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Baston C, Parosanu AI, Stanciu IM, Nitipir C. Metastatic Kidney Cancer: Does the Location of the Metastases Matter? Moving towards Personalized Therapy for Metastatic Renal Cell Carcinoma. Biomedicines 2024; 12:1111. [PMID: 38791072 PMCID: PMC11117570 DOI: 10.3390/biomedicines12051111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
The management of renal cell carcinoma (RCC) has been revolutionized over the past two decades with several practice-changing treatments. Treatment for RCC often requires a multimodal approach: Local treatment, such as surgery or ablation, is typically recommended for patients with localized tumors, while stage IV cancers often require both local and systemic therapy. The treatment of advanced RCC heavily relies on immunotherapy and targeted therapy, which are highly contingent upon histological subtypes. Despite years of research on biomarkers for RCC, the standard of care is to choose systemic therapy based on the risk profile according to the International Metastatic RCC Database Consortium and Memorial Sloan Kettering Cancer Centre models. However, many questions still need to be answered. Should we consider metastatic sites when deciding on treatment options for metastatic RCC? How do we choose between dual immunotherapy and combinations of immunotherapy and tyrosine kinase inhibitors? This review article aims to answer these unresolved questions surrounding the concept of personalized medicine.
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Affiliation(s)
- Catalin Baston
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Urology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Ioana Parosanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Ioana-Miruna Stanciu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Cornelia Nitipir
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 8 Sanitary Heroes Boulevard, 050474 Bucharest, Romania; (C.B.); (I.-M.S.); (C.N.)
- Department of Oncology, Elias University Emergency Hospital, 011461 Bucharest, Romania
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Minghinelli FE, Recalde RJ, Prost DM, Cutuli HJ, Giovannini SJM, Zaninovich RS. Which biological pathways are responsible for the late appearance of brain metastases in renal cell carcinoma? Analysis of eight cases. Surg Neurol Int 2022; 13:466. [PMID: 36324953 PMCID: PMC9610221 DOI: 10.25259/sni_713_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Renal cell carcinoma (RCC) represents 1% of all cancers and its brain metastases amount to 8.1% of all metastatic tumors. Late brain metastases are defined as tumors that appear 10 years after diagnosis of the primary lesion. The objective of this work is to discuss which biological pathways are responsible for the late appearance of these metastases analyzing eight cases. Case Description: We report here eight cases of late brain metastases of RCC treated between 2018 and 2021. Patients consulted for different clinical complaints. Brain magnetic resonance imaging and computed tomography scan were performed on all patients. They were treated by complete surgical resection plus radiosurgery or by radiosurgery alone. The histology of most metastases showed clear cell RCC. Conclusion: In the presence of a patient with an intracranial tumor and a history of RCC with more than 10 years of evolution, the presence of late metastasis should always be considered. There are many theories described in the literature that try to explain the late appearance of brain metastases from RCC (low mitotic index, impaired immune system, cross talk, self-seeding, and among others).
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Affiliation(s)
- Federico E. Minghinelli
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Rodolfo José Recalde
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Diego Martín Prost
- Department of Neurosurgery, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
| | - Hernán Javier Cutuli
- Ángel H. Roffo Institute of Oncology, University of Buenos Aires, School of Medicine, Buenos Aires, Argentina
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Choudhury AK, Verma R, Dhyani A, Paul S, Goyal T. Late Metastasis of Renal Cell Carcinoma in Distal Femur Treated with Knee Joint Preservation: A Case Report. J Orthop Case Rep 2022; 12:1-5. [PMID: 35611298 PMCID: PMC9091406 DOI: 10.13107/jocr.2022.v12.i01.2590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Late metastasis and recurrences after 10 years of curative treatment is a known biological behavior of renal cell carcinoma (RCC) and a long follow-up is required for the detection of metastasis. Late solitary bony metastasis is very rare. No case of a late solitary metastasis of distal femur, treated with wide local excision and reconstruction, is available in the literature. We present a case of solitary metastatic lesion of distal femur 12 years after radical nephrectomy for renal cell carcinoma in a 64-year-old male. Case Report The patient presented to us with swelling in the right distal thigh for three years with a history of radical nephrectomy for RCC 12-years back. The lesion was not responding to local radiotherapy, and chemotherapy in the form of oral pazopanib, taken before orthopedic consultation. After core biopsy, the tumor was managed by intercalary wide local excision and reconstruction using a cement block and a lateral locking plate. Post-operatively, the histopathology report confirmed the diagnosis to be a clear cell tumor, consistent with metastatic RCC. The patient is independently mobile and tumor-free 2 years after the surgery. Conclusion Wide resection and reconstruction of the skeletal defect remains the mainstay of the management of metastatic solitary lesion. We have presented a unique case of distal fem-oral solitary metastatic deposit from a primary RCC 12 years post radical nephrectomy treated by intercalary resection and reconstruction with bone cement-plate hybrid construct.
