Extremely Delayed Brain Metastasis from Renal Cell Carcinoma

Choi, Won Ho; Koh, Young-Cho; Song, Sang Woo; Roh, Hong Gee; Lim, So-Dug

doi:10.14791/btrt.2013.1.2.99

Cited by 14 publications

(7 citation statements)

References 15 publications

(28 reference statements)

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“…The presence of brain metastases constitutes an important clinical feature to be considered, since kidney cancer tends to metastasize to the brain in about 4-11% of cases. 27,28 In this context, the panelists showed preference for cabozantinib over nivolumab, in accord with the data from the Nivoren trial that demonstrated the poor activity of nivolumab against untreated brain metastases in patients with cell clear RCC. 29 Moreover, real-world data showed that cabozantinib is safe and shows preliminary antitumor activity on brain metastasis of mRCC patients.…”

Section: Discussionmentioning

confidence: 56%

Second-line treatment in renal cell carcinoma: clinical experience and decision making

Guadalupi

Cartenì²,

Iacovelli

et al. 2021

Therapeutic Advances in Urology

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Currently, conventional treatments for metastatic RCC (mRCC) include immune-based combination regimens and/or targeted therapies, the latter mainly acting on angiogenesis, a key element of the process of tumor growth and spread. Although these agents proved able to improve patients’ outcomes, drug resistance and disease progression are still experienced by a substantial number of VEGFR-TKIs-treated mRCC patients. Following the inhibition of the VEGF/VEGFRs axis, two strategies have emerged: either specifically targeting resistance pathways, at the same time continuing to inhibit angiogenesis, or using a completely different approach aimed at re-activating the immune system through the use of inhibitors of specific negative immune checkpoints. These two approaches, practically represented by the use of either cabozantinib or nivolumab, seem to remain a rational therapeutic approach also when first-line immune-based combinations are used. The objective of this study is to design a preferential therapeutic pathway for the second-line treatment of mRCC. The procedure applied in this project was a group discussion, based on the Nominal Group Technique (NGT) method in a meeting session, aimed at defining the therapeutic choice for the second-line treatment of mRCC. The NGT process defined the most relevant parameters that, according to the interviewed panelists, clinicians should consider for the selection of the second-line therapy in the context of advanced renal cell carcinoma of mRCC. The algorithm developed for the treatment selection as a result of this process should thus be considered by clinicians as reference for therapy selection. Plain language summary The result of this paper was the definition of an algorithm intended to suggest a preferential therapeutic pathway considering both the outputs of the Nominal Group Technique (NGT) process and the actual clinical practice and the experience of selected panelists. During the NGT process and the discussion phase, panelists defined the most important parameters to be included in the algorithm that are important for the treatment definition. Cabozantinib and nivolumab are identified as the most reasonable therapeutic options for patients progressing after first-line treatment and are the medication options included in the algorithm for therapy selection.

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Section: Discussionmentioning

confidence: 56%

Second-line treatment in renal cell carcinoma: clinical experience and decision making

Guadalupi

Cartenì²,

Iacovelli

et al. 2021

Therapeutic Advances in Urology

View full text Add to dashboard Cite

show abstract

“…In comparison, brain metastasis occurs in 3.9% to 24% of patients with RCC and is most frequently detected within an average of 1 to 3 years after the nephrectomy. [ 16 , 20 ] Similar to the cases of distant metastasis to other parts other than the brain, the prognosis of brain metastasis from RCC is poor; the median overall survival time after a diagnosis of brain metastasis was 10.7 months, and the 5-year survival rate was 12%. [ 20 ] To the best of my knowledge, a total of 20 cases of extremely delayed brain metastases from RCC have been reported in English so far, [ 2 – 17 ] making it a rare occurrence; all 21 cases including the present case are listed in Table 1 .…”

Section: Discussionmentioning

confidence: 99%

“…In 2 cases, the patients expired: 1 patient underwent total resection for a solitary metastatic lesion and expired due to systemic spread, [ 7 ] and the other underwent subtotal resection for multiple metastatic lesions and expired without systemic spread. [ 16 ] We present a case of systemic metastasis accompanied by lymph node metastasis at the time of brain metastasis diagnosis, although total resection and SRS were performed for a single lesion. In addition, Fukushima et al [ 2 ] reported that even in the case of multiple brain metastases, a good prognosis can be expected through total surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Extremely delayed solitary cerebral metastasis in patient with T1N0M0 renal cell carcinoma after radical nephrectomy

Choo¹,

Seo²,

Choi

2021

Medicine

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Rationale: Although renal cell carcinoma (RCC) is one of the common origins of brain metastasis, few cases of extremely delayed brain metastasis from RCC, more than 10 years after nephrectomy, have been reported. We present a rare case of extremely delayed brain metastasis from RCC, also performed a literature review to increase knowledge of the characteristics for extremely delayed brain metastasis from RCC. Patient concerns: A 72-year-old man presented with right-sided hemiplegia and dysarthria. The patient had a history of radical nephrectomy for RCC with stage T1N0M0 15 years earlier. Diagnosis: Magnetic resonance imaging with contrast revealed a 2-cm sized non-homogenous enhanced mass in the left frontal lobe with peritumoral edema. The pathological examination after surgery reported metastatic clear cell RCC. Interventions: A craniotomy for removal of the mass was performed at the time of diagnosis. Stereotactic radiosurgery was performed for the tumor bed 3 weeks after craniotomy, and then, chemotherapy was started 2 months after the SRS. Outcomes: Metastasis progressed to multiple organs 6 months after the craniotomy. The patient chose a hospice and no longer visited the hospital. Lessons: In cases with a history of nephrectomy for RCC, long period follow-up is necessary for monitoring RCC brain metastasis and pathologic diagnosis should be confirmed.

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“…The host’s immune mechanism has been hypothesized to play an important role in this setting, regulating and influencing tumour growth [ 10 ]. Normally, RCC is slow growing in nature, and such slow growth of initially microscopic metastases might receive an acceleration when the host’s immune competency is compromised [ 3 ]. A case described by Cozar et al [ 4 ], where multiple late pulmonary metastases from a RCC treated 8 years earlier, developed only 2 months after an immunosuppressive treatment following renal transplant might give credit to this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

A record-breaking lung metastasis from renal cell carcinoma 37 years after nephrectomy

Tamburrini

Majorino

Duggan

et al. 2017

Journal of Surgical Case Reports

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Development of distant metastases from renal cell carcinoma (RCC) is a frequent occurrence and, in nearly 95% of the cases, secondary lesions present within 5 years following nephrectomy. We performed a left pneumonectomy for a peri-hilar lung mass in an 81-year-old man with history of kidney cancer, resected 37 years earlier. Histopathological examination revealed a solitary lung metastasis from RCC, relapsed after an extraordinary 37-year time interval. To the best of our knowledge, this remarkable case represents the longest time interval between radical nephrectomy for RCC and the occurrence of a pulmonary metastasis. After an uneventful post-operative recovery, there are no signs of disease recurrence at a 3-year follow-up. The possibility of a lung metastasis should be taken into account in patients with history of RCC who present with pulmonary nodules, even decades after treatment of the primary neoplasm.

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Extremely Delayed Brain Metastasis from Renal Cell Carcinoma

Cited by 14 publications

References 15 publications

Second-line treatment in renal cell carcinoma: clinical experience and decision making

Second-line treatment in renal cell carcinoma: clinical experience and decision making

Extremely delayed solitary cerebral metastasis in patient with T1N0M0 renal cell carcinoma after radical nephrectomy

A record-breaking lung metastasis from renal cell carcinoma 37 years after nephrectomy

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