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Strahlentherapie beim metastasierten Nierenzellkarzinom

Radiotherapy of metastasized renal cell carcinoma

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Etwa die Hälfte aller Patienten mit Nierenzellkarzinom entwickeln im Verlauf ihrer Erkrankung Fernmetastasen.

Ziel

Darstellung der strahlentherapeutischen Optionen zur Symptomlinderung und lokalen Kontrolle.

Material und Methode

Durchführung einer systematischen Literaturrecherche zur Strahlentherapie bei Nierenzellkarzinommetastasen.

Ergebnisse

Eine neue Entwicklung ist die hoch dosierte stereotaktische Bestrahlung, von der insbesondere oligometastasierte Patienten profitieren. Eine lokale Kontrolle kann bei mehr als 80 % der Patienten erreicht werden. Bei multiplen Hirnmetastasen ebenso wie bei Patienten in schlechtem Allgemeinzustand mit symptomatischen Knochenmetastasen oder extrakraniellen Metastasen andernorts ist eine moderat hypofraktionierte Strahlentherapie das Vorgehen der Wahl. Die Ansprechrate liegt zwischen 60 % und 80 %.

Abstract

Background

Nearly 50  % of all patients suffering from renal cell cancer develop metastases during the course of the disease.

Objective

The aim of this article is to describe the options for radiotherapy of metastatic renal cell carcinoma.

Material and methods

A systematic search of the literature for articles on radiotherapy of metastatic renal cell carcinoma was carried out.

Results

A new treatment option for long-term local control especially for oligometastatic patients is high-dose stereotactic radiotherapy. Local control rates are around 80  % or higher; however, moderately hypofractionated radiotherapy remains the treatment of choice for symptomatic patients with multiple brain metastases and for patients in a poor general condition with symptomatic bone or other extracranial metastases. Alleviation of symptoms is achieved in 60–80  %.

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Literatur

  1. Stinauer MA, Kavanagh BD, Schefter TE et al (2011) Stereotactic body radiation therapy for melanoma and renal cell carcinoma: impact of single fraction equivalent dose on local control. Radiat Oncol 6:34

    Article  PubMed Central  PubMed  Google Scholar 

  2. Garcia-Barros M, Paris F, Cordon-Cardo C et al (2003)Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science 300(5622):1155–1159

    Article  CAS  PubMed  Google Scholar 

  3. De Meerleer G, Khoo V, Escudier B et al (2014) Radiotherapy for renal-cell carcinoma. Lancet Oncol 15(4):e170–e177

    Article  Google Scholar 

  4. Kingsley DP (1975) An interesting case of possible abscopal effect in malignant melanoma. Br J Radiol 48(574):863–866

    Article  CAS  PubMed  Google Scholar 

  5. Wersäll PJ, Blomgren H, Pisa P et al (2012) Regression of non-irradiated metastases after extracranial stereotactic radiotherapy in metastatic renal cell carcinoma. Acta Oncol 45(4):493–497

    Article  Google Scholar 

  6. Brown JM, Carlson DJ, Brenner DJ (2014) The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved? Int J Radiat Oncol Biol Phys 88(2):254–262

    Article  PubMed  Google Scholar 

  7. Blanco AI, Teh BS, Amato RJ (2011) Role of radiation therapy in the management of renal cell cancer. Cancers (Basel) 3(4):4010–4023

  8. Tree AC, Khoo VS, Eeles RA et al (2013) Stereotactic body radiotherapy for oligometastases. Lancet Oncol 14(1):e28–e37

    Article  PubMed  Google Scholar 

  9. Zelefsky MJ, Greco C, Motzer R et al (2012) 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(5):1744–1748

    Article  PubMed Central  PubMed  Google Scholar 

  10. Svedman C, Sandström P, Pisa P et al (2006) A prospective Phase II trial of using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma. Acta Oncol 45(7):870–875

    Article  PubMed  Google Scholar 

  11. Ranck MC, Golden DW, Corbin KS et al (2013) Stereotactic body radiotherapy for the treatment of oligometastatic renal cell carcinoma. Am J Clin Oncol 36(6):589–595

