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Rich BJ, Noy MA, Dal Pra A. Stereotactic Body Radiotherapy for Localized Kidney Cancer. Curr Urol Rep 2022; 23:371-381. [PMID: 36383304 DOI: 10.1007/s11934-022-01125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE OF REVIEW Stereotactic body radiation therapy (SBRT) is increasingly utilized in the management of localized kidney cancers, particularly for patients who are not surgical candidates. Herein, we provide a narrative review of SBRT in the management of localized kidney cancers. RECENT FINDINGS Recent prospective studies and multi-institutional retrospective studies highlight the safety and efficacy of SBRT in the management of renal tumors, a disease previously thought to be radioresistant. Studies have shown that local control is greater than 90% with rare grade 3 or 4 toxicity and no grade 5 toxicity. SBRT can be utilized successfully in the treatment of large kidney tumors (> 5 cm). New techniques such as MRI-guided radiation therapy may further improve the therapeutic ratio. However, randomized clinical trials are necessary to confirm the optimal dosing schedule and compare outcomes with nephrectomy, which remains the standard of care in suitable patients. Advances in SBRT have made this modality a safe and effective treatment option in the management of localized kidney cancers.
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Affiliation(s)
- Benjamin J Rich
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Alan Dal Pra
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
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2
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High-dose-rate surface brachytherapy as a treatment option for renal cell carcinoma cutaneous metastases. J Contemp Brachytherapy 2021; 13:331-337. [PMID: 34122574 PMCID: PMC8170516 DOI: 10.5114/jcb.2021.105947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this study was to present a case of complete clinical response of renal clear cell carcinoma cutaneous metastases after high-dose-rate surface brachytherapy (HDR sBT). Material and methods An 81-year-old female diagnosed with stage IV clear cell renal carcinoma reported to our center with painful relapse of two cutaneous metastases after a previous metastasectomy. The patient was disqualified from systemic therapy due to comorbidities, and qualified to attempt a treatment using HDR sBT. The unit equipped with an iridium-192 source was used to deliver 36 Gy/6 Gy in 6 fractions twice weekly. Overall treatment time was 18 days. Results Two weeks after HDR sBT, complete response was observed in one irradiated location, while the partial response was observed in the latter. EORTC grade 1 skin toxicity was reported in both irradiated fields. Three and five months after the treatment, the patient presented complete response and pain relief in both locations with no signs of relapse. The patient remained in palliative care and died seven months after the treatment due to sudden cardiac death. Conclusions HDR sBT can be a valuable treatment option for cutaneous metastatic renal cell carcinoma, especially for patients with significant comorbidities. The treatment provided was associated with low toxicity and excellent clinical outcome.
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Safety and Efficacy of Robotic Radiosurgery for Visceral and Lymph Node Metastases of Renal Cell Carcinoma: A Retrospective, Single Center Analysis. Cancers (Basel) 2021; 13:cancers13040680. [PMID: 33567564 PMCID: PMC7915686 DOI: 10.3390/cancers13040680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary In metastatic renal cell carcinoma (mRCC), systemic treatment with checkpoint inhibitors or tyrosine kinase inhibitors is recommended in guidelines. However, the treatment of patients with oligometastatic disease or mixed responses remains challenging. We aimed to investigate the safety and efficacy of robotic radiosurgery in patients with mRCC. Sixty patients with visceral and lymph node metastases were selected for robotic radiosurgery. The median progression free survival of all patients was 17.4 months, local tumor control was achieved in 96.7% of patients, and only 8.3% of patients experienced adverse events. Robotic radiosurgery might be a powerful tool in addition to systemic treatment for patients with mRCC, but additive effects of both treatments require further investigation. Abstract Despite rapid advances of systemic therapy options in renal cell carcinoma (RCC), local tumor or metastases treatment remains important in selected patients. Here, we assess the safety and efficacy of robotic radiosurgery (RRS) as an ablative therapy for visceral and lymph node metastases of RCC. Patients with histologically confirmed RCC and radiologically confirmed progression of visceral or lymph node metastases underwent RRS and were retrospectively analyzed. Overall survival and progression free survival were calculated by the Kaplan–Meier method and log-rank test. Sixty patients underwent RRS and were included in the analysis. Patients presented for RRS treatment with a median age at RRS treatment of 64 years (range 42–83), clear cell histology (88.3%) and favorable international metastatic renal cell carcinoma database (IMDC) risk score (58.3%). Treatment parameters differed for the number of fractions (median visceral metastases: 1, range 1–5; median lymph node metastases: 1, range 0–5; p = 0.003) and prescription dose (median visceral metastases 24 Gy, range 8–26; median lymph node metastases 18 Gy, range 7–26, p < 0.001). The median overall survival was 65.7 months (range: 2.9–108.6), the median progression free survival was 17.4 months (range: 2.7–70.0) and local tumor control was achieved in 96.7% of patients. Adverse events were limited to 8.3% of patients, with one grade 4 toxicity within 6 weeks after RRS therapy. RRS is a safe and effective treatment option in selected patients with metastatic RCC in a multimodal approach. Further research is warranted to confirm our findings prospectively.
