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Ohtakara K, Aoki S, Tajima M, Ohno T, Suzuki K. Gradual and Remarkable Tumor Shrinkage Following Seven-Fraction Stereotactic Radiosurgery Alone With a Marginal Dose of 48.3 Gy for Large Lobar Possibly Intra-sulcal Brain Metastasis From Renal Cell Carcinoma. Cureus 2023; 15:e36346. [PMID: 37082500 PMCID: PMC10111507 DOI: 10.7759/cureus.36346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
Brain metastases (BMs) from renal cell carcinoma (RCC) have the tendency of slow and insufficient tumor shrinkage along with prolongation of massive peritumoral edema following stereotactic radiosurgery (SRS). Herein, we describe a case of large lobar RCC-BM, with possible intra-sulcal location, treated with 7-fraction (fr) SRS without subsequent anti-cancer medication, which resulted in gradual and remarkable tumor shrinkage with extrication from the mass effect. A 59-year-old woman was incidentally diagnosed with bilateral RCC associated with multiple lung metastases and subsequently presented with symptomatic single BM of 32 mm in the maximum diameter (9.54 cm3) two months later while vacillating. A biopsy of the kidney showed clear cell carcinoma. The patient was deemed medically inoperable for BM due to unfit conditions, including severe deep venous thromboses and thrombocytopenia. Considering the tumor volume, irregular tumor configuration, non-superficial location, and mass effect, 98% of the gross tumor volume (GTV D98%) was covered by 48.3 Gy in 7 fr with 64% isodose. Dose distribution was optimized with volumetric modulated arcs with the affirmative allowance of very inhomogeneous GTV dose. Anti-cancer medication was limited to nivolumab plus ipilimumab followed by everolismus 12 days before and during SRS, respectively. Subsequently, the patient transitioned to palliative care due to a declining general condition. Although long-term administration of steroids was required, gradual and marked tumor shrinkage (1.25 cm3, 13.1% of the initial volume) and mitigation of the peritumoral edema was observed during six months after SRS. The main location of the initial BM was deemed as intra-sulcal in the intraparietal sulcus and originated in the cerebral cortex. The patient died nine months after SRS. The gradual but remarkable tumor response obtained with 7-fr SRS alone, in this case, provides a basis to further optimize fractionated SRS dosage to enhance efficacy and safety for large and/or symptomatic RCC-BMs not amenable to immediate surgical removal, in combination with anti-cancer pharmacotherapy, if feasible, including tyrosine kinase inhibitors, which may enhance efficacy against BM and mitigate adverse effects relevant to high dose SRS.
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Fukumitsu N, Ishikawa H, Arimura T, Wada H, Okimoto T, Sato Y, Iwata H, Shimizu S, Sakurai H. Proton Therapy for Primary Renal Cell Carcinoma: The First Nationwide Retrospective Study in Japan. In Vivo 2020; 34:2883-2889. [PMID: 32871828 DOI: 10.21873/invivo.12116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND/AIM This multi-institutional study aimed to investigate the efficacy and feasibility of proton beam therapy (PBT) for renal cell carcinoma (RCC) in Japan. PATIENTS AND METHODS The survival, local control, and toxicities in 22 RCC patients treated between 2001 and 2016 at 6 Japanese PBT institutes were analyzed. RESULTS The 22 patients comprised 20 men and had a median age of 67 (range=42-88) years. The total irradiation dose was 60-79.6 Gy (relative biological effectiveness). Over a median follow-up of 37 months, the 3-year overall and disease-specific survival rates were 95% and 100%, respectively, and no recurrence occurred. No patient experienced grade 3 or higher adverse events. The serum blood urea nitrogen (p=0.25) and creatinine levels (p=0.95) were not significantly affected, although the mean estimated glomerular filtration rate was reduced by 7.1±11.2 ml/min/1.73 m2 Conclusion: Despite the small number of patients, high-dose PBT can control RCC while maintaining their renal function with high probability, and could be and alternative curative therapy especially for inoperable patients.
