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Yu Q, Zhang Z, Ma Y, E S, Zhao L. Clinical analysis of renal cell carcinoma with intestinal metastasis resulting in small bowel and colon fistula. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023. [PMID: 38031915 DOI: 10.17235/reed.2023.10054/2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
An enteric fistula is an abnormal connection between the intestine and other organs and is often caused by inflammation or trauma. Diagnosis and treatment involve imaging and endoscopy. Treatment may include medication and surgery. This report presents a rare case of severe enteric fistula caused by colonic metastasis of clear cell renal carcinoma. The objective of this report is to increase surgeons' awareness of atypical manifestations of intestinal metastatic cancer.
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Affiliation(s)
- Qi Yu
- Weifang Medical University, China
| | | | - Yuhui Ma
- Ultrasound, Qilu Hospital (Qingdao). Cheeloo College of Medicine. Shandong University
| | | | - Lugang Zhao
- The Hospital affiliated with Weifang Medical College
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2
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Shen J, Tao Y, He L, Guan H, Zhen H, Liu Z, Zhang F. Clinical application of radiotherapy in patients with oligometastatic ovarian cancer: a sharp tool to prolong the interval of systemic treatment. Discov Oncol 2022; 13:82. [PMID: 36006491 PMCID: PMC9411494 DOI: 10.1007/s12672-022-00540-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With the advances of radiation technology, treatment of oligometastatic disease, with limited metastatic burden, have more chances to achieve long-term local control. Here we aim to evaluate the efficacy and safety of radiotherapy (RT) in oligometastatic ovarian cancer patients. METHODS A retrospective analysis collecting 142 patients (189 lesions) with oligometastatic ovarian cancer were included in the study. All pateints received radiotherapy and the curative effect and response rate were evaluated by diagnostic imaging after 1-3 months of radiotherapy with RECIST. Endpoints were the rate of complete response (CR), chemotherapy-free interval (CFI), local control (LC) rate and overall survival (OS) rate. Toxicity was evaluated by the Radiation Therapy Oncology Group (RTOG). Logistic and Cox regression were used for the uni- and multivariate analysis of factors influencing survival outcomes. RESULTS From 2013.1.1 to 2020.12.30, a total of 142 ovarian cancer patients (189 oligometastasis lesions) were included in the analysis. Prescribed doses to an average GTV of 3.10 cm were 1.8-8 Gy/fraction, median BED (28-115, a/b = 10 Gy), 5-28 fractions. For 179 evaluable lesions, the cases of CR, partial response (PR), stable disease (SD) and progressive disease (PD) after radiotherapy were 22,39,38 and 80 respectively. The disease control rate (DCR): CR + PR + SD was 55.31%, and the objective response rate (ORR): CR + PR was 34.08%. No patient developed grade 3 or higher side effect. The median CFI was 14 months (1-99 months), and the LC rate was 69.7%, 54.3% and 40.9% in 1 year, 2 years and 5 years respectively. GTV < 3 cm before treatment, platinum sensitivity, time from the last treatment ≥ 6 months, single lesion and BED(a/b = 10 Gy) ≥ 60 are the factors of good LC (p < 0.05). The total OS of 1 year, 2 years and 5 years were 67.1%, 52.6% and 30.3%, respectively. Single lesion (HR 0.598, 95%CI 0.405-0.884), DCR (HR 0.640, 95% CI 0.448-0.918) and ORR(HR 0.466, 95% CI 0.308-0.707) were the significant factors influencing 5-year OS. CONCLUSION For patients with oligometastatic ovarian cancer, radiotherapy has high LC, long chemotherapy-free interval, and survival benefits. Subgroup analysis shows that patients with single lesion and good local treatment results have higher overall survival rate, suggesting that active treatment is also beneficial for oligometastatic ovarian cancer patients.
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Affiliation(s)
- Jing Shen
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Yinjie Tao
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Lei He
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Hui Guan
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Hongnan Zhen
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital. Chinese Academy of Medical Sciences & Peking Union Medical College, NO.1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730 People’s Republic of China
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3
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Black Phosphorus Quantum Dots Enhance the Radiosensitivity of Human Renal Cell Carcinoma Cells through Inhibition of DNA-PKcs Kinase. Cells 2022; 11:cells11101651. [PMID: 35626687 PMCID: PMC9139844 DOI: 10.3390/cells11101651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Renal cell carcinoma (RCC) is one of the most aggressive urological malignancies and has a poor prognosis, especially in patients with metastasis. Although RCC is traditionally considered to be radioresistant, radiotherapy (RT) is still a common treatment for palliative management of metastatic RCC. Novel approaches are urgently needed to overcome radioresistance of RCC. Black phosphorus quantum dots (BPQDs) have recently received great attention due to their unique physicochemical properties and good biocompatibility. In the present study, we found that BPQDs enhance ionizing radiation (IR)-induced apoptotic cell death of RCC cells. BPQDs treatment significantly increases IR-induced DNA double-strand breaks (DSBs), as indicated by the neutral comet assay and the DSBs biomarkers γH2AX and 53BP1. Mechanistically, BPQDs can interact with purified DNA–protein kinase catalytic subunit (DNA-PKcs) and promote its kinase activity in vitro. BPQDs impair the autophosphorylation of DNA-PKcs at S2056, and this site phosphorylation is essential for efficient DNA DSBs repair and the release of DNA-PKcs from the damage sites. Consistent with this, BPQDs suppress nonhomologous end-joining (NHEJ) repair and lead to sustained high levels of autophosphorylated DNA-PKcs on the damaged sites. Moreover, animal experiments indicate that the combined approach with both BPQDs and IR displays better efficacy than monotreatment. These findings demonstrate that BPQDs have potential applications in radiosensitizing RCC cells.