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Christensen BR, Hajja YM, Koshkin V, Barata PC. Update on First-Line Combination Treatment Approaches in Metastatic Clear-Cell Renal Cell Carcinoma. Curr Treat Options Oncol 2021; 22:15. [PMID: 33438115 DOI: 10.1007/s11864-020-00814-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 12/17/2022]
Abstract
OPINION STATEMENT The treatment for metastatic renal cell carcinoma (mRCC) has significantly evolved in recent years with a deeper understanding of the molecular make-up of the disease and the clinical development of therapies with novel mechanisms of action. While some patients with more indolent disease may benefit from local therapy such as metastasectomy or cytoreductive nephrectomy, others may safely embark on an active surveillance program or be offered targeted therapy. Yet, a combination regimen including an ICI is the most effective regimen and should be considered in most mRCC cases. Ongoing studies will help determine which factors can be further used to optimize treatment selection and personalize disease management.
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Affiliation(s)
- Bryce R Christensen
- Tulane University School of Medicine, 1415 Tulane Ave, New Orleans, LA, 70112, USA.,Department of Internal Medicine, Brooke Army Medical Center, San Antonio, TX, USA
| | - Yasmin M Hajja
- Tulane University School of Medicine, 1415 Tulane Ave, New Orleans, LA, 70112, USA.,Tulane Cancer Center, New Orleans, LA, USA
| | - Vadim Koshkin
- University of California, 1825 Fourth St Sixth Floor, San Francisco, CA, 94158, USA
| | - Pedro C Barata
- Tulane University School of Medicine, 1415 Tulane Ave, New Orleans, LA, 70112, USA. .,Tulane Cancer Center, New Orleans, LA, USA. .,Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
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Utilization of Stereotactic Ablative Body Radiation Therapy for Intact Renal Cell Carcinoma: Trends in Treatment and Predictors of Outcome. Adv Radiat Oncol 2019; 5:85-91. [PMID: 32051894 PMCID: PMC7004945 DOI: 10.1016/j.adro.2019.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/28/2019] [Accepted: 07/17/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose Surgery is the standard-of-care treatment in patients with localized renal cell carcinoma (RCC), offering excellent chance of cure. However, there is a subset of patients who are ineligible for surgery and instead manage with ablative therapies, such as stereotactic ablative body radiation therapy (SABR). We used the National Cancer Database to examine trends in the use of SABR for inoperable RCC and identify any predictors of outcome. Methods and Materials We queried the National Cancer Database for patients with unresected RCC between 2004 and 2016 who were treated with SABR. Kaplan-Meier analyses were used to determine overall survival. Multivariable Cox regression was used to identify predictors of survival. Results We identified 347 patients meeting eligibility criteria. Median age was 74, and the majority of patients were clinical stage T1-2 (80%) and N0 (97%). The median tumor size was 3.8 cm (interquartile range [IQR], 2.8-5.2 cm). Six percent of patients received systemic therapy. The median dose of SABR was 45 Gy (IQR, 35-54 Gy) in 3 fractions (IQR, 1-5 fractions). The median follow-up was 36 months (IQR, 1-156 months). Predictors of decreased survival were age >74, larger tumors, and N1 or M1 disease. Median survival across the entire cohort was 58 months. Median survival was 92 months, 88 months, 44 months, and 26 months for primary tumors ≤2.5 cm, 2.6-3.5 cm, 3.5-5.0 cm, and >5.0 cm, respectively (P < .0001). Conclusions SABR is being increasingly used for renal cell carcinoma across the United States with excellent outcomes in smaller tumors.
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Local failure and vertebral body fracture risk using multifraction stereotactic body radiation therapy for spine metastases. Adv Radiat Oncol 2018; 3:245-251. [PMID: 30202794 PMCID: PMC6128022 DOI: 10.1016/j.adro.2018.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose Single-fraction radiation surgery for spine metastases is highly effective. However, a high rate (20-39%) of vertebral body fracture (VBF) has been associated with large, single-fraction doses. We report our experience using multifraction stereotactic body radiation therapy (SBRT). Methods and materials All patients who were treated with multifraction SBRT for spine metastases at our institution between 2009 and 2017 were retrospectively analyzed. SBRT was delivered in 2 to 5 fractions using the Cyberknife System (Accuray, Sunnyvale, CA). Patients were followed clinically and with magnetic resonance imaging every 3 to 6 months. Local control, complications (including VBF), and overall survival were evaluated. Patient, disease, and treatment variables were analyzed for a statistical association with outcomes. Results A total of 83 patients were treated to 98 spine lesions with a median follow-up of 7.6 months. Histologies included non-small cell lung cancer (NSCLC; 24%), renal cell carcinoma (RCC; 18%), and breast cancer (12%). Surgery or vertebroplasty were performed before SBRT in 21% of cases. Patients received a median SBRT dose of 24 Gy in a median of 3 fractions. Local control was 93% at 6 months and 84% at 1 year. Higher prescribed dose, higher biologic effective dose, higher minimum dose to 90% of the planning target volume, tumor histology, and smaller tumor volume predicted improved local control. The cumulative dose was 23 Gy versus 26 Gy for patients with and without failure (P = .02), higher biologic effective dose 39 Gy versus 46 Gy, (P = .01), and higher minimum dose to 90% of the planning target volume 23 Gy versus 26 Gy (P = .03). VBF occurred in 4.2% of all cases and 5.3% of those without surgery or vertebroplasty prior to SBRT. Only preexisting VBF predicted risk of post-SBRT VBF (P < .01). Conclusions Multifraction SBRT results in a high local control rate for metastatic spinal disease with a low VBF rate, which suggests a favorable therapeutic ratio compared with single-fraction SBRT.