    Article  CAS  PubMed  Google Scholar 

  12. Seastone DJ, Elson P, Garcia JA et al (2014) Clinical outcome of stereotactic radiosurgery for central nervous system metastases from renal cell carcinoma. Clin Genitourin Cancer 12(2):111–116

    Article  CAS  PubMed  Google Scholar 

  13. Kano H, Lyer A, Kondziolka D et al (2011) Outcome predictors of gamma knife radiosurgery for renal cell carcinoma metastases. Neurosurgery 69(6):1232–1239

    Article  PubMed  Google Scholar 

  14. Gaspar L, Scott C, Rotman M et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37(4):745–751

    Article  CAS  PubMed  Google Scholar 

  15. Wrónski M, Maor MH, Davis BJ et al (1997) External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M. D. Anderson Cancer Center. Int J Radiat Oncol Biol Phys 37(4):753–759

    Article  PubMed  Google Scholar 

  16. Dziggel L, Segedin B, Podvrsnik NH et al (2014) A survival score for patients with brain metastases from less radiosensitive tumors treated with whole-brain radiotherapy alone. Strahlenther Onkol 190(1):54–58

    Article  CAS  PubMed  Google Scholar 

  17. Rades D, Weber A, Bartscht T et al (2014) A new prognostic factor for the survival of patients with renal cell carcinoma developing metastatic spinal cord compression. Strahlenther Onkol 190(7):667–670

    Article  CAS  PubMed  Google Scholar 

  18. Vickers MM, Al-Harbi H, Choueiri TK et al (2013) Prognostic factors of survival for patients with metastatic renal cell carcinoma with brain metastases treated with targeted therapy: results from the international metastatic renal cell carcinoma database consortium. Clin Genitourin Cancer 11(3):311–315

    Article  PubMed  Google Scholar 

  19. Lwu S, Goetz P, Monsalves E, Aryaee M et al (2013) Stereotactic radiosurgery for the treatment of melanoma and renal cell carcinoma brain metastases. Oncol Rep 29(2):407–412

    CAS  PubMed Central  PubMed  Google Scholar 

  20. Fokas E, Henzel M, Hamm K et al (2010) Radiotherapy for brain metastases from renal cell cancer: should whole-brain radiotherapy be added to stereotactic radiosurgery? Analysis of 88 patients. Strahlenther Onkol 186(4):210–217

    Article  PubMed  Google Scholar 

  21. Samlowski WE, Majer M, Boucher KM et al (2008) Multidisciplinary treatment of brain metastases derived from clear cell renal cancer incorporating stereotactic radiosurgery. Cancer 113(9):2539–2548

    Article  PubMed  Google Scholar 

  22. Yamamoto M, Serizawa T, Sato Y et al (2013) Validity of two recently-proposed prognostic grading indices for lung, gastro-intestinal, breast and renal cell cancer patients with radiosurgically-treated brain metastases. J Neurooncol 111(3):327–335

    Article  PubMed  Google Scholar 

  23. Bennani O, Derrey S, Langlois O et al (2014) Brain metastasis from renal cell carcinoma. Neurochirurgie 60(1–2):12–16

  24. Cannady SB, Cannady SB, Cavanaugh KA et al (2004) Results of whole brain radiotherapy and recursive partitioning analysis in patients with brain metastases from renal cell carcinoma: a retrospective study. Int J Radiat Oncol Biol Phys 58(1):253–258

    Article  PubMed  Google Scholar 

  25. Payne BR, Prasad D, Szeifert G et al (2000) Gamma surgery for intracranial metastases from renal cell carcinoma. J Neurosurg 92(5):760–765

    Article  CAS  PubMed  Google Scholar 

  26. Noel G, Valery CA, Boisserie G et al (2004) LINAC radiosurgery for brain metastasis of renal cell carcinoma. Urol Oncol 22(1):25–31

    Article  PubMed  Google Scholar 

  27. Muacevic A, Muacevic A, Kreth FW et al (2004) Stereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma. Minim Invasive Neurosurg 47(4):203–208

