Leptomeningeal carcinomatosis from renal cell cancer: treatment attempt with radiation and sunitinib (case report)
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WORLD JOURNAL OF SURGICAL ONCOLOGY Open Access
CASE REPORT
Leptomeningeal carcinomatosis from renal cell cancer: treatment attempt with radiation and sunitinib (case report) Case report
Astrid Dalhaug1, Ellinor Haukland1 and Carsten Nieder*1,2
Abstract A case of leptomeningeal carcinomatosis in a patient with known brain and lung metastases from renal cell cancer without previous systemic therapy is presented. Neoplastic meningitis (NM) developed 31 months after first diagnosis of simultaneous extra- and intracranial recurrence of kidney cancer and surgical resection of a cerebellar metastasis. In spite of local radiotherapy to the macroscopic NM lesions in the cervical and lumbar spine followed by initiation of sunitinib, the patient succumbed to his disease 4 months after the diagnosis of NM. The untreated lung metastases progressed very slowly during almost 3 years of observation. This case illustrates important issues around both biological behaviour and treatment approaches in metastatic renal cell cancer. Background Brain metastases from renal cell carcinoma might develop many years after primary nephrectomy and continue to represent a formidable challenge [1]. With increasing numbers of local and systemic treatment options, the issue of patient selection gains importance. While surgery and stereotactic radiosurgery (SRS) provide long-term local control of macroscopic disease, development of new central nervous system lesions can often be observed. Some patients might even present with leptomeningeal carcinomatosis or so called neoplastic meningitis (NM). Only few cases of NM from renal cell carcinoma treated with contemporary systemic approaches have been reported [2,3]. Therefore, the present case illustrates important aspects around potential treatment options. Case presentation A 72-year-old male presented to his family doctor with a 3 week history of headache and dizziness. His medical history was unremarkable except for left-sided nephrectomy for clear cell renal cell cancer stage T2 N0 M0 8 years earlier. Diagnostic imaging with brain computed tomography (CT) scan followed by magnetic resonance * Correspondence: [email protected] 1
Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
imaging (MRI) revealed a 3 cm large contrast-enhancing infratentorial tumor (Figure 1). No additional brain lesions were detected. CT of chest and abdomen revealed 2 small lung nodules (one left-sided, one right-sided) and enlarged mediastinal lymph nodes (Figure 2). Neurosurgical resection of the intracranial tumor confirmed metastasis from clear cell carcinoma. Neither postoperative radiotherapy nor systemic treatment was recommended at this time. Surveillance CT scans showed very slow enlargement of the lung and lymph node metastases during the next year. Seventeen months after resection of the cerebellar metastasis, local recurrence was detected. The patient was treated with gamma knife SRS (peripheral dose 21 Gy). Six months later, a single new brain metastasis was found (8 mm large, l
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