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The Efficacy of Conventionally Fractionated Radiation in the Management of Osseous Metastases from Metastatic Renal Cell Carcinoma. JOURNAL OF ONCOLOGY 2018; 2018:6384253. [PMID: 29552034 PMCID: PMC5818960 DOI: 10.1155/2018/6384253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/18/2017] [Accepted: 12/07/2017] [Indexed: 01/28/2023]
Abstract
Background There is little data regarding the effectiveness of palliative radiation with conventional fractionation for metastatic renal cell carcinoma (RCC), which has been described as radioresistant. We conducted a retrospective analysis of patients with metastatic bony disease from RCC treated with radiation therapy at our institution. Methods Forty patients with histologically confirmed RCC with a total of 53 treatment courses were included. Pain response after radiotherapy was recorded and freedom from progression was generated using posttreatment radiographs. Patient data was analyzed to assess influence on local control. Results Patients had a median age of 63. Median follow-up was 9.3 months. The most common radiation dose was 30 Gy in 10 fractions. Pain control after radiotherapy was achieved in 73.6% of patients. Increasing age was associated with nonresponse at the initial pain assessment post-RT (p = 0.02). In lesions with initial pain response, nonclear cell histology was associated with increased pain recurrence (p = 0.01) and a shorter duration to pain recurrence (p = 0.01). Radiographic control at 1 year was 62%. Conclusions Pain response and control rates for osseous metastatic disease in RCC are comparable to other histologies when treated with conventional fractionation. These appear to be inferior to reported control rates from stereotactic treatments.
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Kim E, Zschiedrich S. Renal Cell Carcinoma in von Hippel-Lindau Disease-From Tumor Genetics to Novel Therapeutic Strategies. Front Pediatr 2018; 6:16. [PMID: 29479523 PMCID: PMC5811471 DOI: 10.3389/fped.2018.00016] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/16/2018] [Indexed: 01/05/2023] Open
Abstract
von Hippel-Lindau (VHL) disease is an autosomal dominant syndrome caused by mutations in the VHL tumor-suppressor gene, leading to the dysregulation of many hypoxia-induced genes. Affected individuals are at increased risk of developing recurrent and bilateral kidney cysts and dysplastic lesions which may progress to clear cell renal cell carcinoma (ccRCC). Following the eponymous VHL gene inactivation, ccRCCs evolve through additional genetic alterations, resulting in both intratumor and intertumor heterogeneity. Genomic studies have identified frequent mutations in genes involved in epigenetic regulation and phosphoinositide 3-kinase-AKT-mechanistic target of rapamycin (mTOR) pathway activation. Currently, local therapeutic options include nephron-sparing surgery and alternative ablative procedures. For advanced metastatic disease, systemic treatment, including inhibition of vascular endothelial growth factor pathways and mTOR pathways, as well as immunotherapy are available. Multimodal therapy, targeting multiple signaling pathways and/or enhancing the immune response, is currently being investigated. A deeper understanding of the fundamental biology of ccRCC development and progression, as well as the development of novel and targeted therapies will be accelerated by new preclinical models, which will greatly inform the search for clinical biomarkers for diagnosis, prognosis, and response to treatment.
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Affiliation(s)
- Emily Kim
- Department of Radiation Oncology, Faculty of Medicine, Albert Ludwigs University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Stefan Zschiedrich
- Renal Division, Department of Medicine IV, Faculty of Medicine, Albert Ludwigs University of Freiburg, Freiburg, Germany
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Wang CJ, Christie A, Lin MH, Jung M, Weix D, Huelsmann L, Kuhn K, Meyer J, Desai N, Kim DWN, Pedrosa I, Margulis V, Cadeddu J, Sagalowsky A, Gahan J, Laine A, Xie XJ, Choy H, Brugarolas J, Timmerman R, Hannan R. Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases. Int J Radiat Oncol Biol Phys 2017; 98:91-100. [PMID: 28587057 DOI: 10.1016/j.ijrobp.2017.01.032] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/28/2016] [Accepted: 01/09/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Renal cell carcinoma is refractory to conventional radiation therapy but responds to higher doses per fraction. However, the dosimetric data and clinical factors affecting local control (LC) are largely unknown. We aimed to evaluate the safety and efficacy of stereotactic ablative radiation therapy (SAbR) for extracranial renal cell carcinoma metastases. METHODS AND MATERIALS We reviewed 175 metastatic lesions from 84 patients treated with SAbR between 2005 and 2015. LC and toxicity after SAbR were assessed with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Predictors of local failure were analyzed with χ2, Kaplan-Meier, and log-rank tests. RESULTS In most cases (74%), SAbR was delivered with total doses of 40 to 60 Gy, 30 to 54 Gy, and 20 to 40 Gy in 5 fractions, 3 fractions, and a single fraction, respectively. The median biologically effective dose (BED) using the universal survival model was 134.5 Gy. The 1-year LC rate after SAbR was 91.2% (95% confidence interval, 84.9%-95.0%; median follow-up, 16.7 months). Local failures were associated with prior radiation therapy (hazard ratio [HR], 10.49; P<.0001), palliative-intent radiation therapy (HR, 4.63; P=.0189), spinal location (HR, 5.36; P=.0041), previous systemic therapy status (0-1 vs >1; HR, 3.52; P=.0217), and BED <115 Gy (HR, 3.45; P=.0254). Dose received by 99% of the target volume was the strongest dosimetric predictor for LC. Upon multivariate analysis, dose received by 99% of the target volume greater than BED of 98.7 Gy and systemic therapy status remained significant (HR, 0.12 and 3.64, with P=.0014 and P=.0472, respectively). Acute and late grade 3 toxicities attributed to SAbR were observed in 3 patients (1.7%) and 5 patients (2.9%), respectively. CONCLUSIONS SAbR demonstrated excellent LC of metastatic renal cell carcinoma with a favorable safety profile when an adequate dose and coverage were applied. Multimodality treatment with surgery should be considered for reirradiation or vertebral metastasis. A higher radiation dose may be required in patients who received previous systemic therapies.
