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Erschienen in: European Radiology 3/2020

14.11.2019 | Musculoskeletal

Concomitant radiotherapy and transarterial chemoembolization reduce skeletal-related events related to bone metastases from renal cell carcinoma

verfasst von: Joichi Heianna, Wataru Makino, Takuro Ariga, Kazuki Ishikawa, Takeaki Kusada, Hitoshi Maemoto, Masafumi Toguchi, Junji Ito, Masato Goya, Minoru Miyazato, Yuko Iraha, Sadayuki Murayama

Erschienen in: European Radiology | Ausgabe 3/2020

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Abstract

Objectives

The purpose of this study was to compare the efficacy of radiotherapy (RT) combined with transcatheter arterial chemoembolization (TACE) with RT alone for the treatment of bone metastases from renal cell carcinoma (RCC).

Methods

We included in this retrospective study 25 RCC patients (28 bone metastases), who were treated with RT at our institution. Patients were divided into two groups: patients treated with RT alone (monotherapy group; n = 17) and those treated with RT combined with TACE (combined therapy group; n = 11). The administered median RT dose was 30 Gy in 10 fractions. Anti-cancer agents used in TACE were cisplatin (median dose, 50 mg) and carboplatin (median dose, 240 mg) for patients with reduced renal function. We evaluated the objective response, post-RT-skeletal-related event (PR-SRE)–free rate, and adverse events associated with treatment for each group.

Results

The objective response rates for bone metastases in the monotherapy and combined therapy groups were 33% and 82%, respectively (p = 0.009). The 2-year PR-SRE-free rate in the monotherapy and combined therapy groups was 41.8% and 100%, respectively (p = 0.009). The objective response and PR-SRE-free rates were significantly superior in the combined therapy than in the monotherapy group. There were no significant differences in adverse events or survival between the two groups.

Conclusion

RT combined with TACE is a promising treatment for bone metastases from RCC, as it results in higher objective response, and PR-SRE-free rates compared with RT alone.

