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Clinical & Experimental Metastasis

, Volume 33, Issue 7, pp 699–705 | Cite as

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

  • Hiroshi Fukushima
  • Takahiro Hozumi
  • Takahiro Goto
  • Keiji Nihei
  • Katsuyuki Karasawa
  • Yasukazu Nakanishi
  • Madoka Kataoka
  • Ken-ichi Tobisu
  • Fumitaka Koga
Research Paper

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.

Keywords

Metastatic renal cell carcinoma Bone metastasis Metastasectomy Radiotherapy Overall survival 

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

Notes

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Supplementary material

10585_2016_9805_MOESM1_ESM.pdf (110 kb)
Supplementary material 1 (PDF 110 kb)
10585_2016_9805_MOESM2_ESM.pdf (106 kb)
Supplementary material 2 (PDF 105 kb)

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Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Hiroshi Fukushima
    • 1
  • Takahiro Hozumi
    • 2
  • Takahiro Goto
    • 2
  • Keiji Nihei
    • 3
  • Katsuyuki Karasawa
    • 3
  • Yasukazu Nakanishi
    • 1
  • Madoka Kataoka
    • 1
  • Ken-ichi Tobisu
    • 1
  • Fumitaka Koga
    • 1
  1. 1.Department of UrologyTokyo Metropolitan Cancer and Infectious diseases Center Komagome HospitalTokyoJapan
  2. 2.Department of Orthopedic Surgery and Musculoskeletal OncologyTokyo Metropolitan Cancer and Infectious diseases Center Komagome HospitalTokyoJapan
  3. 3.Department of Radiation OncologyTokyo Metropolitan Cancer and Infectious diseases Center Komagome HospitalTokyoJapan

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