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Affiliation(s)
- Chiachien Jake Wang
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alana Christie
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew Jung
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Derek Weix
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lorel Huelsmann
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kristin Kuhn
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Meyer
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Neil Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - D W Nathan Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ivan Pedrosa
- Department of Radiology, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arthur Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey Gahan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aaron Laine
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xian-Jin Xie
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James Brugarolas
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Hematology/Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Raquibul Hannan
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Siva S, Kothari G, Muacevic A, Louie AV, Slotman BJ, Teh BS, Lo SS. Radiotherapy for renal cell carcinoma: renaissance of an overlooked approach. Nat Rev Urol 2017. [PMID: 28631740 DOI: 10.1038/nrurol.2017.87] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Conventional radiotherapy previously had a limited role in the definitive treatment of renal cell carcinoma (RCC), owing to the disappointing outcomes of several trials and the perceived radioresistance of this type of cancer. In this context, radiotherapy has been relegated largely to the palliation of symptoms in patients with metastatic disease, with variable rates of response. Following the availability of newer technologies that enable safe delivery of high-dose radiotherapy, stereotactic ablative radiotherapy (SABR) has become increasingly used in patients with RCC. Preclinical evidence demonstrates that RCC cells are sensitive to ablative doses of radiotherapy (≥8-10 Gy). Trials in the setting of intracranial and extracranial oligometastases, as well as primary RCC, have demonstrated excellent tumour control using this approach. Additionally, an awareness of the capacity of high-dose radiation to stimulate antitumour immunity has resulted in novel combinations of SABR with immunotherapies. Here we describe the historical application of conventional radiotherapy, the current biological understanding of the effects of radiation, and the clinical evidence supporting the use of ablative radiotherapy in RCC. We also explore emerging opportunities to combine systemic targeted agents or immunotherapies with radiation. Radiotherapy, although once an overlooked approach, is moving towards the forefront of RCC treatment.
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Affiliation(s)
- Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Grattan Street, Melbourne, Victoria 3000, Australia
| | - Gargi Kothari
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Grattan Street, Melbourne, Victoria 3000, Australia
| | - Alexander Muacevic
- European Cyberknife Center, Max-Lebsche-Platz 31, Munich D-81377, Germany
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, PO Box 5010, London, Ontario N6A 5W9, Canada
| | - Ben J Slotman
- Radiation Oncology, VU University Medical Center, De Boelelaan, PO Box 7057, Amsterdam, 1007 MB, Netherlands
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, 6565 Fannin, Ste#DB1-077, Houston, Texas 77030, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356043, Seattle, Washington 98195-6043, USA
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Maria B, Antonella V, Michela R, Silvana G, Anita S, Anna Maria A, Chiara D, Paolo M. Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy. Ther Adv Med Oncol 2016; 8:450-459. [PMID: 27800033 PMCID: PMC5066543 DOI: 10.1177/1758834016659825] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In patients with renal cancer, brain metastasis is associated with poor survival and high morbidity. Poor life expectancy is often associated with widespread extracranial metastases. In such patients, a multidisciplinary approach is paramount. Brain metastases-specific therapies may include surgery, radiosurgery, conventional radiation and targeted therapies (TT) or a combination of these treatments. Some factors are important prognostically when choosing the best strategy: performance status, the number, size and location of brain metastases, the extension of systemic metastases and a well-controlled primary tumour. Failure of chemical therapy has always been attributed to an intact blood-brain barrier and acquired drug resistance by renal cancer cells. Recent studies have demonstrated objective responses with TT in a variety of cancer types, including renal cancer. In most cases, these agents have been used in combination and in conjunction with whole-brain radiation therapy and radiosurgery. Local control appears to be better with the combined method if the patient has a good performance status and may improve overall survival. This review summarizes current literature data on multidisciplinary approach in the management of renal brain metastasis with radiation, surgery and TT with an emphasis on potential better outcomes with a combination of current treatment methods.