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4
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Magné N, Latorzeff I. Oligometastatic renal cell carcinoma: radiotherapy as a new standard of care? Lancet Oncol 2021; 22:1644-1645. [PMID: 34856135 DOI: 10.1016/s1470-2045(21)00665-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nicolas Magné
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, Unité Mixte de Recherche CNRS5822/IP2I, University of Lyon, Lyon 69921, France; Department of Radiotherapy, Lucien Neuwirth Cancer Centre, Saint-Étienne, France; Radiation Oncology Department, Oncorad, Toulouse Pasteur Clinic, Toulouse, France.
| | - Igor Latorzeff
- Radiation Oncology Department, Oncorad, Toulouse Pasteur Clinic, Toulouse, France; Gamma Knife Unit, Toulouse-Purpan University Hospital, Toulouse, France
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5
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Marvaso G, Corrao G, Oneta O, Pepa M, Zaffaroni M, Corso F, Gandini S, Cecconi A, Zerini D, Mazzola GC, Augugliaro M, Cossu Rocca M, Verri E, Cattani F, La Fauci F, Bergamaschi L, Luzzago S, Mistretta AF, Musi G, Nolè F, De Cobelli O, Orecchia R, Jereczek-Fossa BA. Oligo metastatic renal cell carcinoma: stereotactic body radiation therapy, if, when and how? Clin Transl Oncol 2021; 23:1717-1726. [PMID: 33687659 DOI: 10.1007/s12094-021-02574-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/15/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Renal cell carcinoma (RCC) has traditionally been considered radioresistant with a limited role for conventional fractionation as a local approach. Nevertheless, since the appearance of stereotactic body radiation therapy (SBRT), radiotherapy (RT) has been increasingly employed in the management of metastatic RCC (mRCC). The aim of this study was to evaluate the role of SBRT for synchronous and metachronous oligo metastatic RCC patients in terms of local control, delay of systemic treatment, overall survival and toxicity. PATIENTS AND METHODS A Monocentric single institution retrospective data collection was performed. Inclusion criteria were: (1) oligo-recurrent or oligo-progressive disease (less than 5 metastases) in mRCC patients after radical/partial nephrectomy or during systemic therapy, (2) metastasectomy or other metastasis-directed, rather than SBRT not feasible, (3) any contraindication to receive systemic therapy (such as comorbidities), (4) all the histologies were included, (5) available signed informed consent form for treatment. Tumor response and toxicity were evaluated using the response evaluation criteria in solid tumors and the Common Terminology Criteria for Adverse Events version 4.03, respectively. Progression-free survival in-field and out-field (in-field and out-field PFS) and overall survival (OS) were calculated via the Kaplan-Meier method. The drug treatment-free interval was calculated from the start of SBRT to the beginning of any systemic therapy. RESULTS From 2010 to December 2018, 61 patients with extracranial and intracranial metastatic RCC underwent SBRT on 83 lesions. Intracranial and extracranial lesions were included. Forty-five (74%) patients were treated for a solitary metastatic lesion. Median RT dose was 25 Gy (range 10-52) in 5-10 fractions. With a median follow-up of 2.3 years (range 0-7.15), 1-year in-field PFS was 70%, 2-year in-field PFS was 55%. One year out-field PFS was 39% and 1-year OS was 78%. Concomitant systemic therapy was employed for only 11 (18%) patients, for the others 50 (82%) the drug treatment-free rate was 70% and 50% at 1 and 2 years, respectively. No > G1 acute and late toxicities were reported. CONCLUSION The pattern of failure was pre-dominantly out-of-field, even if the population was negatively selected and the used RT dose could be considered palliative. Therefore, SBRT appears to be a well-tolerated, feasible and safe approach in oligo metastatic RCC patients with an excellent in-field PFS. SBRT might play a role in the management of selected RCC patients allowing for a delay systemic therapy begin (one out of two patients were free from new systemic therapy at 2 years after SBRT). Further research on SBRT dose escalation is warranted.