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Affiliation(s)
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan .,National Institutes for Quantum and Radiological Science and Technology, QST Hospital, Chiba, Japan
| | - Takeshi Arimura
- Medipolis Proton Therapy and Research Center, Kagoshima, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Hyogo, Japan
| | - Yoshitaka Sato
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiromitsu Iwata
- Departments of Radiation Oncology, Nagoya City West Medical Center, Aichi, Japan
| | - Shosei Shimizu
- Department of Radiation Oncology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Faculty of Medicine, Ibaraki, Japan
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Haque W, Verma V, Lewis GD, Lo SS, Butler EB, Teh BS. Utilization of radiotherapy and stereotactic body radiation therapy for renal cell cancer in the USA. Future Oncol 2018. [PMID: 29527938 DOI: 10.2217/fon-2017-0536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM This study evaluated national practice patterns of cT1N0M0 renal cell cancer, with a focus on stereotactic body radiation therapy (SBRT) utilization. METHODS The National Cancer Database was queried (2004-2013) for patients with newly-diagnosed cT1a/bN0M0 renal cell cancer that received definitive treatment. Temporal trends in utilization were tabulated. RESULTS Altogether, 138,495 patients met inclusion criteria; 13,725 (9.9%) patients received ablative therapy, 57,924 (41.8%) partial nephrectomy, 67,168 (48.5%) radical nephrectomy and 308 (0.2%) external beam radiation therapy (EBRT). The proportion of EBRT that was SBRT increased substantially from 25% in 2004 to 95.4% in 2013, with a sharp inflection point from 2005 to 2006. CONCLUSION SBRT utilization has sharply risen over time; in most recent years, the vast majority of EBRT is delivered in the form of SBRT.
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Affiliation(s)
- Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA
| | - Gary D Lewis
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Edward Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
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Radiotherapy for Brain Metastases From Renal Cell Carcinoma in the Targeted Therapy Era: The University of Rochester Experience. Am J Clin Oncol 2017; 40:439-443. [PMID: 25730604 DOI: 10.1097/coc.0000000000000186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Radiotherapy remains the standard approach for brain metastases from renal cell carcinoma (RCC). Kinase inhibitors (KI) have become standard of care for metastatic RCC. They also increase the radiosensitivity of various tumor types in preclinical models. Data are lacking regarding the effect of KIs among RCC patients undergoing radiotherapy for brain metastases. We report our experience of radiotherapy for brain metastatic RCC in the era of targeted therapy and analyzed effects of concurrent KI therapy. METHODS We retrospectively analyzed 25 consecutive patients who received radiotherapy for brain metastases from RCC with whole-brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), or both. Kaplan-Meier rates of overall survival (OS) and brain progression-free survival (BPFS) were calculated and univariate analyses performed. RESULTS Lower diagnosis-specific graded prognostic assessment (DS-GPA) score and multiple intracranial metastases were associated with decreased OS and BPFS on univariate analysis; DS-GPA is also a prognostic factor on multivariate analysis. There was no significant difference in OS or BPFS for SRS compared with WBRT or WBRT and SRS combined. The concurrent use of KI was not associated with any change in OS or BPFS. CONCLUSIONS This hypothesis-generating analysis suggests among patients with brain metastatic RCC treated with the most current therapies, those selected to undergo SRS did not experience significantly different survival or control outcomes than those selected to undergo WBRT. From our experience to date, limited in patient numbers, there seems to be neither harm nor benefit in using concurrent KI therapy during radiotherapy. Given that most patients progress systemically, we would recommend considering KI use during brain radiotherapy in these patients.
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Van de Walle M, Demol J, Staelens L, Rottey S. Abscopal effect in metastatic renal cell carcinoma. Acta Clin Belg 2017; 72:245-249. [PMID: 27425038 DOI: 10.1080/17843286.2016.1201614] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report a case about a possible abscopal effect in a patient with metastatic renal cell carcinoma. Palliative conventional radiation of a metastatic lesion in the neck was performed and in the months after this treatment had been applied, clearance of the non-irradiated lung metastases and a subcutaneous nodule was observed. The abscopal effect is a phenomenon in which local radiotherapy is associated with regression of metastatic cancer at a distance from the irradiated site. It's a rare phenomenon; until now, only case reports and small series demonstrate the abscopal effect. This case supports the fact that further studying of this rare event must be encouraged.
