Factors affecting survival in 37 consecutive patients undergoing de novo stereotactic radiosurgery for contiguous sites of vertebral body metastasis from renal cell carcinoma

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Palliative resection of renal cell carcinoma (RCC) spinal metastasis is indicated in cases of neurological compromise or mechanical instability, whereas conventional external beam radiotherapy (EBRT) is commonly used for pain control. Recently, spinal stereotactic radiosurgery (SRS) has emerged as a safe alternative, delivering higher therapeutic doses of radiation to spinal metastases. To better understand factors affecting survival in patients undergoing spinal SRS for metastatic RCC, the authors performed a retrospective analysis of a consecutive series of cases at a tertiary cancer center.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Patients harboring contiguous sites of vertebral body involvement from metastatic RCC who received upfront spinal SRS treatment at The University of Texas MD Anderson Cancer Center between 2005 and 2012 were identified. Demographic data, pain scores, radiographic data, overall survival, complications, status of systemic disease, neurological and functional status, and time between primary diagnosis and diagnosis of metastasis (systemic and spinal) were analyzed to determine their influence on survival.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Thirty-seven patients receiving treatment for 40 distinct, contiguous sites of disease were included. The median overall survival after spinal SRS was 16.3 months (range 7.4–25.3 months). Univariate analysis revealed several factors significantly associated with improved overall survival. Local progression after spinal SRS was associated with worse overall survival compared with sustained local control (HR 3.4, 95% CI 1.6–7.4, p = 0.002). Median survival in patients with a Karnofsky Performance Scale (KPS) score ≥ 70 was longer than in patients with a KPS score &lt; 70 (HR 4.7, 95% CI 2.1–10.7, p &lt; 0.001). Patients with neurological deficits at the time of spinal SRS had a shorter median survival than those without (HR 4.2, 95% CI 1.4–12.0, p = 0.008). Individuals with nonprogressive systemic disease at the time of spinal SRS had a longer median survival than those with systemic progression at the time of treatment (HR 8.3, 95% CI 3.3–20.7, p &lt; 0.001). Median survival in patients experiencing any metastasis &lt; 12 months after primary RCC diagnosis was shorter than in patients experiencing any metastasis &gt; 12 months after primary diagnosis, a difference that approached but did not attain significance (HR 1.9, 95% CI 0.90–4.1, p = 0.09). On multivariate analysis, local progression of disease after spinal SRS, metastasis &lt; 12 months after primary, KPS score ≤ 70, and progression of systemic disease at time of spinal SRS all remained significant factors influencing survival (respectively, HR 3.7, p = 0.002; HR 2.6, p = 0.026; HR 4.0, p = 0.002; and HR 13.2, p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>We identified several factors associated with survival after spinal SRS for RCC metastases, including local progression, time between first metastasis and primary RCC diagnosis, KPS score, presence of neurological deficits, and progressive metastatic disease. These factors should be taken into consideration when considering a patient for spinal SRS for RCC metastases.</jats:p></jats:sec>

Safety and Efficacy of Stereotactic Ablative Radiation Therapy for Renal Cell Carcinoma Extracranial Metastases

“…However, LF may be detrimental for lesions located in critical locations, such as the spine. A series from MD Anderson using SAbR to treat 40 spinal lesions in 37 RCC patients showed an increased risk of death in patients with LF, even after correction for other competing factors including performance status, neurologic deficits, and systemic disease status (20). Therefore, the risks of LF will have to be carefully balanced with the risks of overdosing the spinal cord.…”

The effect of radiotherapy, and radiotherapy combined with bisphosphonates or RANK ligand inhibitors on bone quality in bone metastases. A systematic review

“…Eighteen clinical studies reported on fracture rate during follow up after radiotherapy [33][34][35]38,41,45,46,49,50,[53][54][55][56][57][58][59]61,62] (Supplementary File D, 7 th column). Overall, fracture rates after primary radiotherapy ranged from 0% to about 15%.…”

The Challenges of Renal Cell Carcinoma Metastatic to the Spine: A Systematic Review of Survival and Treatment

“…In this review, 69.7% and 70.7% of patients presenting with pain or neurologic deficit had improvement following treatment, respectively. Although pain or neurologic deficit did not affect survival in the current analysis, Sellin et al 51 presented a retrospective review of 37 patients with metastatic RCC to the spine, wherein the median survival for patients presenting with neurologic deficit was 7.4 months and those presenting without neurologic deficit was 32 months. All patients were treated with SRS, and 5 went on to receive surgery.…”

“…The literature search identified 1440 unique results, where 47 articles met the inclusion criteria with a total of 807 patients included in the data analysis ( Figure 1 ). 1 , 10 , 11 , 13 , 15 , 18 – 60 Demographics, presenting features, treatment, and survival information were compiled for those patients with known status. The majority of patients were male (75.5%), and the mean age at diagnosis of RCC spine metastasis was 56.7 years.…”