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Affiliation(s)
- G Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy. .,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy.
| | - G Corrao
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - O Oneta
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - M Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Corso
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.,Department of Mathematics (DMAT), Politecnico di Milano, Milan, Italy.,Center for Analysis Decisions and Society (CADS), Human Technopole, Milan, Italy
| | - S Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - A Cecconi
- Scientific Direction, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - D Zerini
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G C Mazzola
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - M Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Cossu Rocca
- Division of Uro-Genital and Head and Neck Medical Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - E Verri
- Division of Uro-Genital and Head and Neck Medical Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - F Cattani
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - F La Fauci
- Unit of Medical Physics, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - L Bergamaschi
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
| | - S Luzzago
- Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - A F Mistretta
- Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Musi
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy.,Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - F Nolè
- Division of Uro-Genital and Head and Neck Medical Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - O De Cobelli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy.,Division of Urology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - R Orecchia
- Scientific Direction, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - B A Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, Milan, Italy
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6
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Wei Q, He H, Lv L, Xu X, Sun W. The promising role of radiotherapy in the treatment of advanced or metastatic renal cell carcinoma: a narrative review. Transl Androl Urol 2020; 9:2821-2830. [PMID: 33457253 PMCID: PMC7807309 DOI: 10.21037/tau-20-1466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Traditionally, renal cell carcinoma (RCC) has been regarded to be “radioresistant”. Conventional fractionated radiation (CFRT) has played a limited role in RCC as a palliative treatment to relieve pain and bleeding. Succeed to the rapid development of precise radiotherapy techniques, realizing safe delivery of high-dose radiotherapy, an increasing amount of convincing data suggests that the delivery of high-dose-per-fraction radiation through stereotactic radiosurgery (SRS) or stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR) can help to overcome resistance to radiotherapy. Herein, we summarized and analyzed the data from randomized controlled trials, retrospective and prospective studies, and meta-analyses relating to the treatment of advanced and metastatic RCC (mRCC) with CFRT, SBRT, or SBRT combined with systemic therapy. CFRT has a limited effect on local control (LC) of advanced RCC and mRCC, but it is a major palliative treatment which could obviously relieve pain caused by cancer. SBRT and SRS have the significant advantage of being able to precisely deliver a high dose of radiation to the target tissues. SBRT could cause a higher LC for advanced and metastatic RCC and could be used as an alternative to surgery for patients with oligometastatic RCC. The combination of SBRT with systemic therapy, such as targeted therapy or immunotherapy, is safe and tolerable. Concurrent immunotherapy and SBRT is a promising treatment strategy for patients with advanced or metastatic RCC. However, research on radiotherapy combined with systemic therapy is still limited and further studies to explore this treatment for RCC are urgently needed.
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Affiliation(s)
- Qinghong Wei
- Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongmei He
- Department of medical Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Long Lv
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaoying Xu
- Department of Radiation Oncology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Weibing Sun
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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7
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Ahn T, Roberts MJ, Abduljabar A, Joshi A, Perera M, Rhee H, Wood S, Vela I. A Review of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography (PET) in Renal Cell Carcinoma (RCC). Mol Imaging Biol 2020; 21:799-807. [PMID: 30617728 DOI: 10.1007/s11307-018-01307-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Metastatic renal cell carcinoma (mRCC) is a disease that portends poor prognosis despite an increasing number of novel systemic treatment options including new targeted therapies and immunotherapy. Ablative intervention directed at oligometastatic RCC has demonstrated survival benefit. Consequently, developing techniques for improved staging of mRCC on contemporary imaging modalities including X-ray computed tomography (CT), magnetic resonance imaging (MRI) and/or bone scan (BS) is a clinical priority. This is relevant for metastatic deposits too small to characterize or lymph nodes within physiological normality. Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein highly expressed on prostate cancer epithelial cells. Recently, small molecules targeting the PSMA receptor, linked to radioactive isotopes have been developed for use with positron emission tomography (PET). Despite its nomenclature, PSMA has also been found to be expressed in the neovasculature of non-prostate cancers such as renal cell carcinoma (RCC) and hence PSMA PET/CT imaging has been proposed as an alternative staging modality. Preliminary small studies involving the use of PSMA PET/CT imaging in mRCC have been encouraging with evidence of improved staging sensitivity which has directly led to change in management in some cases. Given these early encouraging reports, we performed a comprehensive narrative review on the available evidence, including the scientific basis for PSMA expression in RCC, the role of PSMA PET/CT imaging with potential clinical implications in mRCC, its limitations and future opportunities.
