Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery
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ORIGINAL ARTICLE - BRAIN TUMORS
Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery M. Stenman 1 & H. Benmakhlouf 2 & P. Wersäll 3 & P. Johnstone 4 & M. A. Hatiboglu 5 & J. Mayer-da-Silva 6 & U. Harmenberg 3 & M. Lindskog 1 & G. Sinclair 5,7,8 Received: 8 May 2020 / Accepted: 11 August 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Introduction 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. Methods and materials 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). Results 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 CITVSIR, again, did not add further prognostic value. ARE were seldom symptomatic and were associated with tumour volume, 10Gy volume and pre-treatment perifocal oedema. ARE were less common among patients treated with TA within 1 month of sfGKRS. Conclusions 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. Keywords Renal cell carcinoma . RCC . Gamma knife . GKRS . Stereotactic radiosurgery . SRS Dr Stenman and Dr Benmakhlouf share first authorship. U. Harmenberg, M. Lindskog and G. Sinclair contributed equally to this work. This article is part of the Topical Collection on Brain Tumors * G. Sinclair [email protected]; [email protected] 1
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Department of Oncology, Oxford University Hospitals NHS Trust, Oxford, UK
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Departme
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