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Affiliation(s)
| | | | - Roberto Michela
- Universita degli Studi di Roma La Sapienza, Via di Grottarossa 1035, Roma 00189, Italy
| | | | | | | | | | - Marchetti Paolo
- Universita degli Studi di Roma La Sapienza, Roma, Italy Azienda Ospedaliera Sant'Andrea, Roma, Italy
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Park S, Kim KH, Rhee WJ, Lee J, Cho Y, Koom WS. Treatment outcome of radiation therapy and concurrent targeted molecular therapy in spinal metastasis from renal cell carcinoma. Radiat Oncol J 2016; 34:128-34. [PMID: 27306772 PMCID: PMC4938350 DOI: 10.3857/roj.2016.01718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/14/2016] [Accepted: 05/16/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate the clinical outcomes of patients who underwent radiation therapy with or without targeted molecular therapy for the treatment of spinal metastasis from renal cell carcinoma (RCC). MATERIALS AND METHODS A total of 28 spinal metastatic lesions from RCC patients treated with radiotherapy between June 2009 and June 2015 were retrospectively reviewed. Thirteen lesions were treated concurrently with targeted molecular therapy (concurrent group) and 15 lesions were not (nonconcurrent group). Local control was defined as lack of radiographically evident local progression and neurological deterioration. RESULTS At a median follow-up of 11 months (range, 2 to 58 months), the 1-year local progression-free rate (LPFR) was 67.0%. The patients with concurrent targeted molecular therapy showed significantly higher LPFR than those without (p = 0.019). After multivariate analysis, use of concurrent targeted molecular therapy showed a tendency towards improved LPFR (hazard ratio, 0.13; 95% confidence interval, 0.01 to 1.16). There was no difference in the incidence of systemic progression between concurrent and nonconcurrent groups. No grade ≥2 toxicities were observed during or after radiotherapy. CONCLUSION Our study suggests the possibility that concurrent use of targeted molecular therapy during radiotherapy may improve LPFR. Further study with a large population is required to confirm these results.
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Affiliation(s)
- Sangjoon Park
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Joong Rhee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jeongshim Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Yeona Cho
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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Zhang H, Li H. miR-137 inhibits renal cell carcinoma growth in vitro and in vivo. Oncol Lett 2016; 12:715-720. [PMID: 27347205 DOI: 10.3892/ol.2016.4616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/03/2016] [Indexed: 01/03/2023] Open
Abstract
MicroRNA (miR)-137 has been reported to be underexpressed and involved in various cell processes and to have antitumor effects in a range of tumors, but so far not in renal cell carcinoma (RCC). The aim of the present study was to investigate the clinical significance and role of miR-137 in RCC. The expression levels of miR-137 were determined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) in 50 cases of paired RCC tissues and adjacent normal tissues, and in RCC cell lines. The role of miR-137 in the growth and survival of RCC cells was assessed with several in vitro approaches and in nude mice models. The results of the RT-qPCR showed that the miR-137 expression was downregulated in the RCC tissues and cell lines. The in vitro assay showed that ectopic expression of miR-137 robustly impaired RCC cell proliferation, migratory and invasive properties, and increased the induction of cell apoptosis properties. The in vivo assay demonstrated that enforced miR-137 suppressed tumor growth in xenograft nude mice models. In addition, miR-137 was indicated to inhibit the activation of phosphoinositide 3 kinase/protein kinase B signal pathway, which contributes to the inhibition of RCC growth. These findings indicate that miR-137 functions as tumor suppressor in RCC, suggesting that miR-137 may be a potential therapeutic target for RCC.
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Affiliation(s)
- Hongxia Zhang
- Health Examination Center, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Hongjun Li
- Health Examination Center, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
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Stereotactic Radiosurgery for Renal Cancer Brain Metastasis: Prognostic Factors and the Role of Whole-Brain Radiation and Surgical Resection. JOURNAL OF ONCOLOGY 2015; 2015:636918. [PMID: 26681942 PMCID: PMC4668321 DOI: 10.1155/2015/636918] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/20/2022]
Abstract
Background. Renal cell carcinoma is a frequent source of brain metastasis. We present our consecutive series of patients treated with Stereotactic Radiosurgery (SRS) and analyse prognostic factors and the interplay of WBRT and surgical resection. Methods. This is a retrospective study of 66 patients with 207 lesions treated with the Cyberknife radiosurgery system in our institution. The patients were followed up with imaging and clinical examination 1 month and 2-3 months thereafter for the brain metastasis. Patient, treatment, and outcomes characteristics were analysed. Results. 51 male (77.3%) and 15 female (22.7%) patients, with a mean age of 58.9 years (range of 31–85 years) and a median Karnofsky Performance Status (KPS) of 90 (range of 60–100), were included in the study. The overall survival was 13.9 months, 21.9 months, and 5.9 months for the patients treated with SRS only, additional surgery, and WBRT, respectively. The actuarial 1-year Local Control rates were 84%, 94%, and 88% for SRS only, for surgery and SRS, and for WBRT and additional SRS, respectively. Conclusions. Stereotactic radiosurgery is a safe and effective treatment option in patients with brain metastases from RCC. In case of a limited number of brain metastases, surgery and SRS might be appropriate.