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Affiliation(s)
- Arghya Kundu Choudhury
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Ut-tarakhand, India
| | - Rahul Verma
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, India
| | - Aruj Dhyani
- Department of Radiotherapy, All India Institute of Medical Sciences, Rishikesh, India
| | - Souvik Paul
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Ut-tarakhand, India
| | - Tarun Goyal
- Department of Orthopaedic, All India Institute of Medical Sciences, Bath-inda, Punjab, India,Address of Correspondence: Dr. Tarun Goyal, Department of Orthopaedics, All India Insti-tute of Medical Sciences, Bathinda, Punjab, India. E-mail:
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Guadalupi V, Cartenì G, Iacovelli R, Porta C, Pappagallo G, Ricotta R, Procopio G. Second-line treatment in renal cell carcinoma: clinical experience and decision making. Ther Adv Urol 2021; 13:17562872211022870. [PMID: 34211586 PMCID: PMC8216352 DOI: 10.1177/17562872211022870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Currently, conventional treatments for metastatic RCC (mRCC) include immune-based combination regimens and/or targeted therapies, the latter mainly acting on angiogenesis, a key element of the process of tumor growth and spread. Although these agents proved able to improve patients’ outcomes, drug resistance and disease progression are still experienced by a substantial number of VEGFR-TKIs-treated mRCC patients. Following the inhibition of the VEGF/VEGFRs axis, two strategies have emerged: either specifically targeting resistance pathways, at the same time continuing to inhibit angiogenesis, or using a completely different approach aimed at re-activating the immune system through the use of inhibitors of specific negative immune checkpoints. These two approaches, practically represented by the use of either cabozantinib or nivolumab, seem to remain a rational therapeutic approach also when first-line immune-based combinations are used. The objective of this study is to design a preferential therapeutic pathway for the second-line treatment of mRCC. The procedure applied in this project was a group discussion, based on the Nominal Group Technique (NGT) method in a meeting session, aimed at defining the therapeutic choice for the second-line treatment of mRCC. The NGT process defined the most relevant parameters that, according to the interviewed panelists, clinicians should consider for the selection of the second-line therapy in the context of advanced renal cell carcinoma of mRCC. The algorithm developed for the treatment selection as a result of this process should thus be considered by clinicians as reference for therapy selection.
