Stereotactic Radiation Therapy for Renal Cell Carcinoma Brain Metastases in the Tyrosine Kinase Inhibitors Era: Outcomes of 120 Patients

Klausner, G.; Troussier, I.; Biau, J.; Jacob, J.; Schernberg, Antoine; Canova, C.-H.; Simon, Jean‐Marc; Borius, Pierre-Yves; Malouf, Gabriel G.; Spano, Jean‐Philippe; Rouprêt, Morgan; Cornu, Philippe; Mazeron, Jean‐Jacques; Valéry, Charles-Ambroise; Feuvret, L.; Maingon, P.

doi:10.1016/j.clgc.2019.02.007

Cited by 30 publications

(42 citation statements)

References 28 publications

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“…Overall 7 studies met the inclusion criteria and were selected for meta-analysis (25,(43)(44)(45)(46)(47)(48). Search strategy and selection process is demonstrated in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…mTOR inhibitors included: everolimus, and temsirolimus. Moreover, TKI group also received cytokine therapy (1%) in the study of Juloori et al; while, immunotherapy (14%), and chemotherapy (5%) were used in the Klausner et al study in TKI receiving patients (47,48).…”

Section: Resultsmentioning

confidence: 99%

“…General characteristics of the studies along with quality assessment scores are outlined in Table 1. Four studies mainly involved SRS as the local therapy for treating BM (43,45,46,48). Three studies, in addition to SRS, also had used surgery, and WBRT (25,44,47).…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…Overall local control rate was extracted from 3 studies involving 557 patients (43,47,48). There was significant better OLC rate associated with concomitant TKIs (HR 0.34 [0.11, 0.98], p = 0.05) ( Figure 5).…”

Section: Local Tumor Controlmentioning

confidence: 99%

“…Moreover, combination of targeted therapy and radiation therapy was shown to be safe with conflicting reports on the efficacy front (39)(40)(41)(42). Consequently, retrospective studies have compared efficacy outcomes in RCC BM patients treated with TKIs in combination with SRS or SRS alone (43)(44)(45)(46)(47)(48). We seek to systematically review and meta-analyze these reports in order to establish a better clinical perspective for RCC patients with brain metastases.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Tyrosine Kinase Inhibitors (TKIs) Combined With Radiation Therapy for the Management of Brain Metastases From Renal Cell Carcinoma

Khan

Zhao

Arooj³

et al. 2020

Front. Oncol.

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Background: Targeted therapy has transformed the outcome for patients with metastatic renal cell carcinoma. Their efficacy and safety have also been demonstrated in brain metastatic RCC. Preclinical evidence suggests synergism of radiation and tyrosine kinase inhibitors. Consequently, several studies have compared their efficacy in the treatment of RCC brain metastases to the era of brain management with surgery/radiation only. Objectives: We seek to systematically review and meta-analyze the results of those studies that involved comparative intervention groups of brain management; TKIs, and never used TKIs. Methods and Materials: Online databases (PubMed, EMBASE, Cochrane library, and ClinicalTrials.gov) were searched for comparative studies. Overall survival as the primary outcome of interest, and local brain control, distant control, and adverse events as secondary outcomes of interest were recorded for meta-analysis. Hazard ratios were pooled together using Review Manager 5.3. Fixed effects or random effects model were adopted according to the level of heterogeneity. Subgroup analysis included studies that involved SRS as the local treatment of management. Results: Overall 7 studies (n = 897) were included for meta-analysis. TKI use was associated with better survival (HR 0.60 [0.52, 0.69], p < 0.00001) and local brain control (HR 0.34 [0.11, 0.98], p = 0.05). SRS subgroup also revealed significantly better survival (HR 0.61 [0.44, 0.83], p = 0.002) and local brain control (HR 0.19 [0.08, 0.45], p = 0.0002). Distant brain control (HR 0.95 [0.67, 1.35], p = 0.79) and brain progression free survival were unaffected (HR 0.94 [0.56, 1.56], p = 0.80). Only one study (n = 376) reported significantly greater 12-months cumulative incidence of radiation necrosis with TKI use within 30 days of SRS (10.9 vs. 6.4%, p = 0.04). Khan et al. TKIs for RCC BM Conclusions: TKIs use in combination with SRS is safe and effective for treating RCC brain metastases. Larger randomized controlled trials are warranted to validate the results.

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“…Overall 7 studies met the inclusion criteria and were selected for meta-analysis (25,(43)(44)(45)(46)(47)(48). Search strategy and selection process is demonstrated in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%