Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
The Ohio State University, College of Medicine, Columbus, Ohio.
Curr Probl Cancer. 2022 Apr;46(2):100805. doi: 10.1016/j.currproblcancer.2021.100805. Epub 2021 Nov 18.
Patient survival with renal cell carcinoma (RCC) has improved with the use of molecular targeted agents and immunotherapy. Given the potential activity of these agents in treating brain metastases, the role of aggressive local management with surgery and/or radiation may diminish. The aim of this study was to evaluate the role of aggressive local therapy for RCC brain metastasis in the setting of molecular targeted agents and/or checkpoint inhibitor therapy. A retrospective single-center review between 2011-2018 identified patients that developed brain metastasis from RCC. Data analyzed included demographic information, systemic treatments, intracranial interventions, progression free survival and overall survival (OS). Of 1194 patients, 108(9.0%) were diagnosed with brain metastasis from RCC. OS from diagnosis of brain metastasis (OS) was 12.3 months. OS was analyzed based on three treatment groups: systemic therapy (ST) only (2.0 months, n = 23), systemic and radiotherapy (RT + ST) (12.3 months, n = 52), and systemic and radiotherapy plus resection (Surg + RT + ST) (21.7 months, n = 33). Survival benefit was seen with Surg + RT + ST compared to ST (P = 0.001), but not RT + ST (P = 0.081). Progression free survival was significantly prolonged with Surg + RT + ST compared to RT + ST (10.9 vs 5.9 months, respectively, P = 0.04). Variables such as performance status and number of brain metastases at the time of brain metastasis diagnosis did not differ significantly. In the setting of molecular targeted agents and immunotherapy, resection may benefit the appropriate surgical candidate. Prospective clinical trials are necessary to better understand the role of aggressive RCC brain metastasis treatment. Micro Abstract • Renal cell brain metastasis is often excluded from studies and brain metastases effect a large portion of RCC patients. • Retrospective study of 1194 RCC patients, 108 patients had brain metastasis, determination of the role of surgical resection in the setting of recent advances in checkpoint inhibitors. • A benefit was seen in overall survival in patients that had surgical while undergoing radiation therapy and systemic therapies. • In the setting of molecular targeted agents and immunotherapy, resection may benefit the appropriate surgical candidate(s).
患者的肾细胞癌 (RCC) 存活率因分子靶向药物和免疫疗法的应用而提高。鉴于这些药物在治疗脑转移方面的潜在活性，手术和/或放射治疗等积极的局部治疗方法的作用可能会降低。本研究旨在评估在分子靶向药物和/或检查点抑制剂治疗的情况下，积极的局部治疗 RCC 脑转移的作用。在 2011-2018 年期间，我们进行了一项回顾性单中心研究，确定了从 RCC 发展为脑转移的患者。分析的数据包括人口统计学信息、全身治疗、颅内干预、无进展生存期和总生存期 (OS)。在 1194 名患者中，有 108 名(9.0%)被诊断为 RCC 脑转移。从脑转移诊断开始的总生存期 (OS) 为 12.3 个月。根据三组治疗方法分析 OS：仅全身治疗 (ST) (2.0 个月，n=23)、全身治疗联合放疗 (RT+ST) (12.3 个月，n=52) 和全身治疗联合放疗加切除术 (Surg+RT+ST) (21.7 个月，n=33)。与 ST 相比，Surg+RT+ST 组的生存获益具有统计学意义 (P=0.001)，但与 RT+ST 组相比则无统计学意义 (P=0.081)。与 RT+ST 相比，Surg+RT+ST 组无进展生存期显著延长 (分别为 10.9 个月和 5.9 个月，P=0.04)。在脑转移诊断时的表现状态和脑转移灶数量等变量无显著差异。在分子靶向药物和免疫治疗的背景下，切除术可能使适当的手术候选者受益。有必要进行前瞻性临床试验，以更好地了解积极治疗 RCC 脑转移的作用。