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Affiliation(s)
| | - Giacomo Cartenì
- Responsible for Research and Development Kerubin Digital Therapeutic, Italy
| | - Roberto Iacovelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma, Lazio, Italy
| | - Camillo Porta
- Chair of Oncology Department of Biomedical Sciences and Human Oncology University of Bari 'A. Moro' and Division of Oncology AOU Consorziale Policlinico di Bari Bari, Italy
| | | | - Riccardo Ricotta
- RCCS MultiMedica Sesto San Giovanni (MI), Sesto San Giovanni, Lombardia, Italy
| | - Giuseppe Procopio
- Istituto Nazionale dei Tumori IRCCS Milano, Milano, Lombardia, Italy
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Choo YH, Seo Y, Choi J. Extremely delayed solitary cerebral metastasis in patient with T1N0M0 renal cell carcinoma after radical nephrectomy: Case report and literature review. Medicine (Baltimore) 2021; 100:e25586. [PMID: 33847690 PMCID: PMC8052049 DOI: 10.1097/md.0000000000025586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Although renal cell carcinoma (RCC) is one of the common origins of brain metastasis, few cases of extremely delayed brain metastasis from RCC, more than 10 years after nephrectomy, have been reported. We present a rare case of extremely delayed brain metastasis from RCC, also performed a literature review to increase knowledge of the characteristics for extremely delayed brain metastasis from RCC. PATIENT CONCERNS A 72-year-old man presented with right-sided hemiplegia and dysarthria. The patient had a history of radical nephrectomy for RCC with stage T1N0M0 15 years earlier. DIAGNOSIS Magnetic resonance imaging with contrast revealed a 2-cm sized non-homogenous enhanced mass in the left frontal lobe with peritumoral edema. The pathological examination after surgery reported metastatic clear cell RCC. INTERVENTIONS A craniotomy for removal of the mass was performed at the time of diagnosis. Stereotactic radiosurgery was performed for the tumor bed 3 weeks after craniotomy, and then, chemotherapy was started 2 months after the SRS. OUTCOMES Metastasis progressed to multiple organs 6 months after the craniotomy. The patient chose a hospice and no longer visited the hospital. LESSONS In cases with a history of nephrectomy for RCC, long period follow-up is necessary for monitoring RCC brain metastasis and pathologic diagnosis should be confirmed.
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Affiliation(s)
| | | | - Joonhyuk Choi
- Department of Pathology, Yeungnam University Hospital, Yeungnam University College of Medicine Daegu, Republic of Korea
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Late-onset Metastasis of Intracranial Papillary Thyroid Carcinoma. World Neurosurg 2019; 130:7-9. [PMID: 31260848 DOI: 10.1016/j.wneu.2019.06.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Papillary thyroid carcinoma is the most common subtype of thyroid cancers, accounting for >90% of all thyroid carcinomas. Despite a favorable long-term survival rate of 94.4%, people with distant metastases show worse outcome. Cerebral metastases are slightly uncommon and stand for only 1%-3% of all metastases. CASE DESCRIPTION We present a 56-year-old male patient complaining of serious headaches for >20 days. He underwent thyroidectomy surgery 13 years ago due to papillary thyroid carcinoma and was reported "tumor free" on his follow-ups without any complaints. On his cranial magnetic resonance imaging scan a right temporal mass lesion was detected. During surgery, the tumor was removed and reported as papillary thyroid carcinoma metastasis. CONCLUSION A case in which a patient with papillary thyroid carcinoma developed brain metastasis after such a long time was not reported in the literature before.
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Kolsi F, Mechergui H, Kammoun B, Mellouli M, Khrifech M, Zaher boudawara M. Delayed brain metastasis from renal cell carcinoma. Urol Case Rep 2018; 22:54-56. [PMID: 30425927 PMCID: PMC6230915 DOI: 10.1016/j.eucr.2018.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/31/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fatma Kolsi
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
- Sfax University, Tunisia
- Corresponding author. Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia.
| | - Haifa Mechergui
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
- Sfax University, Tunisia
| | - Brahim Kammoun
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
- Sfax University, Tunisia
| | - Manel Mellouli
- Sfax University, Tunisia
- Anatomopathology Laboratory, UHC Habib Bourguiba, Sfax, Tunisia
| | - Mansour Khrifech
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
- Sfax University, Tunisia
| | - Med Zaher boudawara
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
- Sfax University, Tunisia
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Tamburrini A, Majorino A, Duggan S, Jogai S, Alzetani A. A record-breaking lung metastasis from renal cell carcinoma 37 years after nephrectomy. J Surg Case Rep 2018; 2017:rjx205. [PMID: 29423146 PMCID: PMC5798037 DOI: 10.1093/jscr/rjx205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/24/2017] [Accepted: 09/29/2017] [Indexed: 01/29/2023] Open
Abstract
Development of distant metastases from renal cell carcinoma (RCC) is a frequent occurrence and, in nearly 95% of the cases, secondary lesions present within 5 years following nephrectomy. We performed a left pneumonectomy for a peri-hilar lung mass in an 81-year-old man with history of kidney cancer, resected 37 years earlier. Histopathological examination revealed a solitary lung metastasis from RCC, relapsed after an extraordinary 37-year time interval. To the best of our knowledge, this remarkable case represents the longest time interval between radical nephrectomy for RCC and the occurrence of a pulmonary metastasis. After an uneventful post-operative recovery, there are no signs of disease recurrence at a 3-year follow-up. The possibility of a lung metastasis should be taken into account in patients with history of RCC who present with pulmonary nodules, even decades after treatment of the primary neoplasm.