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Affiliation(s)
- Thomas Ahn
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Matthew J Roberts
- Department of Urology, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Aous Abduljabar
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andre Joshi
- Department of Urology, Townsville Hospital, Brisbane, Queensland, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Marlon Perera
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Handoo Rhee
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon Wood
- Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia
| | - Ian Vela
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australian Prostate Cancer Research Center Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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8
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Berghen C, Joniau S, Vulsteke C, Albersen M, Devos G, Rans K, Haustermans K, De Meerleer G. Metastasis-directed therapy for oligometastatic urological tumours: still no second-hand news. Ecancermedicalscience 2020; 14:1036. [PMID: 32565889 PMCID: PMC7289610 DOI: 10.3332/ecancer.2020.1036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/31/2022] Open
Abstract
For patients presenting with limited metastatic disease burden, known as the oligometastatic state of disease, a more aggressive treatment approach targeting the new or progressive metastatic lesions might improve patient outcome, with no or only limited toxicity to be expected from the treatment. This review provides an overview of the existing evidence and on-going trials on oligometastatic disease and metastasis-directed therapy in the field of renal, bladder and prostate cancer.
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Affiliation(s)
- Charlien Berghen
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Christof Vulsteke
- Department of Oncology, Ghent Maria Middelares Hospital, Ghent, Belgium.,Department of Molecular Imaging, Pathology, Radiotherapy and Oncology (MIPRO), Center for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - Maarten Albersen
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Gaëtan Devos
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Kato Rans
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
| | - Karin Haustermans
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, Leuven University Hospital, Leuven, Belgium
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9
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Stereotactic ablative radiation therapy for oligometastatic renal cell carcinoma (SABR ORCA): a meta-analysis of 28 studies. Eur Urol Oncol 2019; 2:515-523. [DOI: 10.1016/j.euo.2019.05.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/24/2022]
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10
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Stereotactic Body Radiation Therapy in Oligometastatic Ovarian Cancer: A Promising Therapeutic Approach. Int J Gynecol Cancer 2019; 28:1507-1513. [PMID: 30036231 DOI: 10.1097/igc.0000000000001324] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Stereotactic body radiation therapy (SBRT) has been successfully used to treat oligometastases of several primary tumors, but few experiences have been described in patients with gynecological oligometastatic cancer, particularly in ovarian neoplasm. The aim of this study was to evaluate the role of this new radiotherapy modality in a series of oligometastatic ovarian cancer patients. MATERIALS AND METHODS Clinical records of patients affected by oligometastatic ovarian carcinoma treated with SBRT were reviewed. RESULTS Twenty-six patients with 44 metastatic lesions (lymph nodes, 63.6%; liver, 31.8%; and lung, 4.5%) treated with SBRT between January 2011 and May 2017 were analyzed. After a median follow-up period of 28.5 months (range, 6-86 months), 17 patients (65.4%) were still alive at time of analysis: 6 are without evidence of disease, 11 experienced a disease progression. Eight patients died of disease, 1 died because of an heart attack while being disease free. The median local control (LC) was not reached. One-, 2-, and 5-year LCs were 92.9%. Median progression-free survival was 19 months, with 1-year progression-free survival of 69.3% and 38% at 2 years, 19% at 5 years. Median overall survival was 64.5 months, with all patients alive after 1 year, 92.7% at 2 years, and 61.7% at 5 years. Five (11.3%) cases experienced G2 toxicity; most common adverse effect was nausea and vomiting (3 cases [6.8%]) followed by abdominal pain (2 cases [4.5%]). None of the patients had grade 3 or grade 4 acute or late toxicity. CONCLUSIONS In conclusion, SBRT is a feasible and safe approach for selected cases of oligometastatic ovarian cancer, with satisfactory results in terms of LC and disease free survival.
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11
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Bersanelli M, Gnetti L, Varotti E, Ampollini L, Carbognani P, Leonardi F, Rusca M, Campanini N, Ziglioli F, Dadomo CI, Pilato FP, Cortellini A, Rapacchi E, Caruso G, Silini EM, Maestroni U, Buti S. Immune context characterization and heterogeneity in primary tumors and pulmonary metastases from renal cell carcinoma. Immunotherapy 2019; 11:21-35. [PMID: 30702014 DOI: 10.2217/imt-2018-0097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: The knowledge of the immune context of renal cell carcinoma (RCC) is useful to predict benefit from immunotherapy. We retrospectively characterized the immune context of RCC patients underwent primary nephrectomy and pulmonary metastasectomy. Materials & methods: Intratumoral infiltrating lymphocytes and peritumoral renal infiltrating lymphocytes, lymphocyte subpopulations (CD4+, CD8+), PD-1, PD-L1 were explored in paired samples of primary RCC (T) and respective pulmonary metastases (M). Results: The immune variables demonstrated intralesional and intratumoral heterogeneity. Intralesional lymphocyte heterogeneity reached 76% of cases in T, 28% in M. The heterogeneity rate for PD-L1 expression was from 44% (T) to 56% (M); it correlated with better survival. Conclusion: The immune context of RCC is highly variable both within a given tumor and among primary and metastases.
