Radiation therapy following targeted therapy in oligometastatic renal cell carcinoma

Gravis,Gwenaelle; Faure,Marjorie; Rybikowski,Stanislas; Dermeche,Slimane; Tyran,Marguerite; Calderon,Benoit; Thomassin,Jeanne; Walz,Jochen; Salem,Naji

doi:10.3892/mco.2015.613

Radiation therapy following targeted therapy in oligometastatic renal cell carcinoma

Authors:
- Gwenaelle Gravis
- Marjorie Faure
- Stanislas Rybikowski
- Slimane Dermeche
- Marguerite Tyran
- Benoit Calderon
- Jeanne Thomassin
- Jochen Walz
- Naji Salem
View Affiliations

Affiliations: Department of Medical Oncology, Paoli-Calmettes Institute, 13009 Marseille, France, Department of Urology, Paoli-Calmettes Institute, 13009 Marseille, France, Research Unit Against Cancer, CRCM‑INSERM U1068, Faculty of Science of Luminy, Aix-Marseille University, 13009 Marseille, France, Department of Pathological Anatomy, Paoli-Calmettes Institute, 13009 Marseille, France, Department of Radiotherapy, Paoli-Calmettes Institute, 13009 Marseille, France
Published online on: July 30, 2015 https://doi.org/10.3892/mco.2015.613
Pages: 1248-1250

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Up to 40% of patients with renal cell carcinoma (RCC) with initially localized disease eventually develop metastasis following nephrectomy. The current standard of care for metastatic RCC (mRCC) is targeted therapy. However, complete response remains rare. A state of oligometastatic disease may exist, in which metastases are present in a limited number of locations; such cases may benefit from metastasis‑directed local therapy, based on the evidence supporting resection of limited‑volume metastases, allowing for improved disease control. We retrospectively analyzed 7 cases of response of RCC metastases, in patients treated with targeted therapies followed by radiation therapy (RT) of residual metastatic lesions in Paoli-Calmettes Institute (Marseille, France). We analyzed disease response rates, response to sequential strategy, relapse at the irradiated locations and disease evolution. The median follow-up was 34.1 months (range, 19.2-54.5 months). No progression at the irradiated sites was observed. A total of 5 patients had stable disease at the irradiated locations at the last follow-up; 3 remained in complete remission at the assessment, and 2 were stable. Excellent local response and clinical benefit may be achieved without added toxicity. In conclusion, sequential therapeutic strategies with RT following systemic treatment using sunitinib appear to be highly effective in patients with progressive mRCC and prompt the conduction of further confirmatory trials.