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Affiliation(s)
| | - Aurelio Majorino
- Thoracic Surgery Division, Southampton University Hospital, Southampton, UK
| | - Simon Duggan
- Thoracic Surgery Division, Southampton University Hospital, Southampton, UK
| | - Sanjay Jogai
- Pathology Division, Southampton University Hospital, Southampton, UK
| | - Aiman Alzetani
- Thoracic Surgery Division, Southampton University Hospital, Southampton, UK
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Fukushima Y, Yoshikawa G, Takasago M, Shimizu S, Tsutsumi K. Extremely Delayed Multiple Brain Metastases from Renal Cell Carcinoma: Remission Achieved with Total Surgical Removal: Case Report and Literature Review. World Neurosurg 2016; 92:583.e13-583.e17. [DOI: 10.1016/j.wneu.2016.05.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
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Kolokythas A, Weiskopf S, Singh M, Cabay RJ. Renal Cell Carcinoma: Delayed Metachronous Metastases to Parotid and Cerebellum. J Oral Maxillofac Surg 2015; 73:1296-303. [PMID: 25925095 DOI: 10.1016/j.joms.2015.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this report is to describe a rare case of delayed metachronous isolated metastases of renal cell carcinoma (RCC) to the parotid gland and the cerebellum. The metastases occurred more than a decade after treatment of the primary tumor without any other systemic involvement. In addition, the potential differential diagnosis of the parotid mass based on presentation and imaging is discussed. MATERIALS AND METHODS An 83-year-old man presented for evaluation and treatment of a rapidly growing mass at the right parotid region. He had a history of RCC resection 10 years before this presentation and had no evidence of persistent disease at the primary site. The diagnosis of metastatic RCC was made after fine-needle aspiration biopsy examination of the mass. The patient underwent superficial parotidectomy for resection of the tumor. Approximately 1.5 years later, he complained of loss of balance. Further investigation disclosed a cerebellar mass that at biopsy examination was found to represent RCC. He underwent stereotactic ablation of the mass. He currently remains free of disease at the primary site and the parotid and without further known brain metastases. RESULTS This report presents the 29th case of a solitary parotid mass consistent with metastatic RCC 10 years after successful treatment of the primary RCC. Approximately 1.5 years later, the patient presented with new-onset loss of balance. Further investigation disclosed a mass to the cerebellum consistent with metastatic RCC. This case is unique because the brain involvement occurred extremely late, 11.5 years after successful treatment of primary RCC and 1.5 years after resection of a metastatic RCC to the parotid, and without any evidence of other metastases. CONCLUSIONS Late distant metastases of RCC are not uncommon and patients require life surveillance follow-up, but such late presentation of metachronous metastases without systemic disease progression is unique. The patterns of metastases of RCC are not clearly defined and this diagnosis should be considered, especially in patients with relevant history.
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Affiliation(s)
- Antonia Kolokythas
- Associate Professor, Program Director, Director of Research, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL.
| | - Scott Weiskopf
- Former Chief Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL
| | - Manmeet Singh
- Surgical Pathology Fellow, Department of Pathology, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL
| | - Robert J Cabay
- Assistant Professor of Clinical Pathology, Department of Pathology, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL
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