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Affiliation(s)
- Melissa Bersanelli
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Letizia Gnetti
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Elena Varotti
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Luca Ampollini
- Department of Thoracic Surgery, University Hospital of Parma, Parma, 43126, Italy
| | - Paolo Carbognani
- Department of Thoracic Surgery, University Hospital of Parma, Parma, 43126, Italy
| | - Francesco Leonardi
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Michele Rusca
- Department of Thoracic Surgery, University Hospital of Parma, Parma, 43126, Italy
| | - Nicoletta Campanini
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Francesco Ziglioli
- Department of Urology, University Hospital of Parma, Parma, 43126, Italy
| | - Clara I Dadomo
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Francesco P Pilato
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Alessio Cortellini
- Department of Biotechnological & Applied Clinical Sciences, Medical Oncology, St Salvatore Hospital, University of L'Aquila, L'Aquila, 67100, Italy
| | - Elena Rapacchi
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Giuseppe Caruso
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
| | - Enrico M Silini
- Department of Pathological Anatomy & Histology, University Hospital of Parma, Parma, 43126, Italy
| | - Umberto Maestroni
- Department of Urology, University Hospital of Parma, Parma, 43126, Italy
| | - Sebastiano Buti
- Department of Medical Oncology, University Hospital of Parma, Parma, 43126, Italy
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12
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Mery B, Rancoule C, Rowinski E, Bosacki C, Vallard A, Guy JB, Magné N. Cancer du rein et radiothérapie : radiorésistance et au-delà. Bull Cancer 2019; 105 Suppl 3:S280-S285. [PMID: 30595157 DOI: 10.1016/s0007-4551(18)30383-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
KIDNEY CANCER AND RADIOTHERAPY RADIORESISTANCE AND BEYOND: Metastatic renal cancer has a poor prognosis because of the limited impact of usual treatment modalities, and notably radiotherapy. Renal cell carcinoma is traditionally considered to be radioresistant, and conventional radiotherapy fraction sizes of 1.8 to 2 Gy are thought to have little role in its management. Technological advances in radiation oncology have led to stereotactic approaches that overcome radio resistance mechanisms of renal cancer cells and could be successful. The technical ability of applying high dose per fraction, leads to a distinct biological response which is different from the one observed with conventional irradiation through high responses rates. The increased radiobiological effect is attributed to endothelial apoptosis triggered by high fractional dose. The combination of such radiotherapy regimens with targeted drugs paves the way for new therapeutic opportunities.
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Affiliation(s)
- Benoîte Mery
- Département d'oncologie médicale, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France
| | - Chloé Rancoule
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France; Laboratoire de radiobiologie cellulaire et moléculaire, CNRS UMR 5822, Institut de physique nucléaire de Lyon, IPNL, 69622 Villeurbanne, France
| | - Elise Rowinski
- Département d'oncologie médicale, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France
| | - Claire Bosacki
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France
| | - Alexis Vallard
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France
| | - Jean-Baptiste Guy
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France; Laboratoire de radiobiologie cellulaire et moléculaire, CNRS UMR 5822, Institut de physique nucléaire de Lyon, IPNL, 69622 Villeurbanne, France
| | - Nicolas Magné
- Département de radiothérapie, institut de cancérologie Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP60008, 42271 Saint-Priest-en-Jarez Cedex, France; Laboratoire de radiobiologie cellulaire et moléculaire, CNRS UMR 5822, Institut de physique nucléaire de Lyon, IPNL, 69622 Villeurbanne, France.
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13
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Stereotactic radiation therapy in the strategy of treatment of metastatic renal cell carcinoma: A study of the Getug group. Eur J Cancer 2018; 98:38-47. [DOI: 10.1016/j.ejca.2018.04.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/04/2018] [Accepted: 04/12/2018] [Indexed: 01/02/2023]
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14
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Integrated molecular subtyping defines a curable oligometastatic state in colorectal liver metastasis. Nat Commun 2018; 9:1793. [PMID: 29728604 PMCID: PMC5935683 DOI: 10.1038/s41467-018-04278-6] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/10/2018] [Indexed: 01/04/2023] Open
Abstract
The oligometastasis hypothesis suggests a spectrum of metastatic virulence where some metastases are limited in extent and curable with focal therapies. A subset of patients with metastatic colorectal cancer achieves prolonged survival after resection of liver metastases consistent with oligometastasis. Here we define three robust subtypes of de novo colorectal liver metastasis through integrative molecular analysis. Patients with metastases exhibiting MSI-independent immune activation experience the most favorable survival. Subtypes with adverse outcomes demonstrate VEGFA amplification in concert with (i) stromal, mesenchymal, and angiogenic signatures, or (ii) exclusive NOTCH1 and PIK3C2B mutations with E2F/MYC activation. Molecular subtypes complement clinical risk stratification to distinguish low-risk, intermediate-risk, and high-risk patients with 10-year overall survivals of 94%, 45%, and 19%, respectively. Our findings provide a framework for integrated classification and treatment of metastasis and support the biological basis of curable oligometastatic colorectal cancer. These concepts may be applicable to many patients with metastatic cancer.
