulmonary metastasis and he was treated with an antiangiogenic factor. Further progressions presenting as enlarged axillary lymph nodes, chest soft tissue lesions, and thoracic spine bone metastases were sequentially observed. He then received a first-generation mammalian target of rapamycin inhibitor, an antiangiogenic factor, and later a second-generation mammalian target of rapamycin inhibitor and palliative radiotherapy. Ten years after the initial diagnosis of renal cell cancer, his disease is stable and he is on a third antiangiogenic factor and leads an active life. CONCLUSIONS One multidisciplinary approach to patients with metastatic renal cell cancer combines nephrectomy, metastasectomy, and radiotherapy (when feasible) with medical therapy based on cytokines and targeted treatment employing agents inhibiting angiogenesis, other receptor tyrosine kinases, and mammalian target of rapamycin. This approach could prolong survival and improve quality of life.
Collapse
Affiliation(s)
- John Syrios
- Department of Pathophysiology, Oncology Unit, Laikon General Hospital, Athens University School of Medicine, 75 Mikras Asias street, Athens, 11527, Greece.
| | | | | |
Collapse
|
5
|
Buse S, Bedke J, Kurosch M, Haferkamp A, Unterberg A, Herfarth K, Hohenfellner M. [Brain metastases in cases of renal cell carcinoma]. Urologe A 2007; 46:36-9. [PMID: 17186191 DOI: 10.1007/s00120-006-1267-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Brain metastases represent the most common intracranial neoplasia. The lung, breast and kidney are the primary tumor locations most often associated with brain metastasis. Seizures and neurological impairment are typical manifestations of neoplastic cerebral dissemination, which, when untreated, usually lead to death within a few months. In this review, we discuss whole brain radiotherapy, surgical resection and stereotactic radiosurgery as the currently used therapeutic options for renal cell cancer metastasis in the brain.
Collapse
Affiliation(s)
- S Buse
- Urologische Universitätsklinik, Ruprecht-Karls-Universität, 69121, Im Neuenheimer Feld 110, Heidelberg, Deutschland.
| | | | | | | | | | | | | |
Collapse
|
7
|
Wowra B, Siebels M, Muacevic A, Kreth FW, Mack A, Hofstetter A. Repeated gamma knife surgery for multiple brain metastases from renal cell carcinoma. J Neurosurg 2002; 97:785-93. [PMID: 12405364 DOI: 10.3171/jns.2002.97.4.0785] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to evaluate the therapeutic profile of repeated gamma knife surgery (GKS) for renal cell carcinoma that has metastasized to the brain on multiple occasions. METHODS Data from this study were culled from a single institution and cover a 6-year period of outpatient radiosurgery. A standard protocol for indication, dose planning, and follow up was established. In cases of distant or local recurrences, radiosurgery was undertaken repeatedly (up to six times in one individual). Seventy-five patients harboring 350 cerebral metastases were treated. Relief from pretreatment neurological symptoms occurred in 72% of patients within a few days or a few weeks after the procedure. The actuarial local tumor control rate after the initial GKS was 95%. In patients free from relapse of intracranial metastases after repeated radiosurgery, long-term survival was 91% after 4 years; median survival was 11.1+/-3.2 months after radiosurgery and 4.5+/-1.1 years after diagnosis of the primary kidney cancer. Survival following radiosurgery was independent of patient age and sex, side of the renal cell carcinoma, pretreatment of the cerebrum by using radiotherapy or surgery, number of brain metastases and their synchronization with the primary renal cell carcinoma, and the frequency of radiosurgical procedures. In contrast, survival was dependent on the patient's clinical performance score and the extracranial tumor status. Tumor bleeding was observed in seven patients (9%) and late radiation toxicity (LRT) in 15 patients (20%). Treatment-related morbidity was moderate and mostly transient. Late radiation toxicity was encountered predominantly in long-term survivors. CONCLUSIONS Outpatient repeated radiosurgery is an effective and only minimally invasive treatment for multiple brain metastases from renal cell cancer and is recommended as being the method of choice to control intracranial disease, especially in selected patients with limited extracranial disease. Physicians dealing with such patients should be aware of the characteristic aspects of LRT.
Collapse
Affiliation(s)
- Berndt Wowra
- Gamma Knife Praxis, Department of Urology, Ludwig-Maximilians-Universily, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
8
|
Fischer CG, Schmid H. Operative therapy in disease progression and local recurrence of renal cell carcinoma. Urol Int 1999; 63:10-5. [PMID: 10592484 DOI: 10.1159/000030412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
When local recurrence or distant metastasis occurs, the question arises as to which therapeutic concept should be applied. In contrast to the data on systemic immunotherapy, there are no systematic studies on surgical management of metastasis. Local recurrence (a rare condition) is frequently resected, whereby a prolongation of life can be achieved in individual cases. The complete surgical resection of pulmonary metastases has been shown, in a number of studies, to achieve a survival rate of 5 years in up to 44% of the cases. There are only few data regarding resection of osseous metastases; although in this respect some studies have reported an average survival rate of 34 months, the indication for this condition has, up to now, usually been seen as palliative. The prognosis of liver or brain metastasis is unfavorable; the survival rates achieved with the help of surgical procedures are scarcely higher than those resulting from the spontaneous progression of metastatic renal carcinoma (12 months). Thus, there is an urgent need for further studies in order to define the indication for the surgical management of metastasis.
Collapse
Affiliation(s)
- C G Fischer
- Department of Urology, University of Giessen, Germany.
| | | |
Collapse
|