Osseous metastases from renal cell carcinoma: embolization and surgery for restoration of function. Work in progress.

Rowe, DE; Gj, Becker; Rabe, FE; Holden, RW; Richmond, B D; Wass, Jah; Sequeira, F. W.

doi:10.1148/radiology.150.3.6695066

Cited by 36 publications

(9 citation statements)

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“…Pathologic fracture associated with metastatic renal cell carcinoma usually results in significant compromise of function. If feasible, operative intervention with reduction and fixation of the fracture site offers restoration of the function for a potentially significant period of time [9]. The hypervascular nature of these metastases may result in technical difficulties at surgery and frequently heavy, uncontrollable bleeding [10].…”

Section: Discussionmentioning

confidence: 99%

Preoperative embolization of bone metastases from renal cell carcinoma

et al. 2000

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The purpose of this study was to correlate the effectiveness of preoperative embolization with the blood loss and transfusion requirement during surgery for bone metastases from renal cell carcinoma. Twenty-eight preoperative embolizations in 26 patients with renal cell carcinoma metastatic to bone were retrospectively evaluated and divided into two groups: Group A included the embolizations that resulted in complete devascularization of the lesion as defined by the post-embolization arteriograms, and group B included those with an incomplete result. The two groups were compared with regard to blood loss and transfusion requirement during surgery, by unpaired two-tailed Student's t-test. Where complete embolization was effected (group A, 10 cases), there was a mean blood loss of 535 +/- 390 ml. When a less than complete embolization was achieved (group B, 18 cases), the mean blood loss was 1.247 +/- 1.047 ml (p = 0.049). The red blood cell transfusion in group A was 1.3 +/- 1 units, whereas in group B it was 2.4 +/- 1.2 (p = 0.03). Preoperative embolization of bone metastases from renal cell carcinoma with subsequent complete devascularization leads to significant reduction of blood loss during surgery. Interventional radiologists should pursue and embolize every feeder to the metastasis, because any less than complete devascularization increases the amount of blood loss and the amount of red blood cell transfusion during surgery.

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Section: Discussionmentioning

confidence: 99%

Preoperative embolization of bone metastases from renal cell carcinoma

et al. 2000

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“…52 Standard treatments for RCC metastases to the spine include radiotherapy alone, radiotherapy combined with systemic chemotherapy, or decompressive surgery and/or spinal stabilization followed by radiotherapy. 9,10,25,30,37,38,40,41,52,56,61,62 Most patients with RCC metastatic to the spine may be treated by nonoperative measures. The goals of local radiotherapy in the treatment of these spinal tumors have been palliation of pain, prevention of pathological fractures, and cessation of progression or reversal of neurological compromise; however, RCC is a relatively radioresistant tumor and failure to respond to radiotherapy or progressive growth after irradiation is not uncommon.…”

Section: J Neurosurg: Spine / Volume 3 / October 2005mentioning

confidence: 99%

Stereotactic radiosurgery for spinal metastases from renal cell carcinoma

Gerszten¹,

Burton²,

Ozhasoglu³

et al. 2005

Journal of Neurosurgery: Spine

224

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Object. The role of stereotactic radiosurgery in treating renal cell carcinoma (RCC) metastases to the spine has previously been limited. In this study the authors evaluated the clinical outcome in patients with spinal RCC who underwent single-fraction radiosurgery. Methods. Forty-eight patients with 60 RCC metastases to the spine (six cervical, 26 thoracic, 18 lumbar, and 10 sacral) were treated with a single-fraction radiosurgery technique and were followed for a period of 14 to 48 months (median 37 months). All patients were successfully treated in an outpatient setting. The tumor volume ranged from 5.5 to 203 cm3 (mean 61.9 cm3). Forty-two of the total 60 lesions had been previously treated with external-beam radiation therapy (EBRT). The maximum tumor dose was maintained at 17.5 to 25 Gy (mean 20 Gy). The volume of the spinal cord exposed to greater than 8 Gy ranged from 0.01 to 3 cm3 (mean 0.64 cm3); the volume of the spinal canal at the cauda equina level exposed to greater than 8 Gy ranged from 0.01 to 2.2 cm3 (mean 0.65 cm3). No radiation-induced toxicity occurred during the follow-up period. Axial and radicular pain improved in 34 (89%) of 38 patients who were treated primarily for pain. Tumor control was demonstrated in seven of eight patients treated primarily for radiographically documented tumor progression. In time six patients required open surgical intervention for tumor progression that had caused neurological dysfunction after radiosurgery. Conclusions. Spinal radiosurgery can be a successful therapeutic modality for the delivery of large-dose single-fraction radiation to RCC spinal metastases that are often poorly controlled with conventional EBRT modalities.

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“…The intraoperative loss of blood can be reduced con siderably [3,10]. If embolization is the only therapy, skel etal pain can be diminished, and the local growth of the tumor clearly slowed.…”

Section: Resultsmentioning

confidence: 99%

“…Embolization of the pelvic ves sels can also be applied before the métastasés are re moved in order to reduce the intraoperative loss of blood, to facilitate surgical treatment and eliminate metastatic foci, which cannot be removed [3,4,10].…”

mentioning

confidence: 99%