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Metastatic renal cell carcinoma management
Heldwein, Flavio L.;Escudier, Bernard;Smyth, Gordon;Souto, Carlos A. V.;Vallancien, Guy;
International braz j urol , 2009, DOI: 10.1590/S1677-55382009000300002
Abstract: purpose: to assess the current treatment of metastatic renal cell carcinoma, focusing on medical treatment options. material and methods: the most important recent publications have been selected after a literature search employing pubmed using the search terms: advanced and metastatic renal cell carcinoma, anti-angiogenesis drugs and systemic therapy; also significant meeting abstracts were consulted. results: progress in understanding the molecular basis of renal cell carcinoma, especially related to genetics and angiogenesis, has been achieved mainly through of the study of von hippel-lindau disease. a great variety of active agents have been developed and tested in metastatic renal cell carcinoma (mrcc) patients. new specific molecular therapies in metastatic disease are discussed. sunitinib, sorafenib and bevacizumab increase the progression-free survival when compared to therapy with cytokines. temsirolimus increases overall survival in high-risk patients. growth factors and regulatory enzymes, such as carbonic anhydrase ix may be targets for future therapies. conclusions: a broader knowledge of clear cell carcinoma molecular biology has permitted the beginning of a new era in mrcc therapy. benefits of these novel agents in terms of progression-free and overall survival have been observed in patients with mrcc, and, in many cases, have become the standard of care. sunitinib is now considered the new reference first-line treatment for mrcc. despite all the progress in recent years, complete responses are still very rare. currently, many important issues regarding the use of these agents in the management of metastatic renal cancer still need to be properly addressed.
CyberKnife Stereotactic Radiosurgery for Recurrent, Metastatic, and Residual Hemangiopericytomas
Anand Veeravagu, Bowen Jiang, Chirag G Patil, Marco Lee, Scott G Soltys, Iris C Gibbs, Steven D Chang
Journal of Hematology & Oncology , 2011, DOI: 10.1186/1756-8722-4-26
Abstract: In a review of the Stanford radiosurgery database between 2002 and 2009, the authors found 14 patients who underwent CK therapy for recurrent, metastatic, and residual hemangiopericytomas. A total of 24 tumors were treated and the median patient age was 52 years (range 29-70 years) at the time of initial CK therapy. The median follow-up period was 37 months (10-73 months) and all patients had been previously treated with surgical resection. Mean tumor volume was 9.16 cm3 and the mean marginal and maximum radiosurgical doses to the tumors were 21.2 Gy and 26.8 Gy, respectively.Of the 24 tumors treated, 22 have clinical follow-up data at this time. Of those 22 tumors, 12 decreased in size (54.5%), 6 remained unchanged (27.3%), and 4 showed recurrence (18.2%) after CK therapy. Progression-free survival rate was 95%, 71.5%, and 71.5% at 1, 3, and 5 years after multiple CK treatments. The 5-year survival rate after CK was 81%.CK is an effective and safe management option for hemangiopericytomas. The current series demonstrates a tumor control of 81.8%. Other institutions have demonstrated similar outcomes with stereotactic radiosurgery, with tumor control ranging from 46.4% to 100%.Hemangiopericytomas (HPCs) are rare vascular tumors arising from Zimmerman pericytes associated with capillary walls. Central nervous systems HPCs are rare and account for 0.4% of primary CNS tumors and 2.4% of meningiomas[1,2]. Both clinically and radiographically, hemangiopericytomas resemble meningiomas but are known for their aggressiveness, high recurrence rates, and propensity for extracranial metastasis. Patients with HPCs present with a wide spectrum of symptoms, dependent upon location and histologic grade of the tumor.Treatment of CNS HPCs is aggressive and consists of gross total resection combined with adjuvant radiotherapy[3]. Given the proposed cellular origin, dural sinus invasion, anatomic inaccessibility, and high vascularity of HPCs, gross total resection is often not suffici
