Metastasectomy and Targeted Therapy for Patients With Spinal Metastases of Renal Cell Carcinoma

Abstract

Background: Renal cell carcinoma (RCC) is an aggressive malignant disease that frequently metastasizes to the spine. The main purpose of our study is to evaluate the influence of surgery as well as targeted therapy on the survival of patients with RCC metastases of the spine.Methods: Retrospective cohort study. We identified 100 patients with spinal RCC metastases who were retrospectively reviewed for preoperative conditions, treatment, and survival. Metastasectomy was performed in 39 cases, and 61 patients underwent decompression procedures with stabilization. Only 26 patients had adjuvant targeted therapy (7 with metastasectomy, 19 with palliative decompression). Pain, neurological status, survival time (from operation to death or last follow up), and local progression-free survival were evaluated.Results: Neurological function recovery and reported significant pain relief were observed. There was no significant difference in overall survival for the patients with metastasectomy and palliative decompression (P ¼ .750). Metastasectomy provided better local control of disease compared with decompression (P ¼ .043). There was a statistically significant difference in overall survival for the patients who received targeted therapy (P ¼ .012).Conclusions: Metastasectomy is effective for local control of tumors. Targeted therapy can potentially prolong overall survival for patients with spinal RCC metastases.Level of Evidence: 3. Clinical Relevance: Our findings suggest that spinal metastasectomy is useful for local control of tumor growth but not for live expectancy. Effective systemic therapy is key role in stopping of disease progression.

En bloc spondylectomy for solitary spinal metastases: A case series analysis and literature review

“…По прошествии времени мы понимаем, что при метастатическом поражении позвоночника значение метастазэктомии для выживаемости противоречиво. С одной стороны, несмотря на данные литературы, наши собственные резуль-таты не показали влияния метастазэктомии на выживаемость при метастазах рака почки [21]. С другой стороны, мы наблюдаем очевидный прогресс в области методов системной терапии.…”

Metastasectomy in kidney cancer: current indications and treatment approaches

“…Among 100 patients with spinal RCC metastases with severe pain, instability, or neurological dysfunction, patients either received complete MTS, partial tumor excision with curettage, or debulking for stabilization of the spine. Nearly all patients showed improvement in neurological function and reduction in spinal pain postoperatively [28]. MTS for osseous RCC is both associated with improved survival and quality of life.…”

The contemporary role of metastasectomy in the management of metastatic RCC

“…• Age > 70 • Higher primary tumor stage/grade Bone [18][19][20][21][22][23][24][25] 11%-48% Liver [26][27][28][29] 43%-62% (29% 2-year OS) [29] • Metachronous metastases • *Solitary metastases A recent descriptive study demonstrated that men were four times more likely to harbor bone metastases. Lesions had a predilection for axial bone and the incidence of severe events, including pathologic fracture, was nearly 55%.…”

“…A study by Lin et al [21] retrospectively assessed 295 consecutive patients with bone metastases treated at a single institution. Surgical interventions included curettage, en bloc resection, closed nailing, or amputation.…”

“…Furthermore, clear-cell histology was associated with an improved prognosis. Notably, 5% of patients died within 30 days of surgery [21] .…”