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. 2012 May;116(5):978-83.
doi: 10.3171/2012.2.JNS111353. Epub 2012 Mar 2.

The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery

D Clay Cochran  1 , Michael D Chan, Mebea Aklilu, James F Lovato, Natalie K Alphonse, J Daniel Bourland, James J Urbanic, Kevin P McMullen, Edward G Shaw, Stephen B Tatter, Thomas L Ellis
Affiliations

The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery

D Clay Cochran et al. J Neurosurg. 2012 May.

Abstract

Object: Gamma Knife surgery (GKS) has been reported as an effective modality for treating brain metastases from renal cell carcinoma (RCC). The authors aimed to determine if targeted agents such as tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, and bevacizumab affect the patterns of failure of RCC after GKS.

Methods: Between 1999 and 2010, 61 patients with brain metastases from RCC were treated with GKS. A median dose of 20 Gy (range 13-24 Gy) was prescribed to the margin of each metastasis. Kaplan-Meier analysis was used to determine local control, distant failure, and overall survival rates. Cox proportional hazard regression was performed to determine the association between disease-related factors and survival.

Results: Overall survival at 1, 2, and 3 years was 38%, 17%, and 9%, respectively. Freedom from local failure at 1, 2, and 3 years was 74%, 61%, and 40%, respectively. The distant failure rate at 1, 2, and 3 years was 51%, 79%, and 89%, respectively. Twenty-seven percent of patients died of neurological disease. The median survival for patients receiving targeted agents (n = 24) was 16.6 months compared with 7.2 months (n = 37) for those not receiving targeted therapy (p = 0.04). Freedom from local failure at 1 year was 93% versus 60% for patients receiving and those not receiving targeted agents, respectively (p = 0.01). Multivariate analysis showed that the use of targeted agents (hazard ratio 3.02, p = 0.003) was the only factor that predicted for improved survival. Two patients experienced post-GKS hemorrhage within the treated volume.

Conclusions: Targeted agents appear to improve local control and overall survival in patients treated with GKS for metastastic RCC.

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Figures

Fig. 1
Fig. 1
Kaplan-Meier plot of overall survival.
Fig. 2
Fig. 2
Left: Kaplan-Meier plot of time to local failure. Right: Kaplan-Meier plot of time to distant failure.
Fig. 3
Fig. 3
Left: Kaplan-Meier plot of overall survival comparing cohorts treated with novel agents and those not treated with novel agents. Right: Kaplan-Meier plot of time to local failure comparing cohorts treated with novel agents and those not treated with novel agents.
See this image and copyright information in PMC

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