CyberKnife? enhanced conventionally fractionated chemoradiation for high grade glioma in close proximity to critical structures
Eric Oermann, Brian T Collins, Kelly T Erickson, Xia Yu, Sue Lei, Simeng Suy, Heather N Hanscom, Joy Kim, Hyeon U Park, Andrew Eldabh, Christopher Kalhorn, Kevin McGrail, Deepa Subramaniam, Walter C Jean, Sean P Collins
Journal of Hematology & Oncology , 2010, DOI: 10.1186/1756-8722-3-22
Abstract: Between January 2002 and January 2009, 24 patients with good performance status and high-grade gliomas in close proximity to critical structures (i.e. eyes, optic nerves, optic chiasm and brainstem) were treated with the CyberKnife. All patients received conventional radiation therapy following tumor resection, with a median dose of 50 Gy (range: 40 - 50.4 Gy). Subsequently, an additional dose of 10 Gy was delivered in 5 successive 2 Gy daily fractions utilizing the CyberKnife? image-guided radiosurgical system. The majority of patients (88%) received concurrent and/or adjuvant Temozolmide.During CyberKnife treatments, the mean number of radiation beams utilized was 173 and the mean number of verification images was 58. Among the 24 patients, the mean clinical treatment volume was 174 cc, the mean prescription isodose line was 73% and the mean percent target coverage was 94%. At a median follow-up of 23 months for the glioblastoma multiforme cohort, the median survival was 18 months and the two-year survival rate was 37%. At a median follow-up of 63 months for the anaplastic glioma cohort, the median survival has not been reached and the 4-year survival rate was 71%. There have been no severe late complications referable to this radiation regimen in these patients.We utilized fractionated CyberKnife radiotherapy as an adjunct to conventional radiation to improve the targeting accuracy of high-grade glioma radiation treatment. This technique was safe, effective and allowed for optimal dose-delivery in our patients. The value of image-guided radiation therapy for the treatment of high-grade gliomas deserves further study.High-grade gliomas are generally aggressive tumors with poor prognosis [1]. They tend to recur locally [2] and rarely spread beyond the confines of the central nervous system. Therefore, local control is considered the primary determinant of overall survival. Treatment routinely consists of maximum safe surgery followed by postoperative conventionally
Metastatic Renal Cell Carcinoma Initially Presented as a Tongue Mass
Deniz ALTINEL,Demet ET?T,Ay?a TAN,ümit BAYOL
Türk Patoloji Dergisi , 2010,
Abstract: Renal cell carcinoma is one of the most common tumours after lung and breast cancer to metastasize to the head and neck. Initial presentation by tongue metastasis is extremely rare. A 67-year-oldmale presented with a 4.8 cm mass on his tongue. The result of the punch biopsy from the tongue was diagnosed as a clear cell variant of squamous cell carcinoma. The biopsy was reevaluated due to the renal mass found during the check-up and the rapid enlargement of the mass. The excision of the tongue mass and the radical nephrectomy material confirmed the diagnosis of a metastatic renal cell carcinoma in the tongue and renal cell carcinoma in the kidney. Since metastasis of renal cell carcinoma to the tongue is uncommon it may cause difficulties in diagnosis and proper management. The metastasis of renal cell carcinoma should always be considered in the differential diagnosis among the clear cell neoplasms.