    Article  CAS  PubMed  Google Scholar 

  28. Shuto T, Matsunaga S, Suenaga J et al (2010) Treatment strategy for metastatic brain tumors from renal cell carcinoma: selection of gamma knife surgery or craniotomy for control of growth and peritumoral edema. J Neurooncol 98(2):169–175

    Article  PubMed  Google Scholar 

  29. Kano H, Iyer A, Kondziolka D et al (2011) Outcome predictors of gamma knife radiosurgery for renal cell carcinoma metastases. Neurosurgery 69(6):1232–1239

    Article  PubMed  Google Scholar 

  30. Lee J, Hodgson D, Chow E et al (2005) A phase II trial of palliative radiotherapy for metastatic renal cell carcinoma. Cancer 104(9):1894–1900

    Article  PubMed  Google Scholar 

  31. Lutz S (2012) The role of radiation therapy in controlling painful bone metastases (Review). Curr Pain Headache Rep 16:300–306

    Article  PubMed  Google Scholar 

  32. Chow E, Zeng L, Salvo N et al (2012) Update on the systematic review of palliative radiotherapy trials for bone metastases. Clin Oncol (R Coll Radiol) 24(2):112–124

    Google Scholar 

  33. Hunter GK, Balagamwala EH, Koyfman SA et al (2012) The efficacy of external beam radiotherapy and stereotactic body radiotherapy for painful spinal metastases from renal cell carcinoma. Pract Radiat Oncol 2(4):e95–e100

    Article  PubMed  Google Scholar 

  34. Ryu S et al (2007) Partial volume tolerance of the spinal cord and complications of single-dose radiosurgery. Cancer 109(3):628–636

    Article  PubMed  Google Scholar 

  35. Ryu S et al (2004) Patterns of failure after single-dose radiosurgery for spinal metastasis. J Neurosurg 101(Suppl 3):402–405

    Article  PubMed  Google Scholar 

  36. Gibbs IC et al (2007) Image-guided robotic radiosurgery for spinal metastases. Radiother Oncol 82(2):185–190

    Article  PubMed  Google Scholar 

  37. Gerszten PC et al (2007) Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 32(2):193–199

    Article  PubMed  Google Scholar 

  38. Nelson JW et al (2009) Stereotactic body radiotherapy for lesions of the spine and paraspinal regions. Int J Radiat Oncol Biol Phys 73(5):1369–1375

    Article  PubMed Central  PubMed  Google Scholar 

  39. Nguyen QN et al (2010) Management of spinal metastases from renal cell carcinoma using stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76(4):1185–1192

    Article  PubMed  Google Scholar 

  40. Balagamwala EH et al (2012) Single-fraction stereotactic body radiotherapy for spinal metastases from renal cell carcinoma. J Neurosurg Spine 17(6):556–564

    Article  PubMed  Google Scholar 

  41. Wang XS et al (2012) Stereotactic body radiation therapy for management of spinal metastases in patients without spinal cord compression: a phase 1–2 trial. Lancet Oncol 13(4):395–402

    Article  PubMed Central  PubMed  Google Scholar 

  42. Mantel F et al (2014) Long-term safety and efficacy of fractionated stereotactic body radiation therapy for spinal metastases. Strahlenther Onkol (Epub ahead of print)

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Einhaltung ethischer Richtlinien

Interessenkonflikt. B. van Oorschot, B. Polat und D. Rades geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor. Der Beitrag enthält keine Studien an Menschen und Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, Interdisziplinäres Zentrum Palliativmedizin, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland

    B. van Oorschot & B. Polat

  2. Klinik für Strahlentherapie, Universität zu Lübeck, Lübeck, Deutschland

    D. Rades

Authors
  1. B. van Oorschot
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  2. B. Polat
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  3. D. Rades
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Correspondence to B. van Oorschot.

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van Oorschot, B., Polat, B. & Rades, D. Strahlentherapie beim metastasierten Nierenzellkarzinom. Onkologe 21, 50–54 (2015). https://doi.org/10.1007/s00761-014-2778-z

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  • DOI: https://doi.org/10.1007/s00761-014-2778-z

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