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Onishi H, Kawasaki T, Zakoji H, Yoshida T, Komiyama T, Kuriyama K, Araya M, Saito R, Aoki S, Maehata Y, Tominaga L, Marino K, Watanabe I, Oguri M, Araki T, Enomoto N, Takeda M, Katoh R. Renal cell carcinoma treated with stereotactic radiotherapy with histological change confirmed on autopsy: a case report. BMC Res Notes 2014; 7:270. [PMID: 24767701 PMCID: PMC4008414 DOI: 10.1186/1756-0500-7-270] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/21/2014] [Indexed: 11/23/2022] Open
Abstract
Background Treatment of primary renal cell carcinoma using radiotherapy with curative intent is rare, because renal cell carcinoma is generally regarded as a radiation-resistant tumor. Recently, stereotactic body radiation therapy has been radically applied for cancers in various organs including renal cell carcinoma. However, there were few reports describing pathological changes of renal cell carcinoma post stereotactic body radiation therapy. This is the first report we are aware of documenting late histological effects of stereotactic body radiation therapy on renal cell carcinoma and surrounding normal tissue. Case presentation A right renal tumor was identified in a Japanese 70-year-old man on follow-up computed tomography for his chronic hepatitis. T1N0M0 renal cell carcinoma was clinically diagnosed as the tumor was 3 cm in diameter and well-enhanced with intravenously infused contrast material in the arterial phase on computed tomography. No metastases in regional lymph nodes or distant sites were evident. Stereotactic body radiation therapy was selected as an alternative therapy to surgery because of his poor liver function. A total dose of 60 Gy in 10 fractions over 12 days was delivered using a 10-megavolt X-ray. The renal tumor gradually decreased in size and partial response had been achieved at 2 years after completing stereotactic body radiation therapy. Hepatocellular carcinoma was identified during follow-up in the patient and he died of progression of hepatocellular carcinoma with hepatic failure 2.5 years after completing stereotactic body radiation therapy. Autopsy was done and it showed almost complete necrosis of tumor tissues with a small amount of viable renal carcinoma cells. These pathological findings suggested marked effects of stereotactic body radiation therapy on clear cell renal cell carcinoma. Conclusion Our case demonstrates a good pathological response with small foci of remnant viable cancer cells after stereotactic body radiation therapy of 60Gy in 10 fractions for small renal cell carcinoma. Although further experiences and longer follow-up are mandatory to conclude the optimal treatment schedule and efficacy of stereotactic body radiation therapy for renal cell carcinoma, stereotactic body radiation therapy may represent a novel less-invasive option for the treatment of primary renal cell carcinoma.
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Affiliation(s)
- Hiroshi Onishi
- Department of Radiation Oncology, University of Yamanashi, 1110 Shimokato, 409-3898 Chuo-city, Yamanashi, Japan.
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Treatment for liver metastasis from renal cell carcinoma with computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT): a case series. World J Urol 2012; 31:1525-30. [PMID: 23132612 DOI: 10.1007/s00345-012-0981-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 10/24/2012] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To retrospectively analyze the clinical outcome of patients with hepatic metastases from renal cell carcinoma who were treated with computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT). METHODS Ten patients (7 men and 3 women; median age 72 ± 7.9 years) with a total number of 16 hepatic metastases from histologically proven renal cell carcinoma were treated with CT-HDRBT after discussing the case in an interdisciplinary tumor conference. All patients had underwent nephrectomy before CT-HDRBT. Three patients had extrahepatic manifestations (2 lung and 1 bone). Six patients had received immunotherapy or targeted therapy before CT-HDRBT. Follow-up included gadoxetic acid (Gd-EOB-DTPA) enhanced MRI two times within 6-8 weeks and after that every 3 months after treatment to evaluate treatment efficacy. RESULTS Mean follow-up time was 21.6 ± 13.7 months. One patient developed local and systemic (pulmonary and osseous) progression after 10.8 months which was treated with targeted therapy and died 20.3 months after CT-HDRBT. None of the remaining nine patients developed local progression or died during the follow-up period. Five patients developed systemic progression (3 pulmonary, 1 osseous and 1 locally at the site of nephrectomy) after an average of 19.7 ± 5.5 months. CONCLUSIONS CT-HDRBT is a viable alternative to hepatic resection of liver metastases from renal cell carcinoma in selected patients.
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Cochran DC, Chan MD, Aklilu M, Lovato JF, Alphonse NK, Bourland JD, Urbanic JJ, McMullen KP, Shaw EG, Tatter SB, Ellis TL. The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery. J Neurosurg 2012; 116:978-83. [PMID: 22385005 DOI: 10.3171/2012.2.jns111353] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECT Gamma Knife surgery (GKS) has been reported as an effective modality for treating brain metastases from renal cell carcinoma (RCC). The authors aimed to determine if targeted agents such as tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and bevacizumab affect the patterns of failure of RCC after GKS. METHODS Between 1999 and 2010, 61 patients with brain metastases from RCC were treated with GKS. A median dose of 20 Gy (range 13-24 Gy) was prescribed to the margin of each metastasis. Kaplan-Meier analysis was used to determine local control, distant failure, and overall survival rates. Cox proportional hazard regression was performed to determine the association between disease-related factors and survival. RESULTS Overall survival at 1, 2, and 3 years was 38%, 17%, and 9%, respectively. Freedom from local failure at 1, 2, and 3 years was 74%, 61%, and 40%, respectively. The distant failure rate at 1, 2, and 3 years was 51%, 79%, and 89%, respectively. Twenty-seven percent of patients died of neurological disease. The median survival for patients receiving targeted agents (n = 24) was 16.6 months compared with 7.2 months (n = 37) for those not receiving targeted therapy (p = 0.04). Freedom from local failure at 1 year was 93% versus 60% for patients receiving and those not receiving targeted agents, respectively (p = 0.01). Multivariate analysis showed that the use of targeted agents (hazard ratio 3.02, p = 0.003) was the only factor that predicted for improved survival. Two patients experienced post-GKS hemorrhage within the treated volume. CONCLUSIONS Targeted agents appear to improve local control and overall survival in patients treated with GKS for metastastic RCC.