View Figures

View References

1	Escudier B: Advanced renal cell carcinoma: Current and emerging management strategies. Drugs. 67:1257–1264. 2007. View Article : Google Scholar : PubMed/NCBI
2	Wuthrick EJ, Kamrava M, Curran WJ Jr, Werner-Wasik M, Camphausen KA, Hyslop T, Axelrod R, Andrews DW, Glass J, Machtay M, et al: A phase 1b trial of the combination of the antiangiogenic agent sunitinib and radiation therapy for patients with primary and metastatic central nervous system malignancies. Cancer. 117:5548–5559. 2011. View Article : Google Scholar : PubMed/NCBI
3	Albiges L, Oudard S, Negrier S, Caty A, Gravis G, Joly F, Duclos B, Geoffrois L, Rolland F, Guillot A, et al: Complete remission with tyrosine kinase inhibitors in renal cell carcinoma. J Clin Oncol. 30:482–487. 2012. View Article : Google Scholar : PubMed/NCBI
4	Zhang HP, Takayama K, Su B, Jiao XD, Li R and Wang JJ: Effect of sunitinib combined with ionizing radiation on endothelial cells. J Radiat Res (Tokyo). 52:1–8. 2011. View Article : Google Scholar
5	Walsh L, Stanfield JL, Cho LC, Chang CH, Forster K, Kabbani W, Cadeddu JA, Hsieh JT, Choy H, Timmerman R, et al: Efficacy of ablative high-dose-per-fraction radiation for implanted human renal cell cancer in a nude mouse model. Eur Urol. 50:795–800; discussion 800. 2006. View Article : Google Scholar : PubMed/NCBI
6	Pellerin O, Medioni J, Vulser C, Déan C, Oudard S and Sapoval M: Management of painful pelvic bone metastasis of renal cell carcinoma using embolization, radio-frequency ablation, and cementoplasty: A prospective evaluation of efficacy and safety. Cardiovasc Intervent Radiol. 37:730–736. 2014. View Article : Google Scholar : PubMed/NCBI
7	Niibe Y and Hayakawa K: Oligometastases and oligo-recurrence: The new era of cancer therapy. Jpn J Clin Oncol. 40:107–111. 2010. View Article : Google Scholar : PubMed/NCBI
8	Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Oudard S, Negrier S, Szczylik C, Pili R, Bjarnason GA, et al: Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. 27:3584–3590. 2009. View Article : Google Scholar : PubMed/NCBI
9	Tsui KH, Shvarts O, Smith RB, Figlin RA, deKernion JB and Belldegrun A: Prognostic indicators for renal cell carcinoma: A multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. J Urol. 163:1090–1095; quiz 1295. 2000. View Article : Google Scholar : PubMed/NCBI
10	Daliani DD, Tannir NM, Papandreou CN, Wang X, Swisher S, Wood CG, Swanson DA, Logothetis CJ and Jonasch E: Prospective assessment of systemic therapy followed by surgical removal of metastases in selected patients with renal cell carcinoma. BJU Int. 104:456–460. 2009. View Article : Google Scholar : PubMed/NCBI
11	DeMeerleer G, Khoo V, Escudier B, Joniau S, Bossi A, Ost P, Briganti A, Fonteyne V, Van Vulpen M, Lumen N, et al: Radiotherapy for renal-cell carcinoma. Lancet Oncol. 15:e170–e177. 2014. View Article : Google Scholar : PubMed/NCBI
12	Escudier B and Kataja V: ESMO Guidelines Working Group: Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 21 (Suppl 5):v137–v139. 2010. View Article : Google Scholar : PubMed/NCBI
13	Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, Negrier S, Chevreau C, Solska E, Desai AA, et al: TARGET Study Group: Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 356:125–134. 2007. View Article : Google Scholar : PubMed/NCBI
14	Stinauer MA, Kavanagh BD, Schefter TE, Gonzalez R, Flaig T, Lewis K, Robinson W, Chidel M, Glode M and Raben D: Stereotactic body radiation therapy for melanoma and renal cell carcinoma: Impact of single fraction equivalent dose on local control. Radiat Oncol. 6:342011. View Article : Google Scholar : PubMed/NCBI
15	Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A and Ferrara J: Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. 17:2530–2540. 1999.PubMed/NCBI
16	Russo P, Jang TL, Pettus JA, Huang WC, Eggener SE, O'Brien MF, Karellas ME, Karanikolas NT and Kagiwada MA: Survival rates after resection for localized kidney cancer: 1989 to 2004. Cancer. 113:84–96. 2008. View Article : Google Scholar : PubMed/NCBI
17	Pantuck AJ, Zisman A and Belldegrun AS: The changing natural history of renal cell carcinoma. J Urol. 166:1611–1623. 2001. View Article : Google Scholar : PubMed/NCBI
18	Zelefsky MJ, Greco C, Motzer R, Magsanoc JM, Pei X, Lovelock M, Mechalakos J, Zatcky J, Fuks Z and Yamada Y: Tumor control outcomes after hypofractionated and single-dose stereotactic image-guided intensity-modulated radiotherapy for extracranial metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys. 82:1744–1748. 2012. View Article : Google Scholar : PubMed/NCBI