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15
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Gardner CS, Ensor JE, Ahrar K, Huang SY, Sabir SH, Tannir NM, Lewis VO, Tam AL. Cryoablation of Bone Metastases from Renal Cell Carcinoma for Local Tumor Control. J Bone Joint Surg Am 2017; 99:1916-1926. [PMID: 29135665 DOI: 10.2106/jbjs.16.01182] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with bone metastases from renal cell carcinoma often are not surgical candidates and have a poor prognosis. There are limited data on the use of cryoablation as a locoregional therapy for bone metastases. Our objective was to assess the local tumor-control rate following cryoablation of bone metastases in the setting of renal cell carcinoma. METHODS We retrospectively reviewed the medical records of patients with metastatic renal cell carcinoma who underwent cryoablation for bone metastases between 2007 and 2014. We excluded patients if the intent of treatment was for pain palliation only, if cryoablation was performed without an attempt for complete tumor control (cytoreduction), or if the patient had no further follow-up beyond the cryoablation procedure. We recorded patient demographics, procedural variables, and complications. Cross-sectional imaging and clinical follow-up were reviewed to determine disease recurrence. The median overall survival and recurrence-free survival were determined using the Kaplan-Meier method. RESULTS Forty patients (30 male and 10 female) with 50 bone metastases were included for analysis. The mean patient age was 62 years (range, 47 to 82 years). The median follow-up was 35 months (95% confidence interval [CI], 22.7 to 74.4 months). Twenty-five (62.5%) of the 40 patients had oligometastatic disease, defined as ≤5 metastases at the time of ablation. The mean tumor size was 3.4 ± 1.5 cm. Metastases in the pelvic region represented 68% of the treated tumors (34 of 50). The overall local tumor-control rate per lesion was 82% (41 of 50). Patients with oligometastatic disease experienced better local tumor control (96% [24 of 25]) compared with patients who had >5 metastases (53.3% [8 of 15]) (p = 0.001). The local tumor-control rate was better for lesions for which a larger mean difference between maximum ice-ball diameter and maximum lesion diameter was achieved (2.2 ± 0.9 cm for those without recurrence versus 1.35 ± 1.2 cm for those with recurrence; p = 0.005). There were 3 grade-3 complications and 1 grade-4 complication. CONCLUSIONS Cryoablation can be effective for achieving local oncologic control in bone metastases from renal cell carcinoma and may represent a valuable alternative to surgical metastasectomy in select patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Carly S Gardner
- 1Department of Radiology, Baylor College of Medicine, Houston, Texas 2Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Texas 3Departments of Interventional Radiology (K.A., S.Y.H., S.H.S., and A.L.T.), Genitourinary Medical Oncology (N.M.T.), and Orthopaedic Oncology (V.O.L.), University of Texas MD Anderson Cancer Center, Houston, Texas
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16
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Integration of radiotherapy and chemotherapy for abdominal lymph node recurrence in gastric cancer. Clin Transl Oncol 2017; 19:1268-1275. [DOI: 10.1007/s12094-017-1665-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/18/2017] [Indexed: 01/16/2023]
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17
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Claeys T, Lumen N, Kumps C, Praet M, De Meerleer G, Rottey S, Ost P, Devisschere P, Villeirs G, Fonteyne V, Decaestecker K. The independent oncological role for cytoreductive nephrectomy in metastatic renal cell carcinoma: Prognostic features in the era of targeted therapies. Urol Oncol 2017; 35:152.e13-152.e22. [PMID: 28153420 DOI: 10.1016/j.urolonc.2016.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 06/16/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To describe the effects of cytoreductive nephrectomy (CN) on the natural course of metastatic renal cell carcinoma (mRCC). CN appears to stabilize metastatic lesions in mRCC in a subgroup of patients and we hypothesize that systemic treatment might be deferred in these patients with stable disease after CN. SUBJECTS AND METHODS Overall, 45 patients with mRCC who underwent CN and subsequent oncologic follow-up were included in this retrospective, single-center analysis. After CN, patients were followed at least every 3 months with clinical evaluation, contrast-enhanced computerized tomography scan of chest and abdomen, with additional imaging if needed. At 3 months, patients were radiographically evaluated and categorized into nonresponders (death or progression) or responders (stable disease or remission). Kaplan-Meier and Cox proportional hazards regression statistics were used to describe prognostic factors for overall survival (OS) and systemic therapy-free survival (STFS). RESULTS Median OS was 31(3-121) months. Further, 24 (53.3%) and 21 (46.7%) patients were classified as responders and nonresponders at 3 months, respectively. Responders had a significant better 2-year OS compared with nonresponders (81.7% vs. 26.5%, P = 0.005). Responders also had a better 2-year STFS (40.3% vs. 6.3%, P = 0.005). On Cox regression analysis, worse OS was found to be associated with low preoperative hemoglobin levels, the absence of postoperative radiographical response, and the presence of non-clear cell pathology. The presence of postoperative radiographical response, normal preoperative lactate dehydrogenase levels, the presence of a single metastasis, and performing metastasis-directed therapy was found to be associated with a longer systemic therapy-free period. CONCLUSION A beneficial oncologic response is observed in approximately half of the patients undergoing CN. Absence of radiographic progression at 3 months is an important marker for OS and STFS. Therefore, systemic treatment might be postponed in selected patients.
