OBJECTIVE: • To analyse the safety and efficacy of simultaneous standard anti-angiogenic therapy and stereotactic radiosurgery (SRS) in patients with spinal and cerebral metastases from renal cell carcinoma. PATIENTS AND METHODS: • In all, 106 patients with spinal (n= 55) or cerebral (n= 51) metastatic lesions and an Eastern Cooperative Oncology Group status of 0 or 1 were treated with sorafenib or sunitinib and simultaneous SRS. • The primary endpoint was local control. • Secondary endpoints were toxicity and overall survival. RESULTS: • Median follow up was 14.7 months (range 1-42 months). Forty-five patients were treated with sunitinb and 61 patients with sorafenib. Two patients had asymptomatic tumour haemorrhage after SRS. • No skin toxicity, neurotoxicity or myelopathy occurred after SRS, and SRS did not alter the adverse effects of anti-angiogenic therapy. • Local tumour control 15 months after SRS was 98% (95% confidence interval 89-99%). The median pain score before SRS was 5 (range 1-8) and was lowered to 0 (range 0-2, P < 0.01) after SRS. There were no treatment-related deaths or late complications after SRS. • Overall survival was 17.4 months in patients with spinal lesions and 11.1 month in patients with cerebral lesions (P= 0.038). CONCLUSIONS: • Simultaneous systemic anti-angiogenic therapy and SRS for selected patients with renal cell carcinoma who have spinal and cerebral metastases is safe and effective. • Single-fraction delivery allows for efficacious integration of focal radiation treatment into oncological treatment concepts without additional toxicity. • Further studies are needed to determine the limits of SRS for renal cell carcinoma metastases outside the brain and spine.
OBJECTIVE: • To analyse the safety and efficacy of simultaneous standard anti-angiogenic therapy and stereotactic radiosurgery (SRS) in patients with spinal and cerebral metastases from renal cell carcinoma. PATIENTS AND METHODS: • In all, 106 patients with spinal (n= 55) or cerebral (n= 51) metastatic lesions and an Eastern Cooperative Oncology Group status of 0 or 1 were treated with sorafenib or sunitinib and simultaneous SRS. • The primary endpoint was local control. • Secondary endpoints were toxicity and overall survival. RESULTS: • Median follow up was 14.7 months (range 1-42 months). Forty-five patients were treated with sunitinb and 61 patients with sorafenib. Two patients had asymptomatic tumour haemorrhage after SRS. • No skin toxicity, neurotoxicity or myelopathy occurred after SRS, and SRS did not alter the adverse effects of anti-angiogenic therapy. • Local tumour control 15 months after SRS was 98% (95% confidence interval 89-99%). The median pain score before SRS was 5 (range 1-8) and was lowered to 0 (range 0-2, P < 0.01) after SRS. There were no treatment-related deaths or late complications after SRS. • Overall survival was 17.4 months in patients with spinal lesions and 11.1 month in patients with cerebral lesions (P= 0.038). CONCLUSIONS: • Simultaneous systemic anti-angiogenic therapy and SRS for selected patients with renal cell carcinoma who have spinal and cerebral metastases is safe and effective. • Single-fraction delivery allows for efficacious integration of focal radiation treatment into oncological treatment concepts without additional toxicity. • Further studies are needed to determine the limits of SRS for renal cell carcinoma metastases outside the brain and spine.
Authors: Shankar Siva; Gargi Kothari; Alexander Muacevic; Alexander V Louie; Ben J Slotman; Bin S Teh; Simon S Lo Journal: Nat Rev Urol Date: 2017-06-20 Impact factor: 14.432
Authors: U Harmenberg; M Lindskog; G Sinclair; M Stenman; H Benmakhlouf; P Wersäll; P Johnstone; M A Hatiboglu; J Mayer-da-Silva Journal: Acta Neurochir (Wien) Date: 2020-09-09 Impact factor: 2.216
Authors: Jonathan Verma; Eric Jonasch; Pamela K Allen; Jeffrey S Weinberg; Nizar Tannir; Eric L Chang; Anita Mahajan Journal: Am J Clin Oncol Date: 2013-12 Impact factor: 2.339
Authors: Paul W Sperduto; Brian J Deegan; Jing Li; Krishan R Jethwa; Paul D Brown; Natalie Lockney; Kathryn Beal; Nitesh G Rana; Albert Attia; Chia-Lin Tseng; Arjun Sahgal; Ryan Shanley; William A Sperduto; Emil Lou; Amir Zahra; John M Buatti; James B Yu; Veronica Chiang; Jason K Molitoris; Laura Masucci; David Roberge; Diana D Shi; Helen A Shih; Adam Olson; John P Kirkpatrick; Steve Braunstein; Penny Sneed; Minesh P Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2018-04-12 Impact factor: 7.038