Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery.
GKRS
Gamma knife
RCC
Renal cell carcinoma
SRS
Stereotactic radiosurgery
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
08
05
2020
accepted:
11
08
2020
pubmed:
10
9
2020
medline:
9
7
2021
entrez:
9
9
2020
Statut:
ppublish
Résumé
The effects of single-fraction gamma knife radiosurgery (sf-GKRS) on patients with renal cell carcinoma (RCC) brain metastases (BM) in the era of targeted agents (TA) and immune checkpoint inhibitors (ICI) are insufficiently studied. Clear cell metastatic RCC patients treated with sf-GKRS due to BM in 2005-2014 at three European centres were retrospectively analysed (n = 43). Median follow-up was 56 months. Ninety-five percent had prior nephrectomy, 53% synchronous metastasis and 86% extracranial disease at first sf-GKRS. Karnofsky performance status (KPS) ranged from 60 to 100%. Outcome measures were overall survival (OS), local control (LC) and adverse radiation effects (ARE). One hundred and ninety-four targets were irradiated. The median number of targets at first sf-GKRS was two. The median prescription dose was 22.0 Gy. Thirty-seven percent had repeated sf-GKRS. Eighty-eight percent received TA. LC rates at 12 and 18 months were 97% and 90%. Median OS from the first sf-GKRS was 15.7 months. Low serum albumin (HR for death 5.3), corticosteroid use pre-sf-GKRS (HR for death 5.8) and KPS < 80 (HR for death 9.1) were independently associated with worse OS. No further prognostic information was gleaned from MSKCC risk group, synchronous metastasis, age, number of BM or extracranial metastases. Other prognostic scores for BM radiosurgery, including DS-GPA, renal-GPA, LLV-SIR and CITV-SIR, again, did not add further prognostic value. ARE were seldom symptomatic and were associated with tumour volume, 10-Gy volume and pre-treatment perifocal oedema. ARE were less common among patients treated with TA within 1 month of sf-GKRS. We identified albumin, corticosteroid use and KPS as independent prognostic factors for sf-GKRS of clear cell RCC BM. Studies focusing on the prognostic significance of albumin in sf-GKRS are rare. Further studies with a larger number of patients are warranted to confirm the above analytical outcome. Also, in keeping with previous studies, our data showed optimal rates of local tumour control and limited toxicity post radiosurgery, rendering GKRS the tool of choice in the management of RCC BM.
Identifiants
pubmed: 32902689
doi: 10.1007/s00701-020-04537-w
pii: 10.1007/s00701-020-04537-w
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
333-342Références
Andrews DW, Scott CB, Sperduto PW et al (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363(9422):1665–1672
pubmed: 15158627
Angelov L, Mohammadi AM, Bennett EE et al (2018) Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases ≥2 cm. J Neurosurg 129(2):366–382
pubmed: 28937324
Auchter RM, Lamond JP, Alexander E et al (1996) A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35(1):27–35
pubmed: 8641923
Barata PC, Mendiratta P, Kotecha R et al (2018) Effect of switching systemic treatment after stereotactic radiosurgery for oligoprogressive, metastatic renal cell carcinoma. Clin Genitourin Cancer 16(5):413–419
pubmed: 30172552
Calvo E, Porta C, Grünwald V, Escudier B (2019) The current and evolving landscape of first-line treatments for advanced renal cell carcinoma. Oncologist 24(3):338–348
pubmed: 30158285
Carapella CM, Gorgoglione N, Oppido PA (2018) The role of surgical resection in patients with brain metastases. Curr Opin Oncol 30(6):390–395
pubmed: 30142093