Evaluation of Magnetic Resonance Imaging Findings and Short-Term Outcome in Brain Metastatic Tumors after CyberKnife Treatment  [PDF]
Jiashou Hu, Hongzi Tian, Na Guo, Di Wang, Jinfeng Sun
International Journal of Medical Physics,Clinical Engineering and Radiation Oncology (IJMPCERO) , 2016, DOI: 10.4236/ijmpcero.2016.51010
Abstract: Objective: To evaluate the treatments’ outcomes in brain metastatic tumors after CyberKnife treatment according to magnetic resonance imaging (MRI) findings and improvement of symptoms. Methods: A retrospective analysis of CyberKnife treatment; 63 cases of patients with brain metastases; the use of CyberKnife treatment; short-term outcome evaluation after treatment and the MRI findings and measured before treatment and underwent diffusion-weighted imaging MRI scan of apparent diffusion coefficient (ADC) values. Results: 3 months after CyberKnife treatment and effectiveness were 82.5% and 96.8% respectively; 6 months and one year survival rates were 82.5% and 55.6% respectively; the median survival time was 16 months. MRI of 52 patients (67 lesions) ADC values after treatment increased to some extent than before treatment. There are 38 lesions volume to shrink or disappear, no enhancement or slight enhancement in the lesion, no edema zone; 27 lesions does not change in volume, no edema (18 lesions significantly weakened the degree of enhancement; 6 lesions showed no obvious change enhancement; 3 lesions showed ring enhancement, internal cystic); 2 lesions volume were larger, heterogeneous enhancement, peripheral edema. Conclusion: CyberKnife is an effective method for treating brain metastatic tumor. MRI can accurately evaluate tumor lesions after treatment.
Metastatic Renal Cell Carcinoma to the Parotid Gland in the Setting of Chronic Lymphocytic Leukemia
Robert Deeb,Ziying Zhang,Tamer Ghanem
Case Reports in Medicine , 2012, DOI: 10.1155/2012/265708
Abstract: Renal cell carcinoma (RCC) is infamous for its unpredictable behavior and metastatic potential. We report a case of a patient with a complex history of multifocal renal cell carcinoma and chronic lymphocytic leukemia (CLL), who subsequently developed a parotid mass. Total parotidectomy revealed this mass to be an additional site of metastasis which had developed 19 years after his initial diagnosis of RCC.
Clinically Undiagnosed Prostate Carcinoma Metastatic to Renal Oncocytoma  [PDF]
Adam J. Horn,Bari E. Fritz,Chad A. LaGrange,William W. West,Subodh M. Lele
Case Reports in Urology , 2012, DOI: 10.1155/2012/307813
Abstract: Tumors-to-tumor metastasis is an uncommon occurrence and can be a source of great diagnostic difficulty, especially when the donor tumor is undiagnosed. Here we report a case of a kidney resected for a primary neoplasm (oncocytoma) that harbored metastases from a clinically undiagnosed prostatic adenocarcinoma. The presence of the poorly differentiated metastasis within an otherwise typical oncocytoma in the absence of metastases in the surrounding nonneoplastic renal parenchyma resulted in a diagnostic dilemma. To our knowledge, this is the first report of a case in the English literature of a clinically undiagnosed prostatic adenocarcinoma metastatic to a renal oncocytoma identified on examination of the resected renal neoplasm. 1. Introduction While tumor metastasis is a common occurrence, the tumor-to-tumor metastasis is quite rare, being first documented in 1902. The most common donor site is lung, followed by breast, prostate, and thyroid carcinomas [1]. The kidney (in particular, renal cell carcinoma) is the most common recipient, followed by sarcomas, meningiomas, thyroid, and pituitary adenomas [1, 2]. In addition to renal cell carcinoma, angiomyolipomas and renal oncocytomas have been described as being recipients [3, 4]. In this paper we present a case of renal oncocytoma harboring metastases from a previously undiagnosed prostatic adenocarcinoma. To the best of our knowledge, there has been no documented cases of prostatic adenocarcinoma with metastasis to a renal oncocytoma. 2. Case Report A 92-year-old man presented with complaints of low back pain. He had magnetic resonance imaging of the spine performed which incidentally revealed a mass in the left kidney. A CT scan confirmed this finding, demonstrating a 6?cm solid enhancing mass in the left kidney, in addition to multiple bilateral lung nodules and lesions in the spine worrisome for metastatic disease. He was presumed to have metastatic renal cell carcinoma and underwent a radical nephrectomy. Dissection of the radical nephrectomy specimen revealed a solitary tumor measuring ?cm, which was well circumscribed, tan-brown, and confined to the kidney. Microscopic examination of the renal tumor revealed areas typical of an oncocytoma with an archipelaginous architectural pattern near the center of the tumor (Figure 1). In addition to the oncocytic cells, a second population of cells arranged in small groups containing high nuclear/cytoplasmic ratios, nuclear hyperchromasia, occasional prominent nucleoli, and rare mitoses were noted (Figure 2). The nests were restricted to the oncocytic
Radiological changes in renal cell carcinoma after extracorporeal CyberKnife radiosurgical ablation: a case report
Fernando Korkes,Oseas de Castro-Neves Neto,Irving D. Kaplan,Darren D. Brennan
Einstein (S?o Paulo) , 2009,
Abstract: Small asymptomatic renal masses are more commonly discovered in elderly patients; however, multiple comorbidities in this population may preclude definitive surgical treatment. In this context, treatment options include active surveillance and ablative techniques. Stereotactic radiosurgery is a relatively innovative method of delivering ablative energy to abdominal organs, with very few human or animal experiences published. We describe our experience treating a patient with a large centrally located renal mass using CyberKnife stereotactic radiosurgery.
