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Treatment outcome of radiation therapy and concurrent targeted molecular therapy in spinal metastasis from renal cell carcinoma

  • Park, Sangjoon (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Kim, Kyung Hwan (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Rhee, Woo Joong (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Lee, Jeongshim (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Cho, Yeona (Department of Radiation Oncology, Yonsei University College of Medicine) ;
  • Koom, Woong Sub (Department of Radiation Oncology, Yonsei University College of Medicine)
  • Received : 2016.03.16
  • Accepted : 2016.05.16
  • Published : 2016.06.30

Abstract

Purpose: To evaluate the clinical outcomes of patients who underwent radiation therapy with or without targeted molecular therapy for the treatment of spinal metastasis from renal cell carcinoma (RCC). Materials and Methods: A total of 28 spinal metastatic lesions from RCC patients treated with radiotherapy between June 2009 and June 2015 were retrospectively reviewed. Thirteen lesions were treated concurrently with targeted molecular therapy (concurrent group) and 15 lesions were not (nonconcurrent group). Local control was defined as lack of radiographically evident local progression and neurological deterioration. Results: At a median follow-up of 11 months (range, 2 to 58 months), the 1-year local progression-free rate (LPFR) was 67.0%. The patients with concurrent targeted molecular therapy showed significantly higher LPFR than those without (p = 0.019). After multivariate analysis, use of concurrent targeted molecular therapy showed a tendency towards improved LPFR (hazard ratio, 0.13; 95% confidence interval, 0.01 to 1.16). There was no difference in the incidence of systemic progression between concurrent and nonconcurrent groups. No grade ${\geq}2$ toxicities were observed during or after radiotherapy. Conclusion: Our study suggests the possibility that concurrent use of targeted molecular therapy during radiotherapy may improve LPFR. Further study with a large population is required to confirm these results.

Keywords

References

  1. Levy DA, Slaton JW, Swanson DA, Dinney CP. Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol 1998;159:1163-7. https://doi.org/10.1016/S0022-5347(01)63541-9
  2. Uchida K, Miyao N, Masumori N, et al. Recurrence of renal cell carcinoma more than 5 years after nephrectomy. Int J Urol 2002;9:19-23. https://doi.org/10.1046/j.1442-2042.2002.00418.x
  3. Juusela H, Malmio K, Alfthan O, Oravisto KJ. Preoperative irradiation in the treatment of renal adenocarcinoma. Scand J Urol Nephrol 1977;11:277-81. https://doi.org/10.3109/00365597709179965
  4. van der Werf-Messing B. Proceedings: carcinoma of the kidney. Cancer 1973;32:1056-61. https://doi.org/10.1002/1097-0142(197311)32:5<1056::AID-CNCR2820320505>3.0.CO;2-M
  5. Nguyen QN, Shiu AS, Rhines LD, et al. Management of spinal metastases from renal cell carcinoma using stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2010;76:1185-92. https://doi.org/10.1016/j.ijrobp.2009.03.062
  6. Balagamwala EH, Angelov L, Koyfman SA, et al. Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma. J Neurosurg Spine 2012;17:556-64. https://doi.org/10.3171/2012.8.SPINE12303
  7. Ghia AJ, Chang EL, Bishop AJ, et al. Single-fraction versus multifraction spinal stereotactic radiosurgery for spinal metastases from renal cell carcinoma: secondary analysis of Phase I/II trials. J Neurosurg Spine 2016;24:829-36. https://doi.org/10.3171/2015.8.SPINE15844
  8. Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med 1996;335:865-75. https://doi.org/10.1056/NEJM199609193351207
  9. Mattei J, da Silva RD, Sehrt D, Molina WR, Kim FJ. Targeted therapy in metastatic renal carcinoma. Cancer Lett 2014;343:156-60. https://doi.org/10.1016/j.canlet.2013.09.038
  10. De Wolf K, Vermaelen K, De Meerleer G, Lambrecht BN, Ost P. The potential of radiotherapy to enhance the efficacy of renal cell carcinoma therapy. Oncoimmunology 2015;4:e1042198. https://doi.org/10.1080/2162402X.2015.1042198
  11. Kao J, Packer S, Vu HL, et al. Phase 1 study of concurrent sunitinib and image-guided radiotherapy followed by maintenance sunitinib for patients with oligometastases: acute toxicity and preliminary response. Cancer 2009;115:3571-80. https://doi.org/10.1002/cncr.24412
  12. Tong CC, Ko EC, Sung MW, et al. Phase II trial of concurrent sunitinib and image-guided radiotherapy for oligometastases. PLoS One 2012;7:e36979. https://doi.org/10.1371/journal.pone.0036979
  13. Wilson D, Hiller L, Gray L, Grainger M, Stirling A, James N. The effect of biological effective dose on time to symptom progression in metastatic renal cell carcinoma. Clin Oncol (R Coll Radiol) 2003;15:400-7. https://doi.org/10.1016/S0936-6555(03)00164-X
  14. Thibault I, Chang EL, Sheehan J, et al. Response assessment after stereotactic body radiotherapy for spinal metastasis: a report from the SPIne response assessment in Neuro- Oncology (SPINO) group. Lancet Oncol 2015;16:e595-603. https://doi.org/10.1016/S1470-2045(15)00166-7
  15. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidencebased approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976) 2010;35:E1221-9. https://doi.org/10.1097/BRS.0b013e3181e16ae2
  16. DiBiase SJ, Valicenti RK, Schultz D, Xie Y, Gomella LG, Corn BW. Palliative irradiation for focally symptomatic metastatic renal cell carcinoma: support for dose escalation based on a biological model. J Urol 1997;158(3 Pt 1):746-9. https://doi.org/10.1016/S0022-5347(01)64305-2
  17. Jhaveri PM, Teh BS, Paulino AC, et al. 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. https://doi.org/10.3109/0284186X.2011.652741
  18. Amini A, Altoos B, Bourlon MT, et al. Local control rates of metastatic renal cell carcinoma (RCC) to the bone using stereotactic body radiation therapy: is RCC truly radioresistant? Pract Radiat Oncol 2015;5:e589-96. https://doi.org/10.1016/j.prro.2015.05.004
  19. Sohn S, Chung CK, Sohn MJ, et al. Stereotactic radiosurgery compared with external radiation therapy as a primary treatment in spine metastasis from renal cell carcinoma: a multicenter, matched-pair study. J Neurooncol 2014;119:121-8. https://doi.org/10.1007/s11060-014-1455-9
  20. Geels P, Eisenhauer E, Bezjak A, Zee B, Day A. Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol 2000;18:2395-405. https://doi.org/10.1200/JCO.2000.18.12.2395
  21. Vakaet LA, Boterberg T. Pain control by ionizing radiation of bone metastasis. Int J Dev Biol 2004;48:599-606. https://doi.org/10.1387/ijdb.041817lv

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