Chen L, Douglass J, Kleinberg L et al (2018) Concurrent immune checkpoint inhibitors and stereotactic radiosurgery for brain metastases in non-small cell lung cancer, melanoma, and renal cell carcinoma. Int J Radiat Oncol Biol Phys 100(4):916–925
pubmed: 29485071
Chin LS, Ma L, DiBiase S (2001) Radiation necrosis following gamma knife surgery: a case-controlled comparison of treatment parameters and long-term clinical follow up. J Neurosurg 94(6):899–904
pubmed: 11409517
Choi HJ, Cho BC, Sohn JH et al (2009) Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC. J Neuro-Oncol 91(3):307–313
Choi SY, Yoo S, You D et al (2017) Prognostic factors for survival of patients with synchronous or metachronous brain metastasis of renal cell carcinoma. Clin Genitourin Cancer 15(6):717–723
pubmed: 28552571
De Felice F, Tombolini V (2018) Radiation therapy in renal cell carcinoma. Crit Rev Oncol Hematol 128:82–87
pubmed: 29958634
Dietrich J, Rao K, Pastorino S, Kesari S (2011) Corticosteroids in brain cancer patients: benefits and pitfalls. Expert Rev Clin Pharmacol 4(2):233–242
pubmed: 21666852
pmcid: 3109638
Dudek AZ, Raza A, Chi M et al (2013) Brain metastases from renal cell carcinoma in the era of tyrosine kinase inhibitors. Clin Genitourin Cancer 11(2):155–160
pubmed: 23265925
Fabiano A, Prasad D, Qiu J (2017) Adverse radiation effect in the brain during cancer radiotherapy. J Radiat Cancer Res 8(3):135–140
Flickinger JC, Kondziolka D, Lunsford LD et al (1994) A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28(4):797–802
pubmed: 8138431
Flippot R, Dalban C, Laguerre B et al (2019) Safety and Efficacy of nivolumab in brain metastases from renal cell carcinoma: results of the GETUG-AFU 26 NIVOREN multicenter phase II study. J Clin Oncol 37(23):2008–2016
pubmed: 31194611
Goel S, Duda DG, Xu L et al (2011) Normalization of the vasculature for treatment of cancer and other diseases. Physiol Rev 91(3):1071–1121
pubmed: 21742796
pmcid: 3258432
Gore ME, Hariharan S, Porta C et al (2011) Sunitinib in metastatic renal cell carcinoma patients with brain metastases. Cancer. 117(3):501–509
pubmed: 20862748
Ha FJ, Spain L, Dowling A, et al.(2019) Timing of brain metastases development in metastatic renal cell cancer patients treated with targeted therapies and survival outcomes: an Australian multicenter study. Asia Pac J Clin Oncol 1-6. Epub ahead of print.
Halasz LM, Rockhill JK (2013) Stereotactic radiosurgery and stereotactic radiotherapy for brain metastases. Surg Neurol Int 4(4_suppl):S185–S191
pubmed: 23717789
pmcid: 3656557
Hatiboglu MA, Wildrick DM, Sawaya R (2013) The role of surgical resection in patients with brain metastases. Ecancermedicalscience. 7:308
pubmed: 23634178
pmcid: 3628720
Haque W, Verma V, Butler EB et al (2018) Utilization of stereotactic radiosurgery for renal cell carcinoma brain metastases. Clin Genitourin Cancer 16(4):e935–e943
pubmed: 29680768
Heng DYC, Xie W, Regan MM et al (2009) Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol 27(34):5794–5799
pubmed: 19826129
Hirshman BR, Wilson B, Ali MA et al (2018) Superior prognostic value of cumulative intracranial tumor volume relative to largest intracranial tumor volume for stereotactic radiosurgery-treated brain metastasis Patients. Neurosurgery. 82(4):473–480
pubmed: 28658940
Jain RK (2001) Normalizing tumor vasculature with anti-angiogenic therapy: a new paradigm for combination therapy. Nat Med 7(9):987–989
pubmed: 11533692
Juloori A, Miller JA, Parsai S et al (2019) Overall survival and response to radiation and targeted therapies among patients with renal cell carcinoma brain metastases. J Neurosurg 132(1):188–196
Kim JM, Miller JA, Kotecha R et al (2017) The risk of radiation necrosis following stereotactic radiosurgery with concurrent systemic therapies. J Neuro-Oncol 133(2):357–368
