酪氨酸激酶抑制剂对肾细胞癌脑转移的多模态治疗的影响。
The impact of tyrosine kinase inhibitors on the multimodality treatment of brain metastases from renal cell carcinoma.
机构信息
*Department of Radiation Oncology, The Methodist Hospital Departments of †Genitourinary Oncology ‡Radiation Oncology §Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Am J Clin Oncol. 2013 Dec;36(6):620-4. doi: 10.1097/COC.0b013e31825d59db.
OBJECTIVES
This study evaluated the effect of tyrosine kinase inhibitors (TKIs) on the brain metastasis (BM), local control (LC), and overall survival (OS) of patients with renal cell carcinoma (RCC) with BM.
METHODS
A retrospective review of patients with RCC BM was conducted. Eligible patients from 2 eras: pre-TKI, 2002 to 2003 and post-TKI, 2006 to 2007, were identified. Prognostic factors, use, and type of systemic therapy were noted. The timing, number, size, and treatment modality data for each BM were recorded. Use of TKI and BM treatment modality were correlated to LC and OS.
RESULTS
Eighty-one patients with 216 BMs were identified. Thirty-seven patients had BM at diagnosis and the remaining 44 were found to have BM at a later point. Forty-one patients never received a TKI and the remaining 40 received TKIs. Stereotactic radiosurgery, surgery, whole brain radiotherapy, or no local brain treatment was used for 89, 19, 24, and 75 lesions, respectively. The median OS from BM diagnosis was 5.4 months for the whole group: 4.4 versus 6.71 months in the never-TKI versus TKI groups, respectively. Patients who received TKIs post-BM development had a median OS of 23.6 months versus 2.08 and 4.41 months for the patients who received TKIs pre-BM or never-TKI, respectively (P=0.0001). LC was statistically superior in lesions managed with surgery or stereotactic radiosurgery versus the no local therapy.
CONCLUSIONS
In patients with RCC and BM, TKIs are associated with a trend of improved OS, but no significant improvement in LC of BM. They may provide a significant benefit to patients with BM with no prior TKI exposure.
目的
本研究评估了酪氨酸激酶抑制剂（TKI）对伴脑转移（BM）的肾细胞癌（RCC）患者的脑转移、局部控制（LC）和总生存（OS）的影响。
方法
对伴 BM 的 RCC 患者进行回顾性研究。纳入两个时期的合格患者：TKI 前时期，2002 年至 2003 年；TKI 后时期，2006 年至 2007 年。记录患者的预后因素、系统治疗的使用和类型。记录每个 BM 的时间、数量、大小和治疗方式数据。TKI 的使用和 BM 治疗方式与 LC 和 OS 相关联。
结果
共发现 81 例患者 216 个 BM。37 例患者在诊断时即有 BM，其余 44 例患者在后期发现有 BM。41 例患者从未接受过 TKI，其余 40 例患者接受了 TKI。立体定向放射外科手术、手术、全脑放疗或无局部脑治疗分别用于 89、19、24 和 75 个病灶。全组 BM 诊断后的中位 OS 为 5.4 个月：从未接受 TKI 与接受 TKI 组的中位 OS 分别为 4.4 个月和 6.71 个月。在 BM 进展后接受 TKI 治疗的患者的中位 OS 为 23.6 个月，而在 BM 前接受 TKI 治疗或从未接受 TKI 治疗的患者的中位 OS 分别为 2.08 个月和 4.41 个月（P=0.0001）。与无局部治疗相比，手术或立体定向放射外科治疗的 LC 统计学上更优。
结论
在伴 BM 的 RCC 患者中，TKI 与 OS 改善趋势相关，但 BM 的 LC 无显著改善。对于无先前 TKI 暴露的 BM 患者，它们可能为患者带来显著获益。
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