Prognostic significance of intensive local therapy to bone lesions in renal cell carcinoma patients with bone metastasis
We evaluated the prognostic roles of local therapy to bone metastasis (BM) in metastatic renal cell carcinoma (mRCC) patients with BM. This retrospective study included 71 mRCC patients with BM. Local therapy to BM included en bloc resection, curettage, and radiotherapy (RT). RT was classified into RT with biological effective dose (BED) ≥85 Gy and <85 Gy by its therapeutic intensity. Local therapy to BM was given for 64 patients (90 %): en bloc resection, curettage, and RT for 16, 10, and 38 patients, respectively. Fifteen patients received RT with BED ≥85 Gy. The median overall survival (OS) was 25 months (median follow-up 16 months). For 46 patients with solitary BM, patients treated with en bloc resection, curettage, and RT with BED ≥85 Gy showed significantly better OS than those treated with RT with BED <85 Gy or no local therapy (P = 0.006). Because OS was comparable among patients treated with en bloc resection, curettage, and RT with BED ≥85 Gy, these three treatment modalities were defined as “intensive local therapy”. Intensive local therapy to BM was also associated with favorable OS with marginal significance (P = 0.052) in a cohort of 25 patients with multiple BM. A multivariate analysis in the whole cohort revealed that intensive local therapy to BM was independently associated with favorable OS (hazard ratio 0.23, P < 0.001) along with Memorial-Sloan Kettering Cancer Center risk category (P < 0.001). Thus, intensive local therapy to BM might improve OS in mRCC patients with BM including multiple BM.
KeywordsMetastatic renal cell carcinoma Bone metastasis Metastasectomy Radiotherapy Overall survival
Biological effective dose
External beam radiotherapy
Metastatic renal cell carcinoma
Memorial-Sloan Kettering Cancer Center
Renal cell carcinoma
Stereotactic body radiotherapy
The authors acknowledge Prof. Kazunori Kihara and Prof. Yasuhisa Fujii (Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan) for their thoughtful advice and encouragement throughout the present study. The authors declare that there is no fund of research, grants and financial support.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
- 3.Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A, Tian Z, Schmitges J, Graefen M, Perrotte P, Menon M, Montorsi F, Karakiewicz PI (2012) Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol 23(4):973–980. doi: 10.1093/annonc/mdr362 CrossRefPubMedGoogle Scholar
- 4.Santini D, Procopio G, Porta C, Ibrahim T, Barni S, Mazzara C, Fontana A, Berruti A, Berardi R, Vincenzi B, Ortega C, Ottaviani D, Carteni G, Lanzetta G, Virzi V, Santoni M, Silvestris N, Satolli MA, Collova E, Russo A, Badalamenti G, Fedeli SL, Tanca FM, Adamo V, Maiello E, Sabbatini R, Felici A, Cinieri S, Tonini G, Bracarda S (2013) Natural history of malignant bone disease in renal cancer: final results of an Italian bone metastasis survey. PLoS One 8(12):e83026. doi: 10.1371/journal.pone.0083026 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Beuselinck B, Oudard S, Rixe O, Wolter P, Blesius A, Ayllon J, Elaidi R, Schoffski P, Barrascout E, Morel A, Escudier B, Lang H, Zucman-Rossi J, Medioni J (2011) Negative impact of bone metastasis on outcome in clear-cell renal cell carcinoma treated with sunitinib. Ann Oncol 22(4):794–800. doi: 10.1093/annonc/mdq554 CrossRefPubMedGoogle Scholar
- 7.Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, Grunwald V, Thompson JA, Figlin RA, Hollaender N, Kay A, Ravaud A (2010) Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 116(18):4256–4265. doi: 10.1002/cncr.25219 CrossRefPubMedGoogle Scholar
- 8.Patil S, Figlin RA, Hutson TE, Michaelson MD, Negrier S, Kim ST, Huang X, Motzer RJ (2011) Prognostic factors for progression-free and overall survival with sunitinib targeted therapy and with cytokine as first-line therapy in patients with metastatic renal cell carcinoma. Ann Oncol 22(2):295–300. doi: 10.1093/annonc/mdq342 CrossRefPubMedGoogle Scholar
- 11.Jhaveri PM, Teh BS, Paulino AC, Blanco AI, Lo SS, Butler EB, Amato RJ (2012) A dose-response relationship for time to bone pain resolution after stereotactic body radiotherapy (SBRT) for renal cell carcinoma (RCC) bony metastases. Acta Oncol 51(5):584–588. doi: 10.3109/0284186X.2011.652741 CrossRefPubMedGoogle Scholar