Klausner G, Troussier I, Biau J et al (2019) Stereotactic radiation therapy for renal cell carcinoma brain metastases in the tyrosine kinase inhibitors era: outcomes of 120 patients. Clin Genitourin Cancer 17(3):191–200
pubmed: 30926219
Kocher M, Wittig A, Piroth MD et al (2014) Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther Onkol 190(6):521–532
pubmed: 24715242
Korytko T, Radivoyevitch T, Colussi V et al (2006) 12 Gy gamma knife radiosurgical volume is a predictor for radiation necrosis in non-AVM intracranial tumors. Int J Radiat Oncol Biol Phys 64(2):419–424
pubmed: 16226848
Kothari G, Foroudi F, Gill S et al (2015) Outcomes of stereotactic radiotherapy for cranial and extracranial metastatic renal cell carcinoma: a systematic review. Acta Oncol 54(2):148–157
pubmed: 25140860
Lawrence YR, Li XA, el Naqa I et al (2010) Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys 76(3_suppl):S20–S27
pubmed: 20171513
pmcid: 3554255
Leksell L (1968) Cerebral radiosurgery. I. Gammathalanotomy in two cases of intractable pain. Acta Chir Scand 134(8):585–595
pubmed: 5713443
Lesueur P, Lequesne J, Barraux V et al (2018) Radiosurgery or hypofractionated stereotactic radiotherapy for brain metastases from radioresistant primaries (melanoma and renal cancer). Radiat Oncol 13(1):138
pubmed: 30055640
pmcid: 6064124
Lippitz B, Lindquist C, Paddick I et al (2014) Stereotactic radiosurgery in the treatment of brain metastases: the current evidence. Cancer Treat Rev 40(1):48–59
pubmed: 23810288
Mariotta M, Perewusnyk G, Koechli OR et al (1999) Dexamethasone-induced enhancement of resistance to ionizing radiation and chemotherapeutic agents in human tumor cells. Strahlenther Onkol 175(8):392–396
pubmed: 10481771
Minniti G, Clarke E, Lanzetta G et al (2011) Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol 6:48
pubmed: 3108308
pmcid: 3108308
Morales-Orue I, Chicas-Sett R, Lara PC (2019) Nanoparticles as a promising method to enhance the abscopal effect in the era of new targeted therapies. Rep Pract Oncol Radiother 24(1):86–91
pubmed: 30505238
Morris S-AL, Zhu P, Rao M et al (2019) Gamma knife stereotactic radiosurgery in combination with bevacizumab for recurrent glioblastoma. World Neurosurg 127:e523–e533
pubmed: 30954746
Motzer RJ, Mazumdar M, Bacik J et al (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17(8):2530–2540
pubmed: 10561319
Nam HC, Sung PS, Song DS et al (2019) Control of intracranial disease is associated with improved survival in patients with brain metastasis from hepatocellular carcinoma. Int J Clin Oncol 24(6):666–676
pubmed: 30788672
Nieder C, Dalhaug A, Haukland E et al (2015) Tumor marker analyses in patients with brain metastases: patterns of practice and implications for survival prediction research. Tumour Biol 36(8):6471–6476
pubmed: 25801247
Nieder C, Dalhaug A, Pawinski A (2019) External validation of the LABBM score in patients with brain metastases. J Clin Med Res 11(5):321–325
pubmed: 31019625
pmcid: 6469893
Nieder C, Marienhagen K, Dalhaug A et al (2014) Prognostic models predicting survival of patients with brain metastases: integration of lactate dehydrogenase, albumin and extracranial organ involvement. Clin Oncol (R Coll Radiol) 26(8):447–452
Okuda T, Hayashi N, Takahashi M et al (2018) Clinical outcomes of brain metastases from hepatocellular carcinoma: a multicenter retrospective study and a literature review. Int J Clin Oncol 23:1095–1100
pubmed: 29968168
Pitter KL, Tamagno I, Alikhanyan K et al (2016) Corticosteroids compromise survival in glioblastoma. Brain 139(Pt 5):1458–1471
pubmed: 27020328
pmcid: 5006251
Shaverdian N, Wang J, Levin-Epstein R et al (2016) Pro-inflammatory state portends poor outcomes with stereotactic radiosurgery for brain metastases. Anticancer Res 36(10):5333–5337