Metastatic sarcomatoid renal cell carcinoma to the mandible treated with Sorafenib  [PDF]
Kazuhiro Murakami, Kazuhiko Yamamoto, Kumiko Aoki, Ikuyo Fukumoto, Tsutomu Sugiura, Tadaaki Kirita
Open Journal of Stomatology (OJST) , 2012, DOI: 10.4236/ojst.2012.23039
Abstract: A case of metastatic sarcomatoid renal cell carcinoma to the mandible treated with Sorafenib is reported. A 76-year-old man consulted us for hyposthesia of the right lower lip. Panorama X-ray film showed a ra-diolucent lesion in the right mandibular body. A diagnosis of metastatic tumor to the mandible from the left kidney was made after evaluation by computed tomography and positron emission tomography, which also revealed multiple bone metastases. After radiotherapy for mandibular and thoracic lesions, nephrectomy was performed. Histological diagnosis was sarcomatoid renal cell carcinoma. Interferon therapy was performed but was not effective; therefore, a molecular targeted drug, Sorafenib, was administered. Sorafenib effectively inhibited the growth of oral and other metastatic lesions for 10 months. Quality of life was relatively well maintained with tolerable adverse effects. The patient survived for as long as 2 years after appearance of the first symptom.
Vascularity of primary and metastatic renal cell carcinoma specimens  [cached]
Aziz Saadia A,Sznol Joshua,Adeniran Adebowale,Colberg John W
Journal of Translational Medicine , 2013, DOI: 10.1186/1479-5876-11-15
Abstract: Purpose Anti-angiogenic therapies are among the most commonly used drugs in renal cell carcinoma. Tumor vascularity, defined by microvessel area, may be associated with response to these drugs. Clinical studies suggest that metastatic sites are more responsive than primary tumors. Our purpose was to characterize microvessel area (MVA) in matched primary and metastatic samples and in samples of different histologies. Methods We employed a method of automated, quantitative analysis of in situ tumor components to identify the area of CD-34 staining endothelial cells within renal cell carcinoma tumors. MVA was assessed in corresponding primary and metastatic samples from 34 patients, as well as in 334 primary nephrectomy specimens with variable histologies. Results MVA measurements from different parts of the same tumor correlated well (R = 0.75), indicating that MVA was fairly uniform within a tumor. While MVA was slightly higher in primary tumors than corresponding metastatic sites, the difference was not statistically significant (P = 0.1). MVA in paired primary and metastatic samples correlated moderately well (R = 0.36). MVA was higher in clear cell than papillary histology and oncocytomas (P < 0.0001 and P = 0.018, respectively). Conclusions Lack of significant differences MVA in matched primary and metastatic samples suggests that both types of tumors should respond to anti-angiogenic drugs. This should be confirmed on additional cohorts. Given the small cohort, future predictive biomarker studies entailing MVA measurements should include specimens from both sites. Clear cell carcinomas are more vascular than other histologic subtypes, which may explain the higher response rates to anti-angiogenic therapies in clear cell tumors.
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