Matsui Yoshiyuki
The Department of Urology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
Cancers (Basel). 2020 Oct 6;12(10):2875. doi: 10.3390/cancers12102875.
In patients with renal cell carcinoma, brain metastasis is generally one of the poor prognostic factors. However, the recent introduction of molecular target therapy and immune checkpoint inhibitor has remarkably advanced the systemic treatment of metastatic renal cell carcinoma and prolonged the patients' survival. The pivotal clinical trials of those agents usually excluded patients with brain metastasis. The incidence of brain metastasis has been increasing in the actual clinical setting because of longer control of extra-cranial disease. Brain metastasis subgroup data from the prospective and retrospective series have been gradually accumulated about the risk classification of brain metastasis and the efficacy and safety of those new agents for brain metastasis. While the local treatment against brain metastasis includes neurosurgery, stereotactic radiosurgery, and conventional whole brain radiation therapy, the technology of stereotactic radiosurgery has been especially advanced, and the combination with systemic therapy such as molecular target therapy and immune checkpoint inhibitor is considered promising. This review summarizes recent progression of multimodality treatment of brain metastasis of renal cell carcinoma from literature data and explores the future direction of the treatment.
在肾细胞癌患者中，脑转移通常是不良预后因素之一。然而，近年来分子靶向治疗和免疫检查点抑制剂的引入显著推进了转移性肾细胞癌的全身治疗，并延长了患者的生存期。这些药物的关键临床试验通常排除了脑转移患者。由于颅外疾病得到更长时间的控制，在实际临床环境中脑转移的发生率一直在增加。关于脑转移的风险分类以及这些新药对脑转移的疗效和安全性，来自前瞻性和回顾性系列研究的脑转移亚组数据已逐渐积累。虽然针对脑转移的局部治疗包括神经外科手术、立体定向放射外科和传统的全脑放射治疗，但立体定向放射外科技术尤其先进，并且与分子靶向治疗和免疫检查点抑制剂等全身治疗相结合被认为很有前景。本综述从文献数据总结了肾细胞癌脑转移多模态治疗的最新进展，并探讨了治疗的未来方向。