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Affiliation(s)
- D Clay Cochran
- Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA
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Blanco AI, Teh BS, Amato RJ. Role of radiation therapy in the management of renal cell cancer. Cancers (Basel) 2011; 3:4010-23. [PMID: 24213122 PMCID: PMC3763407 DOI: 10.3390/cancers3044010] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/11/2011] [Accepted: 10/19/2011] [Indexed: 12/11/2022] Open
Abstract
Renal cell carcinoma (RCC) is traditionally considered to be radioresistant; therefore, conventional radiotherapy (RT) fraction sizes of 1.8 to 2 Gy are thought to have little role in the management of primary RCC, especially for curative disease. In the setting of metastatic RCC, conventionally fractionated RT has been an effective palliative treatment in 50% of patients. Recent technological advances in radiation oncology have led to the clinical implementation of image-guided radiotherapy, allowing biologically potent doses to the tumors intra- and extra-cranially. As predicted by radiobiologic modeling, favorable outcomes have been observed with highly hypofractionated schemes modeled after the experience with intracranial stereotactic radiosurgery (SRS) for RCC brain metastases with reported local control rates averaging 85%. At present, both primary and metastatic RCC tumors may be successfully treated using stereotactic approaches, which utilize steep dose gradients to maximally preserve function and avoid toxicity of adjacent organs including liver, uninvolved kidney, bowel, and spinal cord regions. Future endeavors will combine stereotactic body radiation therapy (SBRT) with novel targeted therapies, such as tyrosine kinase inhibitors and targeted rapamycin (mTOR) inhibitors, to maximize both local and systemic control.
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Affiliation(s)
- Angel I. Blanco
- Department of Radiation Oncology, The Methodist Hospital, The Methodist Hospital Research Institute, Houston, TX 77030, USA; E-Mails: (A.I.B.); (B.S.T.)
- Department of Radiation Oncology, The Methodist Hospital, Houston, TX 77030, USA
| | - Bin S. Teh
- Department of Radiation Oncology, The Methodist Hospital, The Methodist Hospital Research Institute, Houston, TX 77030, USA; E-Mails: (A.I.B.); (B.S.T.)
- Department of Radiation Oncology, The Methodist Hospital, Houston, TX 77030, USA
| | - Robert J. Amato
- Division of Oncology, University of Texas Health Science Center at Houston, Memorial Hermann Cancer Center, Houston, TX 77030, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-832-325-7702; Fax: +1-179-512-7132
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Renal cell carcinoma with synchronous metastasis to the calcaneus and metachronous metastases to the ovary and gallbladder. Case Rep Med 2011; 2011:671645. [PMID: 22028725 PMCID: PMC3199123 DOI: 10.1155/2011/671645] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/12/2011] [Accepted: 08/10/2011] [Indexed: 11/17/2022] Open
Abstract
Renal cell carcinomas (RCCs) are known for their unpredictable metastatic pattern. We present the case of a 63-year-old woman who initially presented in 1992 with a metastasis in the left calcaneus that led to the discovery of RCC. In 1998, a new metastasis was found in the ovary. In 2008, the diagnosis of a gallbladder metastasis was made. All metastases were surgically removed; no additional systemic therapies were used. Aggressive surgical treatment can prolong the survival of patients with resectable metastases. Patterns of metastasis are discussed, and a brief review of the literature is given regarding each localization.
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20
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Abstract
Renal cell carcinoma represents 3% of all adult malignant tumors. It occurs more frequently in the fifth and sixth decade of life and in a male-female ratio of 1.5 : 1. Among all the primary tumors that arise below the level of the clavicle, renal cell carcinoma is the third most common neoplasm that metastasizes to the head and neck region, but rarely has it been described as the presenting symptom of this tumor. In 7.5% of the patients with renal cell carcinoma, head and neck metastasis is the presenting complaint. However, only 1% of the patients with renal cell carcinoma have metastases confined only to the head and neck; and a solitary cervical metastatic mass, as in the case of our patient, is rare.It seems that head and neck metastasis of renal cell carcinoma should preferentially be treated with surgical excision because of the associated morbidity and quality-of-life issues. Renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck.
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Affiliation(s)
- Mahmut Özkiriş
- Department of Otolaryngology, Head and Neck Surgery, Kayseri Tekden Hospital, Kayseri, Turkey
| | - Utku Kubilay
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ozan Seymen Sezen
- Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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21
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Ruys AT, Tanis PJ, Nagtegaal ID, Iris ND, van Duijvendijk P, Verhoef C, Porte RJ, van Gulik TM. Surgical treatment of renal cell cancer liver metastases: a population-based study. Ann Surg Oncol 2011; 18:1932-8. [PMID: 21347794 PMCID: PMC3115064 DOI: 10.1245/s10434-010-1526-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate outcomes of surgical treatment in patients with hepatic metastases from renal-cell carcinoma in the Netherlands, and to identify prognostic factors for survival after resection. Renal-cell carcinoma has an incidence of 2,000 new patients in the Netherlands each year (12.5/100,000 inhabitants). According to literature, half of these patients ultimately develop distant metastases with 20% involvement of the liver. Resection of renal-cell carcinoma liver metastases (RCCLM) is performed in only a minority of patients. Hence, little is known about outcome of resectable RCCLM. METHODS Patients were retrieved from local databases of the Netherlands Task Force for Liver Surgery (14 centers) and from the Dutch collective pathology database. Survival and prognostic factors were determined by Kaplan-Meier analysis and log rank test. RESULTS Thirty-three patients were identified who underwent resection (n = 29) or local ablation (n = 4) of RCCLM in the Netherlands between 1990 and 2008. These patients comprise 0.5% to 1% of the total population of patients diagnosed with RCCLM in that period. There was no operative mortality. The overall survival at 1, 3, and 5 years was 79, 47, and 43%, respectively. Metachronous metastases (n = 23, P = 0.03) and radical resection (n = 19, P < 0.001) were statistically significant prognosticators of overall survival. Size < 50 mm (n = 18, P = 0,54), solitary metastases (n = 19, P = 0.93), and presence of extrahepatic metastases (n = 11, P = 0.28) did not have a statistically significant impact on survival. CONCLUSIONS The favorable 5-year survival rate of 43% without operative mortality as found in this nationwide study indicates that selected patients with RCCLM can benefit from surgical treatment.