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Affiliation(s)
- Tom Claeys
- Department of Urology, Ghent University Hospital, Gent, Belgium.
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Candy Kumps
- Department of Urology, Ghent University Hospital, Gent, Belgium
| | - Marleen Praet
- Department of Pathology, Ghent University Hospital, Gent, Belgium
| | - Gert De Meerleer
- Department of Radiotherapy, Ghent University Hospital, Gent, Belgium
| | - Sylvie Rottey
- Department of Oncology, Ghent University Hospital, Gent, Belgium
| | - Piet Ost
- Department of Radiotherapy, Ghent University Hospital, Gent, Belgium
| | | | - Geert Villeirs
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Valerie Fonteyne
- Department of Radiotherapy, Ghent University Hospital, Gent, Belgium
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18
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Siva S, Callahan J, Pryor D, Martin J, Lawrentschuk N, Hofman MS. Utility of 68
Ga prostate specific membrane antigen - positron emission tomography in diagnosis and response assessment of recurrent renal cell carcinoma. J Med Imaging Radiat Oncol 2017; 61:372-378. [DOI: 10.1111/1754-9485.12590] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/17/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
| | - Jason Callahan
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - David Pryor
- Department of Radiation Oncology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Jarad Martin
- Calvary Mater Hospital; Waratah New South Wales Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Michael S Hofman
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Victoria Australia
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19
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Siva S, Ellis RJ, Ponsky L, Teh BS, Mahadevan A, Muacevic A, Staehler M, Onishi H, Wersall P, Nomiya T, Lo SS. Consensus statement from the International Radiosurgery Oncology Consortium for Kidney for primary renal cell carcinoma. Future Oncol 2016; 12:637-45. [DOI: 10.2217/fon.16.2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aim: To provide a multi-institutional consensus document for stereotactic body radiotherapy of primary renal cell carcinoma. Materials & methods: Eight international institutions completed a 65-item survey covering patient selection, planning/treatment aspects and response evaluation. Results: All centers treat patients with pre-existing hypertension and solitary kidneys. Five institutions apply size constraints of 5–8 cm. The total planning target volume expansion is 3–10 mm. All institutions perform pretreatment imaging verification, while seven institutions perform some form of intrafractional monitoring. Number of fractions used are 1–12 to a total dose of 25 Gy–80 GyE. Imaging follow-up for local tumor response includes computed tomography (n = 8), PET-computed tomography (n = 1) and MRI (n = 5). Follow-up frequency is 3–6 months for the first 2 years and 3–12 months for subsequent 3 years. Conclusion: Key methods for safe implementation and practice for stereotactic body radiotherapy kidney have been identified and may aid standardization of treatment delivery.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology & Cancer Imaging, Peter MacCallum Cancer Center, East Melbourne, Australia
| | - Rodney J Ellis
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Lee Ponsky
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Bin S Teh
- Houston Methodist Hospital, Weil Cornell Medical College, Houston, TX, USA
| | | | | | | | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Peter Wersall
- Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden
| | - Takuma Nomiya
- National Institute of Radiological Sciences, Chiba, Japan
| | - Simon S Lo
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
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20
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Siva S, Jackson P, Kron T, Bressel M, Lau E, Hofman M, Shaw M, Chander S, Pham D, Lawrentschuk N, Wong LM, Goad J, Foroudi F. Impact of stereotactic radiotherapy on kidney function in primary renal cell carcinoma: Establishing a dose-response relationship. Radiother Oncol 2016; 118:540-6. [PMID: 26873790 DOI: 10.1016/j.radonc.2016.01.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/31/2016] [Accepted: 01/31/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate renal dysfunction after stereotactic ablative body radiotherapy (SABR) for inoperable primary renal cell carcinoma (RCC) using nuclear medicine assessments. MATERIALS AND METHODS In a prospective clinical trial, patients received single fraction renal SABR (26 Gy) for tumours <5 cm, or fractionated SABR (3 × 14 Gy) for tumours ⩾5 cm. Global and regional glomerular filtration rate (GFR) was calculated through (51)Cr-EDTA and (99m)Tc-DMSA SPECT/CT, respectively, at baseline and post-treatment (14, 90 days and at 1-year). Regional loss in function was correlated to the absolute and biologically effective doses (BED) delivered. RESULTS In 21 patients the mean (range) tumour size was 48 mm (21-75 mm). The mean ± SD GFR at baseline was 52 ± 24 ml/min. Net change in mean GFR was +0.6 ± 11.3, +3.2 ± 14.5 and -8.7 ± 13.4 ml/min (p=0.03) at 2 weeks, 3 months and 1 year, respectively. For every 10 Gy of physical dose delivered, an exponential decline in affected kidney GFR was observed at 39% for 26 Gy/1 fraction and 25% for 42 Gy/3 fractions. When normalised to BED3Gy, the dose-response relationship for each treatment prescription was similar with a plateau beyond 100 Gy. The R50% conformity index correlated with GFR loss (p=0.04). No patient required dialysis. CONCLUSIONS SABR results in clinically acceptable and dose-dependent renal dysfunction at 1-year. Sparing functional kidney from high-dose regions (>50% isodoses) may help reduce risk of functional loss.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia.