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Affiliation(s)
- Mieke Van de Walle
- Department of Medical Oncology, Gent University Hospital, De Pintelaan 185, 2B-II, 9000 Gent, Belgium
| | - Jan Demol
- Department of Medical Oncology, AZ Delta, Wilgenstraat 2, 8800 Roeselare, Belgium
| | - Lorenzo Staelens
- Department of Radiation Oncology, AZ Delta, Wilgenstraat 2, 8800 Roeselare, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, Gent University Hospital, De Pintelaan 185, 2B-II, 9000 Gent, Belgium
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Ponsky L, Lo SS, Zhang Y, Schluchter M, Liu Y, Patel R, Abouassaly R, Welford S, Gulani V, Haaga JR, Machtay M, Ellis RJ. Phase I dose-escalation study of stereotactic body radiotherapy (SBRT) for poor surgical candidates with localized renal cell carcinoma. Radiother Oncol 2015; 117:183-7. [DOI: 10.1016/j.radonc.2015.08.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 12/01/2022]
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Lo SS, Fakiris AJ, Teh BS, Cardenes HR, Henderson MA, Forquer JA, Papiez L, McGarry RC, Wang JZ, Li K, Mayr NA, Timmerman RD. Stereotactic body radiation therapy for oligometastases. Expert Rev Anticancer Ther 2014; 9:621-35. [DOI: 10.1586/era.09.15] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Lo SS, Cardenes HR, Teh BS, Fakiris AJ, Henderson MA, Papiez L, McGarry RC, Wang JZ, Li K, Mayr NA, Timmerman RD. Stereotactic body radiation therapy for nonpulmonary primary tumors. Expert Rev Anticancer Ther 2014; 8:1939-51. [DOI: 10.1586/14737140.8.12.1939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Barrière J, Hoch B, Ferrero JM. New perspectives in the treatment of metastatic renal cell carcinoma. Crit Rev Oncol Hematol 2012; 84 Suppl 1:e16-23. [DOI: 10.1016/j.critrevonc.2011.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/21/2011] [Accepted: 10/19/2011] [Indexed: 01/04/2023] Open
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Jhaveri PM, Teh BS, Paulino AC, Blanco AI, Lo SS, Butler EB, Amato RJ. A dose-response relationship for time to bone pain resolution after stereotactic body radiotherapy (SBRT) for renal cell carcinoma (RCC) bony metastases. Acta Oncol 2012; 51:584-8. [PMID: 22248089 DOI: 10.3109/0284186x.2011.652741] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To investigate the utility of stereotactic body radiotherapy (SBRT) in the treatment of painful renal cell carcinoma (RCC) bone metastases, and for a possible dose effect on time to symptom relief. MATERIAL AND METHODS Eighteen patients with 24 painful osseous lesions from metastatic RCC were treated with SBRT. The most common treatment regimens were 24 Gy in 3 fractions and 40 Gy in 5 fractions. The times from treatment to first reported pain relief and time to symptom recurrence were evaluated. Median follow-up was 38 weeks (1-156 weeks). RESULTS Seventy-eight percent of all patients had pain relief. Patients treated with a BED > 85 Gy achieved faster and more durable pain relief compared to those treated with a BED < 85 Gy. There was decrease in time to pain relief after a change in treatment regimen to 8 Gy × 5 fractions (BED = 86). There was only one patient with grade 1 skin toxicity. No neurological or other toxicity was observed. CONCLUSIONS SBRT can safely and effectively treat painful RCC bony metastases. There appears to be a relationship between radiation dose and time to stable pain relief.
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Affiliation(s)
- Pavan M Jhaveri
- Department of Radiology, Section of Radiation Oncology, Baylor College of Medicine, 6565 Fannin, Houston, TX 77030, USA
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Pioneering innovative radiation oncology technology in clinics. Biomed Imaging Interv J 2007. [DOI: 10.2349/biij.3.3.e57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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