Key Points

• Skeletal-related events (SREs) are common in patients with bone metastases from renal cell carcinoma (RCC).
• Radiotherapy (RT) provides pain relief in patients with bone metastases from RCC, but rarely achieves objective response.
• Combination of RT with transcatheter arterial chemoembolization results in higher objective response and post-RT-SRE-free rates compared with RT alone and is a promising treatment for bone metastases from RCC, as it.
Literatur
1.
Zurück zum Zitat Woodward E, Jagdev S, McParland L et al (2011) Skeletal complications and survival in renal cancer patients with bone metastases. Bone 48:160–166CrossRefPubMed Woodward E, Jagdev S, McParland L et al (2011) Skeletal complications and survival in renal cancer patients with bone metastases. Bone 48:160–166CrossRefPubMed
2.
Zurück zum Zitat Bianchi M, Sun M, Jeldres C et al (2012) Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol 23:973–980CrossRefPubMed Bianchi M, Sun M, Jeldres C et al (2012) Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol 23:973–980CrossRefPubMed
3.
Zurück zum Zitat Beuselinck B, Oudard S, Rixe O et al (2011) Negative impact of bone metastasis on outcome in clear-cell renal cell carcinoma treated with sunitinib. Ann Oncol 22:794–800CrossRefPubMed Beuselinck B, Oudard S, Rixe O et al (2011) Negative impact of bone metastasis on outcome in clear-cell renal cell carcinoma treated with sunitinib. Ann Oncol 22:794–800CrossRefPubMed
5.
Zurück zum Zitat McKay RR, Kroeger N, Xie W et al (2014) Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. Eur Urol 65:577–584CrossRefPubMed McKay RR, Kroeger N, Xie W et al (2014) Impact of bone and liver metastases on patients with renal cell carcinoma treated with targeted therapy. Eur Urol 65:577–584CrossRefPubMed
6.
Zurück zum Zitat Motzer RJ, Hutson TE, Tomczak P et al (2009) Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 27:3584–3590CrossRefPubMed Motzer RJ, Hutson TE, Tomczak P et al (2009) Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 27:3584–3590CrossRefPubMed
7.
Zurück zum Zitat Escudier B, Eiseen T, Stadler WM et al (2009) Sorafenib for treatment of renal cell carcinoma: final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol 27:3312–3318CrossRefPubMed Escudier B, Eiseen T, Stadler WM et al (2009) Sorafenib for treatment of renal cell carcinoma: final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol 27:3312–3318CrossRefPubMed
8.
Zurück zum Zitat Calvo E, Escudier B, Motzer RJ et al (2012) Everolimus in metastatic renal cell carcinoma: subgroup analysis of patients with 1 or 2 previous vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapies enrolled in the phase III RECORD-1 study. Eur J Cancer 48:333–339CrossRefPubMed Calvo E, Escudier B, Motzer RJ et al (2012) Everolimus in metastatic renal cell carcinoma: subgroup analysis of patients with 1 or 2 previous vascular endothelial growth factor receptor-tyrosine kinase inhibitor therapies enrolled in the phase III RECORD-1 study. Eur J Cancer 48:333–339CrossRefPubMed
9.
Zurück zum Zitat Bedke J, Stuhler V, Stenzl A, Brehmer B (2018) Immunotherapy for kidney cancer: status quo and the future. Curr Opin Urol 28:8–14CrossRefPubMed Bedke J, Stuhler V, Stenzl A, Brehmer B (2018) Immunotherapy for kidney cancer: status quo and the future. Curr Opin Urol 28:8–14CrossRefPubMed
10.
Zurück zum Zitat Teyssonneau D, Gross-Goupil M, Domblides C et al (2018) Treatment of spinal metastases in renal cell carcinoma: a critical review. Crit Rev Oncol Hematol 125:19–29CrossRefPubMed Teyssonneau D, Gross-Goupil M, Domblides C et al (2018) Treatment of spinal metastases in renal cell carcinoma: a critical review. Crit Rev Oncol Hematol 125:19–29CrossRefPubMed
11.
Zurück zum Zitat Lipton A, Zheng M, Seaman J (2003) Zoledronic acid delays the onset of skeletal-related events and progression of skeletal disease in patients with advanced renal cell carcinoma. Cancer 98:962–969CrossRefPubMed Lipton A, Zheng M, Seaman J (2003) Zoledronic acid delays the onset of skeletal-related events and progression of skeletal disease in patients with advanced renal cell carcinoma. Cancer 98:962–969CrossRefPubMed
12.
Zurück zum Zitat Jung ST, Ghert MA, Harrelson JM, Scully SP (2003) Treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop Relat Res 409:223–231CrossRef Jung ST, Ghert MA, Harrelson JM, Scully SP (2003) Treatment of osseous metastases in patients with renal cell carcinoma. Clin Orthop Relat Res 409:223–231CrossRef
13.