pubmed: 27798896
Sinclair G, Benmakhlouf H, Brigui M et al (2018) The concept of rapid rescue radiosurgery in the acute management of critically located brain metastases: a retrospective short-term outcome analysis. Surg Neurol Int 9:218
pubmed: 30505620
pmcid: 6219289
Sinclair G, Benmakhlouf H, Martin H et al (2019) Adaptive hypofractionated gamma knife radiosurgery in the acute management of brainstem metastases. Surg Neurol Int 10:14
pubmed: 30783544
pmcid: 6367951
Sneed PK, Mendez J, Vemer-van den Hoek JGM et al (2015) Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg 123(2):373–386
pubmed: 25978710
Sperduto PW, Chao ST, Sneed PK et al (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 77(3):655–661
pubmed: 19942357
Sperduto PW, Deegan BJ, Li J et al (2018) Effect of targeted therapies on prognostic factors, patterns of care, and survival in patients with renal cell carcinoma and brain metastases. Int J Radiat Oncol Biol Phys 101(4):845–853
pubmed: 29976497
pmcid: 6925530
Sperduto PW, Deegan BJ, Li J et al (2018) Estimating survival for renal cell carcinoma patients with brain metastases: an update of the Renal Graded Prognostic Assessment tool. Neuro-oncology. 20(12):1652–1660
pubmed: 30418657
pmcid: 6231200
Staehler M, Haseke N, Nuhn P et al (2011) Simultaneous anti-angiogenic therapy and single-fraction radiosurgery in clinically relevant metastases from renal cell carcinoma. BJU Int 108(5):673–678
pubmed: 21156017
Stenman M, Laurell A, Lindskog M (2014) Prognostic significance of serum albumin in patients with metastatic renal cell carcinoma. Med Oncol 31(3):841
pubmed: 24477648
Stenman M, Sinclair G, Paavola P et al (2018) Overall survival after stereotactic radiotherapy or surgical metastasectomy in oligometastatic renal cell carcinoma patients treated at two Swedish centres 2005-2014. Radiother Oncol 127(3):501–506
pubmed: 29754859
Torrens M, Chung C, Chung H-T, et al.(2014) Standardization of terminology in stereotactic radiosurgery: report from the Standardization Committee of the International Leksell Gamma Knife Society: special topic. J Neurosurg (121_suppl):S2-15.
Vanpouille-Box C, Formenti SC, Demaria S (2018) Toward precision radiotherapy for use with immune checkpoint blockers. Clin Cancer Res 24(2):259–265
pubmed: 28751442
Verma J, Jonasch E, Allen PK et al (2013) The impact of tyrosine kinase inhibitors on the multimodality treatment of brain metastases from renal cell carcinoma. Am J Clin Oncol 36(6):620–624
pubmed: 22892430
pmcid: 4630800
Vickers MM, Al-Harbi H, Choueiri TK et al (2013) Prognostic factors of survival for patients with metastatic renal cell carcinoma with brain metastases treated with targeted therapy: results from the international metastatic renal cell carcinoma database consortium. Clin Genitourin Cancer 11(3):311–315
pubmed: 23684422
Vogl UM, Bojic M, Lamm W et al (2010) Extracerebral metastases determine the outcome of patients with brain metastases from renal cell carcinoma. BMC Cancer 10:480
pubmed: 20819239
pmcid: 2942853
Wardak Z, Christie A, Bowman A et al (2019) Stereotactic radiosurgery for multiple brain metastases from renal-cell carcinoma. Clin Genitourin Cancer 17(2):e273–e280
pubmed: 30595522
Weltman E, Salvajoli JV, Brandt RA et al (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46(5):1155–1161
pubmed: 10725626
Weltman E, Salvajoli JV, Oliveira VC et al (1998) Score index for stereotactic radiosurgery of brain metastases. J Radiosurg 1:89–95
Wowra B, Siebels M, Muacevic A et al (2002) Repeated gamma knife surgery for multiple brain metastases from renal cell carcinoma. J Neurosurg 97(4):785–793
pubmed: 12405364