Stenman M, Benmakhlouf H, Wersäll P, Johnstone P, Hatiboglu M A, Mayer-da-Silva J, Harmenberg U, Lindskog M, Sinclair G
Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden.
Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.
Acta Neurochir (Wien). 2021 Feb;163(2):333-342. doi: 10.1007/s00701-020-04537-w. Epub 2020 Sep 9.
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.
在靶向药物（TA）和免疫检查点抑制剂（ICI）时代，单次分割伽玛刀放射外科治疗（sf-GKRS）对肾细胞癌（RCC）脑转移瘤（BM）患者的影响尚未得到充分研究。
对2005年至2014年在欧洲三个中心因脑转移接受sf-GKRS治疗的透明细胞转移性RCC患者进行回顾性分析（n = 43）。中位随访时间为56个月。95%的患者曾接受过肾切除术，53%为同步转移，86%在首次sf-GKRS时有颅外疾病。卡诺夫斯基功能状态（KPS）范围为60%至100%。观察指标为总生存期（OS）、局部控制（LC）和放射性不良反应（ARE）。
共照射194个靶点。首次sf-GKRS时靶点的中位数为2个。中位处方剂量为22.0 Gy。37%的患者接受了重复sf-GKRS。88%的患者接受了TA治疗。12个月和18个月时的LC率分别为97%和90%。首次sf-GKRS后的中位OS为15.7个月。低血清白蛋白（死亡风险比5.3）、sf-GKRS前使用皮质类固醇（死亡风险比5.8）和KPS < 80（死亡风险比9.1）与较差的OS独立相关。从MSKCC风险组、同步转移、年龄、BM数量或颅外转移中未获得进一步的预后信息。其他BM放射外科的预后评分，包括DS-GPA、肾-GPA、LLV-SIR和CITV-SIR，同样未增加进一步的预后价值。ARE很少有症状，且与肿瘤体积、10-Gy体积和治疗前灶周水肿有关。在sf-GKRS后1个月内接受TA治疗的患者中，ARE较少见。
我们确定白蛋白、皮质类固醇使用和KPS是透明细胞RCC BM的sf-GKRS的独立预后因素。关注白蛋白在sf-GKRS中的预后意义的研究很少。需要更多患者的进一步研究来证实上述分析结果。此外，与先前的研究一致，我们的数据显示局部肿瘤控制率最佳，放射外科治疗后毒性有限，使GKRS成为RCC BM治疗的首选工具。