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Affiliation(s)
- Anthony T Ruys
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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22
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Cho J, Kim GE, Rha KH, Ahn JB, Lee CG, Suh CO, Seong J, Keum KC, Kim SI, Lee YH. Hypofractionated high-dose intensity-modulated radiotherapy (60 Gy at 2.5 Gy per fraction) for recurrent renal cell carcinoma: a case report. J Korean Med Sci 2008; 23:740-3. [PMID: 18756070 PMCID: PMC2526393 DOI: 10.3346/jkms.2008.23.4.740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A patient with renal cell carcinoma (RCC) developed synchronous bone metastasis with metachronous relapses to the bone and renal fossa. The primary lesion was initially removed surgically, and the metastatic bone lesions and locally recurrent tumours were treated by a high-fractional dose and high-total-dose intensity-modulated radiotherapy (IMRT, 60 Gy at 2.5 Gy per fraction) without significant side effects. All the grossly relapsed tumors underwent complete remission (CR) within a short time after IMRT. To date, CR has been maintained for more than two years. This case study reports the successful treatment of radioresistant RCC using a new scheme that involves a fractionation regimen with a high precision radiotherapy.
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Affiliation(s)
- Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seodaemoon-gu, Seoul, Korea.
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Teh BS, Bloch C, Galli-Guevara M, Doh L, Richardson S, Chiang S, Yeh P, Gonzalez M, Lunn W, Marco R, Jac J, Paulino AC, Lu HH, Butler EB, Amato RJ. The treatment of primary and metastatic renal cell carcinoma (RCC) with image-guided stereotactic body radiation therapy (SBRT). Biomed Imaging Interv J 2007; 3:e6. [PMID: 21614267 PMCID: PMC3097653 DOI: 10.2349/biij.3.1.e6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 02/11/2007] [Accepted: 02/13/2007] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions. This paper reports the authors' initial experience with image-guided SBRT in treating primary and metastatic RCC. MATERIALS AND METHODS The image-guided Brainlab Novalis stereotactic system was used. Fourteen patients with 23 extra-cranial metastatic RCC lesions (orbits, head and neck, lung, mediastinum, sternum, clavicle, scapula, humerus, rib, spine and abdominal wall) and two patients with biopsy-proven primary RCC (not surgical candidates) were treated with SBRT (24-40 Gy in 3-6 fractions over 1-2 weeks). All patients were immobilised in body cast or head and neck mask. Image-guidance was used for all fractions. PET/CT images were fused with simulation CT images to assist in target delineation and dose determination. SMART (simultaneous modulated accelerated radiation therapy) boost approach was adopted. 4D-CT was utilised to assess tumour/organ motion and assist in determining planning target volume margins. RESULTS Median follow-up was nine months. Thirteen patients (93%) who received SBRT to extra-cranial metastases achieved symptomatic relief. Two patients had local progression, yielding a local control rate of 87%. In the two patients with primary RCC, tumour size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There were no significant treatment-related side effects. CONCLUSION Image-guided SBRT provides excellent symptom palliation and local control without any significant toxicity. SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC.
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Affiliation(s)
- BS Teh
- Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States
- Department of Radiology, Baylor College of Medicine, Houston, Texas, United States
| | - C Bloch
- Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States
- Department of Radiology, Baylor College of Medicine, Houston, Texas, United States
| | - M Galli-Guevara
- Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States
- Department of Radiology, The Methodist Hospital, Houston, Texas, United States
| | - L Doh
- Department of Radiology, Baylor College of Medicine, Houston, Texas, United States
| | - S Richardson
- Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States
- Department of Radiology, Baylor College of Medicine, Houston, Texas, United States
| | - S Chiang
- Department of Radiology, The Methodist Hospital, Houston, Texas, United States
| | - P Yeh
- Department of Neurosurgery, The Methodist Hospital, Houston, Texas, United States
| | - M Gonzalez
- Department of Pulmonary Medicine, The Methodist Hospital, Houston, Texas, United States
| | - W Lunn
- Department of Pulmonary Medicine, The Methodist Hospital, Houston, Texas, United States
- Department of Pulmonary Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - R Marco
- Department of Orthopedic Surgery, The Methodist Hospital, Houston, Texas, United States
| | - J Jac
- Department of Genitourinary Oncology, The Methodist Hospital, Houston, Texas, United States
| | - AC Paulino
- Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States
- Department of Radiology, Baylor College of Medicine, Houston, Texas, United States
| | - HH Lu
- Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States
- Department of Radiology, Baylor College of Medicine, Houston, Texas, United States
| | - EB Butler
- Department of Radiation Oncology, The Methodist Hospital, Houston, Texas, United States
| | - RJ Amato
- Department of Genitourinary Oncology, The Methodist Hospital, Houston, Texas, United States
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