| | - Price Jackson
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia
| | - Tomas Kron
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Mathias Bressel
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Australia
| | - Eddie Lau
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia; Department of Radiology, University of Melbourne, Australia
| | - Michael Hofman
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Mark Shaw
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia
| | - Sarat Chander
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia
| | - Daniel Pham
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia
| | | | - Lih-Ming Wong
- Department of Surgery, University of Melbourne, Australia
| | - Jeremy Goad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Australia
| | - Farshad Foroudi
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Australia
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Bludau F, Reis T, Schneider F, Clausen S, Wenz F, Obertacke U. [Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT). Alternative therapy for patients with oligometastatic spinal metastases]. Radiologe 2015; 55:859-67. [PMID: 26420600 DOI: 10.1007/s00117-015-0018-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to a more effective systemic therapy the survival of patients suffering from malignant tumors has been significantly improved but a longer life span is often associated with a higher incidence of osseous metastases. The majority of these metastases are localized in the spine causing pain, instability and neurological impairments. The interdisciplinary management of spinal metastases previously consisted of stabilization followed by fractionated external body radiation therapy. A reduction in procedural severity and morbidity as well as consideration of self-sufficiency and hospitalization time are important target parameters for these palliative patients. METHOD AND RESULTS Kyphoplasty combined with intraoperative radiotherapy (Kypho-IORT) is one of several modern treatment options, which involves a minimally invasive procedure with local high-dose transpedicular irradiation of the spine with low-energy (50 kV) X-rays. Immediately following irradiation, stabilization of the spine is carried out using kyphoplasty via the same access route so that a single stage procedure with excellent pain reduction and good local tumor control can be achieved. This article presents clinical data for this procedure and the different fields of indications are critically reviewed and compared to other therapy options. Methodological improvements and options for further individualization of therapy are demonstrated. CONCLUSION The Kypho-IORT procedure is a safe, feasible and beneficial modern treatment option for instant stabilization and local tumor control in patients with spinal metastases. More than 100 operations have been successfully performed so that the method can be deemed suitable for inclusion in the clinical routine. A phase II dose escalation study has now been completed and submitted for publication and a 2-arm non-inferiority trial (phase III study) for comparison with conventional irradiation is in progress.
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Affiliation(s)
- F Bludau
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland.
| | - T Reis
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - F Schneider
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - S Clausen
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - F Wenz
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
| | - U Obertacke
- Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Med. Fakultät Mannheim der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland
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Reyes DK, Pienta KJ. The biology and treatment of oligometastatic cancer. Oncotarget 2015; 6:8491-524. [PMID: 25940699 PMCID: PMC4496163 DOI: 10.18632/oncotarget.3455] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 12/15/2022] Open
Abstract
Clinical reports of limited and treatable cancer metastases, a disease state that exists in a transitional zone between localized and widespread systemic disease, were noted on occasion historically and are now termed oligometastasis. The ramification of a diagnosis of oligometastasis is a change in treatment paradigm, i.e. if the primary cancer site (if still present) is controlled, or resected, and the metastatic sites are ablated (surgically or with radiation), a prolonged disease-free interval, and perhaps even cure, may be achieved. Contemporary molecular diagnostics are edging closer to being able to determine where an individual metastatic deposit is within the continuum of malignancy. Preclinical models are on the outset of laying the groundwork for understanding the oligometastatic state. Meanwhile, in the clinic, patients are increasingly being designated as having oligometastatic disease and being treated owing to improved diagnostic imaging, novel treatment options with the potential to provide either direct or bridging therapy, and progressively broad definitions of oligometastasis.
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Affiliation(s)
- Diane K. Reyes
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
| | - Kenneth J. Pienta
- Departments of Urology and Brady Urological Institute, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
- Departments of Pharmacology and Molecular Sciences, and Chemical and Biomolecular Engineering, The Johns Hopkins Medical Institutions, Baltimore, MD, 21287, USA
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Brandes AA, Franceschi E. The metastatic process: a kaleidoscope of concepts. Future Oncol 2014; 10:697-8. [PMID: 24799049 DOI: 10.2217/fon.14.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology, Bellaria-Maggiore Hospital, Azienda USL, IRCCS Institute for Neurological Sciences, Bologna, Italy
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