Radiotherapy for Brain Metastases from Renal Cell Cancer: Should Whole-Brain Radiotherapy Be Added to Stereotactic Radiosurgery?

Fokas, Emmanouil; Henzel, Martin; Hamm, Klaus; Surber, Gunnar; Kleinert, Gabriele; Engenhart‐Cabillic, Rita

doi:10.1007/s00066-010-2055-z

Cited by 73 publications

(33 citation statements)

References 36 publications

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“…We have described the best available contemporary evidence base, from which 12 Amiraliev et al (2012) 23 Brinkmann et al (2007) 29 Eggener et al (2008) 27 Fokas et al (2010) 36 Fuchs et al (2005) 35 Hunter et al (2012) 34 Ikushima et al (2000) 37 Kwak et al (2007) 30 Lee et al (2006) 32 Pretalia et al (2010) 24 Russo et al (2007) 31 Staehler et al (2009) 26 Staehler et al (2010) 25 Zelefsky et al (2012) 33 Zerbi et al (2008) Review some conclusions can be made, and identifi ed knowledge gaps that can only be addressed through well-designed, prospective comparative studies. However, there are several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…One study 36 compared SRS, WBRT, and the combination of both SRS and WBRT. All patients in the WBRT and combination groups had at least two brain metastases, whereas such patients accounted for 17·6% of the SRS group.…”

Section: Local Therapies For Brain Metastasesmentioning

confidence: 99%

“…There was a moderate-to-high risk of confounding regarding previous treatment, tumour histology, grade, and size or volume of metastases, especially in studies on local treatments of bone and brain metastases. [33][34][35][36][37] Regarding diff erent sites treated in the same study, there was generally a moderate-to-high risk of confounding, especially for studies pertaining to treatment of metastases at various sites, 12,27,[30][31][32] because it was often unclear if these confounders were adjusted. Evidence quality was not assessed by GRADE because of the nature of the included studies (ie, retrospective comparative studies), and the high risk of bias across the studies.…”

Section: Local Therapies For Brain Metastasesmentioning

confidence: 99%

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Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

283

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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Section: Discussionmentioning

confidence: 99%

Section: Local Therapies For Brain Metastasesmentioning

confidence: 99%

Section: Local Therapies For Brain Metastasesmentioning

confidence: 99%

See 1 more Smart Citation

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

283

205

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“…Stereotactic RT, if available, is an alternative to surgery for limited-volume brain metastasis, and whole-brain irradiation is recommended for those patients with multiple brain metastases. 200 Surgery also may be appropriate for selected patients with malignant spinal cord compression, or impending or actual fractures in weight-bearing bones, if the rest of the disease burden is limited or patients remain symptomatic. Additionally, RT along with bisphosphonates is considered for palliation, particularly for painful bone metastases.…”

Section: Supportive Carementioning

confidence: 99%

Kidney Cancer, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Motzer¹,

Jonasch²,

Agarwal³

et al. 2017

J Natl Compr Canc Netw

511

516

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“…By contrast, SRT with WBRT compared with WBRT alone increases the overall survival of treated patients, indicating that these treatment modalities should be combined. Again when comparing SRS alone with SRT, and SRS with WBRT, the overall survival rate remains the same, however the chance of local recurrence decreases by ~30% when WBRT is added (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Another issue related to WBRT is the potentially increased risk of cognitive function impairment (30).…”

Section: Discussionmentioning

confidence: 99%

Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing

et al. 2016

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Abstract.Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm 3 , with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience. IntroductionRenal cell cancer (RCC) with brain metastases is a disease with poor prognosis (1). The treatment strategy generally depends on the patient performance status, tumor burden and patient preference. The departmental facility device equipment often plays a significant role in the decision making process. Targeted therapy is the mainstay of the systemic treatment at present (2). There are a few viable treatment options with respect to the number of brain lesions, their location and patient overall fitness: Surgical resection, hypofractionated stereotactic radiotherapy (SRT), stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT) and symptomatic treatment with steroids (best supportive care (BSC) (3). The main difference between SRS and SRT is in the number of fractions delivered. SRS utilizes only 1 fraction (1 day) for delivery of the whole ablative dose of radiotherapy, which imitates the surgical techniques of treating a patient in one day; whereas, SRT uses 3-6 fractions for treatment dose delivery (4,5). Several prognostic indexes were created to assess the expected patient survival to help clinicians to decide about proper treatment strategy. The recursive partitioning analysis (RPA) index combines the patient's performance status, age and disease burden. One of the greatest disadv...

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Radiotherapy for Brain Metastases from Renal Cell Cancer: Should Whole-Brain Radiotherapy Be Added to Stereotactic Radiosurgery?

Abstract: Addition of WBRT to SRS offers better IC and should be considered for RCC patients with one to three brain metastases, especially in RPA class I group. SRS offers excellent LC rates, while WBRT should be reserved for patients with multiple metastases and poor prognosis.

Cited by 73 publications

References 36 publications

Local treatments for metastases of renal cell carcinoma: a systematic review

Local treatments for metastases of renal cell carcinoma: a systematic review

Kidney Cancer, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing

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