Zurück zum Zitat Lee J, Hodgson D, Chow E et al (2005) A phase II trial of palliative radiotherapy for metastatic renal cell carcinoma. Cancer 104:1894–1900CrossRefPubMed Lee J, Hodgson D, Chow E et al (2005) A phase II trial of palliative radiotherapy for metastatic renal cell carcinoma. Cancer 104:1894–1900CrossRefPubMed
14.
Zurück zum Zitat Kijima T, Fujii Y, Suyama T et al (2008) Radiotherapy to bone metastases from renal cell carcinoma with or without zoledronate. BJU Int 103:620–624CrossRefPubMed Kijima T, Fujii Y, Suyama T et al (2008) Radiotherapy to bone metastases from renal cell carcinoma with or without zoledronate. BJU Int 103:620–624CrossRefPubMed
15.
Zurück zum Zitat Hosaka S, Katagiri H, Niwakawa M et al (2018) Radiotherapy combined with zoledronate can reduce skeletal-related events in renal cell carcinoma patients with bone metastasis. Int J Clin Oncol 23:1127–1133CrossRefPubMed Hosaka S, Katagiri H, Niwakawa M et al (2018) Radiotherapy combined with zoledronate can reduce skeletal-related events in renal cell carcinoma patients with bone metastasis. Int J Clin Oncol 23:1127–1133CrossRefPubMed
16.
Zurück zum Zitat Sun S, Lang EV (1998) Bone metastases from renal cell carcinoma: preoperative embolization. J Vasc Interv Radiol 9:263–269CrossRefPubMed Sun S, Lang EV (1998) Bone metastases from renal cell carcinoma: preoperative embolization. J Vasc Interv Radiol 9:263–269CrossRefPubMed
17.
Zurück zum Zitat Wirbel RJ, Roth R, Schlte M, Kramann B, Mutschler W (2005) Preoperative embolization in spinal and pelvic metastases. J Orthop Sci 10:253–257CrossRefPubMed Wirbel RJ, Roth R, Schlte M, Kramann B, Mutschler W (2005) Preoperative embolization in spinal and pelvic metastases. J Orthop Sci 10:253–257CrossRefPubMed
18.
Zurück zum Zitat Gupta P, Gamanagatti S (2012) Preoperative transarterial embolisation in bone tumors. World J Radiol 4:186–192CrossRefPubMed Gupta P, Gamanagatti S (2012) Preoperative transarterial embolisation in bone tumors. World J Radiol 4:186–192CrossRefPubMed
19.
Zurück zum Zitat Radeleff B, Eiers M, Lopez-Benitez R et al (2006) Transarterial embolization of primary and secondary tumors of the skeletal system. Eur J Radiol 58:68–75CrossRefPubMed Radeleff B, Eiers M, Lopez-Benitez R et al (2006) Transarterial embolization of primary and secondary tumors of the skeletal system. Eur J Radiol 58:68–75CrossRefPubMed
20.
Zurück zum Zitat Forauer AR, Kent E, Cwikiel W, Esper P, Redman B (2007) Selective palliative transcatheter embolization of bony metastases from renal cell carcinoma. Acta Oncol 46:1012–1018CrossRefPubMed Forauer AR, Kent E, Cwikiel W, Esper P, Redman B (2007) Selective palliative transcatheter embolization of bony metastases from renal cell carcinoma. Acta Oncol 46:1012–1018CrossRefPubMed
21.
Zurück zum Zitat Nagata Y, Mitsumori M, Okajima K et al (1998) Transcatheter arterial embolization for malignant osseous and soft tissue sarcomas. II. Clinical results. Cardiovasc Intervent Radiol 21:208–213CrossRefPubMed Nagata Y, Mitsumori M, Okajima K et al (1998) Transcatheter arterial embolization for malignant osseous and soft tissue sarcomas. II. Clinical results. Cardiovasc Intervent Radiol 21:208–213CrossRefPubMed
22.
Zurück zum Zitat Chiras J, Adem C, Vallee JN, Spelle L, Cormier E, Rose M (2004) Selective intra-arterial chemoembolization of pelvic and spine bone metastases. Eur Radiol 13:1774–1780 Chiras J, Adem C, Vallee JN, Spelle L, Cormier E, Rose M (2004) Selective intra-arterial chemoembolization of pelvic and spine bone metastases. Eur Radiol 13:1774–1780
23.
Zurück zum Zitat Koike Y, Takizawa K, Ogawa Y et al (2011) Transcatheter arterial chemoembolization (TACE) or embolization (TAE) for symptomatic bone metastases as a palliative treatment. Cardiovasc Intervent Radiol 34:793–801CrossRefPubMed Koike Y, Takizawa K, Ogawa Y et al (2011) Transcatheter arterial chemoembolization (TACE) or embolization (TAE) for symptomatic bone metastases as a palliative treatment. Cardiovasc Intervent Radiol 34:793–801CrossRefPubMed
24.
Zurück zum Zitat Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17:2530–2540CrossRefPubMed Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17:2530–2540CrossRefPubMed
25.
Zurück zum Zitat Diamond E, Molina AM, Carbonaro M et al (2015) Cytotoxic chemotherapy in the treatment of advanced renal cell carcinoma in the era of targeted therapy. Crit Rev Oncol Hematol 96:518–526CrossRefPubMed Diamond E, Molina AM, Carbonaro M et al (2015) Cytotoxic chemotherapy in the treatment of advanced renal cell carcinoma in the era of targeted therapy. Crit Rev Oncol Hematol 96:518–526CrossRefPubMed
