Radiotherapy for Brain Metastases From Renal Cell Carcinoma in the Targeted Therapy Era

Bates, James E.; Youn, Paul; Peterson, Carl R.; Usuki, K.Y.; Walter, Kevin A.; Okunieff, Paul; Milano, Michael T.

doi:10.1097/coc.0000000000000186

Cited by 22 publications

(34 citation statements)

References 45 publications

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“…The role of TT in combination with radiation therapy is currently under investigation. In a retrospective study of the University of Rochester Medical Center, the concurrent use of TT (sunitinib, sorafenib, pazopanib or temsirolimus) with radiotherapy treatment (WBRT, STS or both) was not associated with a statistical increased OS [Bates et al 2015]. Cochran and colleagues showed that TT (TKI, mTOR inhibitors, bevacizumab) improved OS and local control in patients with metastatic RCC (mRCC) treated with GKS when compared with other treatments (chemotherapy or immunotherapy).…”

Section: Targeted Therapy In Combination With Radiotherapymentioning

confidence: 99%

Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy

Bassanelli

Viterbo²,

Roberto

et al. 2016

Ther Adv Med Oncol

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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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Section: Targeted Therapy In Combination With Radiotherapymentioning

confidence: 99%

Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy

Bassanelli

Viterbo²,

Roberto

et al. 2016

Ther Adv Med Oncol

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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%

“…More specifically if the management should follow the guidelines for surgical resection, which means in the case of renal cell cancer metastasis continuing with observation and waiting to administer systemic treatment only in the case of disease progression or commencing targeted therapy immediately after ablative radiotherapy. No randomized data or recommendations exists regarding this issue and decision should be made on an individual basis (27,40).…”

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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Section: Treatment Strategy Against Rcc-bmmentioning

confidence: 99%

“…However, retrospective studies of the additional impact of TKI on local control and survival have conflicting findings [ 45 , 76 , 77 , 78 , 79 ]. Three studies retrospectively compared BM patients treated by brain RT (SRS or WBRT) with or without TKI [ 45 , 76 , 77 ]. Bates et al suggested that concurrent TKI use was not associated with any change in OS or local control, but their analysis included only 25 patients [ 76 ]; whereas Cochran suggested that combining TKI with local therapy improved local control and extended median OS (targeted therapy: 16.6 months [ n = 24], no targeted therapy: 7.2 months [ n = 37]; p = 0.04) and lower local failure at one year (targeted therapy: 93%, no targeted therapy: 60%; p = 0.01) [ 77 ].…”

Section: Treatment Strategy Against Rcc-bmmentioning

confidence: 99%

Current Multimodality Treatments against Brain Metastases from Renal Cell Carcinoma

Matsui

2020

Cancers

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In patients with renal cell carcinoma, brain metastasis is generally one of the poor prognostic factors. However, the recent introduction of molecular target therapy and immune checkpoint inhibitor has remarkably advanced the systemic treatment of metastatic renal cell carcinoma and prolonged the patients’ survival. The pivotal clinical trials of those agents usually excluded patients with brain metastasis. The incidence of brain metastasis has been increasing in the actual clinical setting because of longer control of extra-cranial disease. Brain metastasis subgroup data from the prospective and retrospective series have been gradually accumulated about the risk classification of brain metastasis and the efficacy and safety of those new agents for brain metastasis. While the local treatment against brain metastasis includes neurosurgery, stereotactic radiosurgery, and conventional whole brain radiation therapy, the technology of stereotactic radiosurgery has been especially advanced, and the combination with systemic therapy such as molecular target therapy and immune checkpoint inhibitor is considered promising. This review summarizes recent progression of multimodality treatment of brain metastasis of renal cell carcinoma from literature data and explores the future direction of the treatment.

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Radiotherapy for Brain Metastases From Renal Cell Carcinoma in the Targeted Therapy Era

Cited by 22 publications

References 45 publications

Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy

Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy

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

Current Multimodality Treatments against Brain Metastases from Renal Cell Carcinoma

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