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

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

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Cochran, D. Clay Chan, Michael D. Aklilu, Mebea Lovato, James F. Alphonse, Natalie K. Bourland, J. Daniel Urbanic, James J. McMullen, Kevin P. Shaw, Edward G. Tatter, Stephen B. Ellis, Thomas L.
Description	Country affiliation: United States Author Affiliation: Cochran DC ( Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina, USA.)
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.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
DOI	10.3171/2012.2.JNS111353
Journal	Journal of Neurosurgery
Issue Number	5
Volume Number	116
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2012-05-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Antineoplastic Agents Therapeutic Use Brain Neoplasms Surgery Carcinoma, Renal Cell Pathology Kidney Neoplasms Radiosurgery Antibodies, Monoclonal, Humanized Adverse Effects Administration & Dosage Bevacizumab Drug Delivery Systems Intracranial Hemorrhages Etiology Kaplan-meier Estimate Karnofsky Performance Status Postoperative Complications Epidemiology Predictive Value Of Tests Protein-tyrosine Kinases Antagonists & Inhibitors Radiation Injuries Retrospective Studies Salvage Therapy Survival Analysis Tor Serine-threonine Kinases Treatment Failure
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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