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Simultaneous anti-angiogenic therapy and single-fraction radiosurgery in clinically relevant metastases from renal cell carcinoma

OBJECTIVE: * To analyse the safety and efficacy of simultaneous standard anti-angiogenic therapy and stereotactic radiosurgery (SRS) in patients with spinal and cerebral metastases from renal cell carcinoma. PATIENTS AND METHODS: * In all, 106 patients with spinal (n= 55) or cerebral (n= 51) metastatic lesions and an Eastern Cooperative Oncology Group status of 0 or 1 were treated with sorafenib or sunitinib and simultaneous SRS. * The primary endpoint was local control. * Secondary endpoints were toxicity and overall survival. RESULTS: * Median follow up was 14.7 months (range 1-42 months). Forty-five patients were treated with sunitinb and 61 patients with sorafenib. Two patients had asymptomatic tumour haemorrhage after SRS. * No skin toxicity, neurotoxicity or myelopathy occurred after SRS, and SRS did not alter the adverse effects of anti-angiogenic therapy. * Local tumour control 15 months after SRS was 98% (95% confidence interval 89-99%). The median pain score before SRS was 5 (range 1-8) and was lowered to 0 (range 0-2, P < 0.01) after SRS. There were no treatment-related deaths or late complications after SRS. * Overall survival was 17.4 months in patients with spinal lesions and 11.1 month in patients with cerebral lesions (P= 0.038). CONCLUSIONS: * Simultaneous systemic anti-angiogenic therapy and SRS for selected patients with renal cell carcinoma who have spinal and cerebral metastases is safe and effective. * Single-fraction delivery allows for efficacious integration of focal radiation treatment into oncological treatment concepts without additional toxicity. * Further studies are needed to determine the limits of SRS for renal cell carcinoma metastases outside the brain and spine Keywords : Adult,adverse effects,Aged,Aged,80 and over,Angiogenesis Inhibitors,Brain,Brain Neoplasms,Carcinoma,Carcinoma,Renal Cell,Chemotherapy,Adjuvant,complications,drug therapy,Female,Follow-Up Studies,Germany,Humans,Indoles,Kidney Neoplasms,Male,methods,Middle Aged,Pain,pathology,Patients,Pyrroles,Radiosurgery,Safety,secondary,Skin,Spinal Neoplasms,Spine,Sunitinib,surgery,Survival Analysis,therapeutic use,therapy,toxicity,Treatment Outcome,Universities,Young Adult,, Antiangiogenic,Therapy,Singlefraction,Radiosurgery, rsi using mouse

Date of Publication : 2011 Sep

Authors : Staehler M;Haseke N;Nuhn P;Tullmann C;Karl A;Siebels M;Stief CG;Wowra B;Muacevic A;

Organisation : Department of Urology, University of Munich, Klinikum Grosshadern, Munich, Germany. michael.staehler@med.unimuenchen.de

Journal of Publication : BJU Int

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21156017

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