Evaluation of a new prognostic score (Munich score) to predict long-term survival after resection of pulmonary renal cell carcinoma metastases

Meimarakis, G.; Angele, Martin K.; Staehler, Michael; Clevert, D.‐A.; Crispin, Alexander; Rüttinger, Dominik; Löhe, F.; Preißler, Gerhard; Hatz, Rudolf; Winter, Hauke

doi:10.1016/j.amjsurg.2010.06.029

Cited by 88 publications

(59 citation statements)

References 33 publications

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“…Tumor size cutoff, as an independent favorable prognostic factor, is still controversial (19,23,26,30) but in our report, 2 cm was a significant cutoff value as in other previous studies (24,32).…”

Section: Resultssupporting

confidence: 60%

Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience

et al. 2017

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IntroductionRenal cell carcinoma (RCC) represents approximately 2% of all tumors, and about 30% of patients are affected by metastatic lesions at diagnosis (1,2). About 20% to 40% of patients develops a metastatic disease after nephrectomy (3) and lung is one of the sites most frequently affected by RCC metastases (second after liver) (4). Patients that receive no treatment for metastatic RCC (mRCC) have a 0-18% 5-year survival (5). Nonsurgical therapy for mRCC has limited efficacy, with a median overall survival (OS) reported between 26.4 and 32.0 months (6,7) for mRCC patients receiving several agents targeting angiogenesis or the mTOR pathway, in addition to traditional chemotherapeutic regimens and immunotherapy (8). On the contrary, the 5-year survival rates data published in literature after pulmonary surgery for metastasectomy from 36-54% (9,10), emphasizing the role of surgery as the Background: The lung is one of the sites most frequently affected by metastatic renal cell carcinoma

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Section: Resultssupporting

confidence: 60%

Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience

et al. 2017

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“…However, comparison between these studies is limited, as nearly all patients in this study were classified as medically inoperable due to comorbidities or higher age. While median age was 68.5 years in this study, reported median ages were 6-11 years lower in the surgical series, ranging from 57.7-62.0 years, potentially explaining the marginally lower OS rates observed in our study (17)(18)(19)(21)(22)(23)(25)(26)(27). Hence, SBRT for pulmonary metastases might be a valid alternative at least for patients in higher age and with comorbidities.…”

Section: Toxicitycontrasting

confidence: 39%

“…Surgical series for pulmonary metastasectomy as a local treatment method of RCC patients report excellent local control (LC) in case of complete resection and promising 3-and 5-year survival rates of 49-66% and 31-58%, respectively (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). However, some RCC patients are medically inoperable due to reduced performance status or comorbidities and some pulmonary metastases are technically not accessible or resectable.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma—a multicenter analysis of the German working group “Stereotactic Radiotherapy”

Hoerner-Rieber¹,

Duma²,

Blanck³

et al. 2017

J. Thorac. Dis.

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Background: Renal cell carcinoma (RCC) is traditionally considered to be radioresistant. Radiotherapy response rates are believed to improve with hypofractionated, high dose stereotactic body radiotherapy (SBRT).However, limited data exist regarding the role of SBRT in the treatment of pulmonary metastases. Methods: The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology analyzed its multi-institutional database of more than 700 patients who received SBRT for pulmonary metastases. Treatment was performed at 10 centers between 2001 and 2016. Patients with metastatic RCC were included in the study. Tumor characteristics, treatment details, and follow-up data including survival, local control (LC), distant metastases, and toxicity were evaluated. Results: A total of 46 RCC patients treated with SBRT for 67 lung metastases were identified, who received a median total biologically effective dose (BED iso ) at planning target volume (PTV) isocenter of 117.0 Gy (range, 48.0-189.0 Gy). A median fractional dose of 20.8 Gy at isocenter (range, 6.0-37.9 Gy) was administered in a median number of 3 fractions (1-8 fractions). After a median follow-up time of 28.3 months for all patients, 1-and 3-year LC rates were 98.1% and 91.9%, with corresponding 1-and 3-year overall survival (OS) of 84.3% and 43.8%, respectively. Pulmonary metastases treated with BEDiso ≥130 Gy showed a trend for superior LC (P=0.054). OS was significantly improved in both uni-and multivariate analysis for patients with higher Karnofsky performance scale, lower maximum pulmonary metastasis diameter and lack of post-SBRT systemic therapy due to progression (P=0.014; P=0.049; P=0.006). Only mild acute and late toxicity was reported.

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“…47,52,55 A lung-specifi c prognostic score including these factors has been developed from 200 consecutive patients with pulmonary metastases; this score needs external validation. 56 Interpretation of the identifi ed studies for bone and brain metastases that assessed radiotherapy or compared radiotherapy to surgery is problematic. During the long study periods of 6-15 years represented by the included studies, substantial advances were made in radiotherapy, including changes in dosage and modalities.…”

Section: Discussionmentioning

confidence: 99%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

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287

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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Evaluation of a new prognostic score (Munich score) to predict long-term survival after resection of pulmonary renal cell carcinoma metastases

Cited by 88 publications

References 33 publications

Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience

Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience

Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma—a multicenter analysis of the German working group “Stereotactic Radiotherapy”

Local treatments for metastases of renal cell carcinoma: a systematic review

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