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Prognostic significance of intensive local therapy to bone lesions in renal cell carcinoma patients with bone metastasis

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Abstract

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.

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Abbreviations

ALP:

Alkaline phosphatase

BED:

Biological effective dose

BM:

Bone metastasis

CRP:

C-reactive protein

EBRT:

External beam radiotherapy

IORT:

Intraoperative radiotherapy

mRCC:

Metastatic renal cell carcinoma

MSKCC:

Memorial-Sloan Kettering Cancer Center

OS:

Overall survival

PS:

Performance status

RCC:

Renal cell carcinoma

RT:

Radiotherapy

SBRT:

Stereotactic body radiotherapy

SRE:

Skeletal-related event

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Urology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Hiroshi Fukushima, Yasukazu Nakanishi, Madoka Kataoka, Ken-ichi Tobisu & Fumitaka Koga

  2. Department of Orthopedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Takahiro Hozumi & Takahiro Goto

  3. Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Keiji Nihei & Katsuyuki Karasawa

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  1. Hiroshi Fukushima
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  2. Takahiro Hozumi
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Correspondence to Fumitaka Koga.

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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.

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Fukushima, H., Hozumi, T., Goto, T. et al. Prognostic significance of intensive local therapy to bone lesions in renal cell carcinoma patients with bone metastasis. Clin Exp Metastasis 33, 699–705 (2016). https://doi.org/10.1007/s10585-016-9805-y

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  • DOI: https://doi.org/10.1007/s10585-016-9805-y

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