26.
Zurück zum Zitat Hussain M, Vaishampayan U, Du W, Redman B, Smith DC (2001) Combination paclitaxel, carboplatin, and gemcitabine is an active treatment for advanced urothelial cancer. J Clin Oncol 19:2527–2533CrossRefPubMed Hussain M, Vaishampayan U, Du W, Redman B, Smith DC (2001) Combination paclitaxel, carboplatin, and gemcitabine is an active treatment for advanced urothelial cancer. J Clin Oncol 19:2527–2533CrossRefPubMed
27.
Zurück zum Zitat Hosogoe S, Hatakeyama S, Kusaka A et al (2018) Platinum-based neoadjuvant chemotherapy improves oncological outcomes in patients with locally advanced upper tract urothelial carcinoma. Eur Urol Focus 4:946–953CrossRefPubMed Hosogoe S, Hatakeyama S, Kusaka A et al (2018) Platinum-based neoadjuvant chemotherapy improves oncological outcomes in patients with locally advanced upper tract urothelial carcinoma. Eur Urol Focus 4:946–953CrossRefPubMed
28.
Zurück zum Zitat Drooz AT, Lewis CA, Allen TE et al (2003) Quality improvement guidelines for percutaneous transcatheter embolization. J Vasc Interv Radiol 14:S237–S242PubMed Drooz AT, Lewis CA, Allen TE et al (2003) Quality improvement guidelines for percutaneous transcatheter embolization. J Vasc Interv Radiol 14:S237–S242PubMed
29.
Zurück zum Zitat Mizumoto M, Hrada H, Asakura H et al (2009) Radiotherapy for patients with metastases to the spinal column: a review of 603 patients at Shizuoka Cancer Center Hospital. Int J Radiat Oncol Biol Phys 79:208–213CrossRef Mizumoto M, Hrada H, Asakura H et al (2009) Radiotherapy for patients with metastases to the spinal column: a review of 603 patients at Shizuoka Cancer Center Hospital. Int J Radiat Oncol Biol Phys 79:208–213CrossRef
30.
Zurück zum Zitat Soo CS, Wallace S, Chuang VP, Carrasco CH, Phillies G (1982) Lumbar artery embolization in cancer patients. Radiology 145:655–659CrossRefPubMed Soo CS, Wallace S, Chuang VP, Carrasco CH, Phillies G (1982) Lumbar artery embolization in cancer patients. Radiology 145:655–659CrossRefPubMed
31.
Zurück zum Zitat Uemura A, Fujimoto H, Yasuda S et al (2001) Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma. Eur Radiol 11:1457–1462CrossRefPubMed Uemura A, Fujimoto H, Yasuda S et al (2001) Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma. Eur Radiol 11:1457–1462CrossRefPubMed
32.
Zurück zum Zitat Yamaura H, Yamada K, Matsuzawa T (1976) Radiation effect on the proliferating capillaries in rat transparent chambers. Int J Radiat Biol Relat Stud Phys Chem Med 30:179–187CrossRefPubMed Yamaura H, Yamada K, Matsuzawa T (1976) Radiation effect on the proliferating capillaries in rat transparent chambers. Int J Radiat Biol Relat Stud Phys Chem Med 30:179–187CrossRefPubMed
33.
Zurück zum Zitat Yamaura H, Matsuzawa T (1979) Tumor regrowth after irradiation: an experimental approach. Int J Radiat Biol Relat Stud Phys Chem Med 35:201–219CrossRefPubMed Yamaura H, Matsuzawa T (1979) Tumor regrowth after irradiation: an experimental approach. Int J Radiat Biol Relat Stud Phys Chem Med 35:201–219CrossRefPubMed
34.
Zurück zum Zitat Coldwell DM, Stokes KR, Yakes WF (1994) Embolotherapy: agents, clinical applications and techniques. Radiographics 14:623–643CrossRefPubMed Coldwell DM, Stokes KR, Yakes WF (1994) Embolotherapy: agents, clinical applications and techniques. Radiographics 14:623–643CrossRefPubMed
35.
Zurück zum Zitat Kato T, Nemoto R, Mori H, Takahashi M, Harada M (1981) Arterial chemoembolization with mitomycin C microcapsules in the treatment of primary or secondary carcinoma of the kidney, liver bone and intrapelvic organs. Cancer 48:674–680CrossRefPubMed Kato T, Nemoto R, Mori H, Takahashi M, Harada M (1981) Arterial chemoembolization with mitomycin C microcapsules in the treatment of primary or secondary carcinoma of the kidney, liver bone and intrapelvic organs. Cancer 48:674–680CrossRefPubMed
Metadaten
Titel
Concomitant radiotherapy and transarterial chemoembolization reduce skeletal-related events related to bone metastases from renal cell carcinoma
verfasst von
Joichi Heianna
Wataru Makino
Takuro Ariga
Kazuki Ishikawa
Takeaki Kusada
Hitoshi Maemoto
Masafumi Toguchi
Junji Ito
Masato Goya
Minoru Miyazato
Yuko Iraha
Sadayuki Murayama
Publikationsdatum
14.11.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Radiology / Ausgabe 3/2020
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06454-8

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