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

D. Clay Cochran, 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

Research output: Contribution to journalArticle

48 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)978-983
Number of pages6
JournalJournal of Neurosurgery
Volume116
Issue number5
DOIs
StatePublished - May 2012
Externally publishedYes

Fingerprint

Renal Cell Carcinoma
Neoplasm Metastasis
Brain
Survival
Kaplan-Meier Estimate
Sirolimus
Protein-Tyrosine Kinases
Multivariate Analysis
Survival Rate
Hemorrhage

Keywords

  • Brain metastasis
  • Renal cell carcinoma
  • Stereotactic radiosurgery
  • Targeted agent

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

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

In: Journal of Neurosurgery, Vol. 116, No. 5, 05.2012, p. 978-983.

Research output: Contribution to journalArticle

Cochran, DC, Chan, MD, Aklilu, M, Lovato, JF, Alphonse, NK, Bourland, JD, Urbanic, JJ, McMullen, KP, Shaw, EG, Tatter, SB & Ellis, TL 2012, 'The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery: Clinical article', Journal of Neurosurgery, vol. 116, no. 5, pp. 978-983. https://doi.org/10.3171/2012.2.JNS111353
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. / The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery : Clinical article. In: Journal of Neurosurgery. 2012 ; Vol. 116, No. 5. pp. 978-983.
@article{588e4d3af77b4294954a862835256b66,
title = "The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery: Clinical article",
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.",
keywords = "Brain metastasis, Renal cell carcinoma, Stereotactic radiosurgery, Targeted agent",
author = "Cochran, {D. Clay} and Chan, {Michael D.} and Mebea Aklilu and Lovato, {James F.} and Alphonse, {Natalie K.} and Bourland, {J. Daniel} and Urbanic, {James J.} and McMullen, {Kevin P.} and Shaw, {Edward G.} and Tatter, {Stephen B.} and Ellis, {Thomas L.}",
year = "2012",
month = "5",
doi = "10.3171/2012.2.JNS111353",
language = "English (US)",
volume = "116",
pages = "978--983",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "5",

}

TY - JOUR

T1 - The effect of targeted agents on outcomes in patients with brain metastases from renal cell carcinoma treated with Gamma Knife surgery

T2 - Clinical article

AU - Cochran, D. Clay

AU - Chan, Michael D.

AU - Aklilu, Mebea

AU - Lovato, James F.

AU - Alphonse, Natalie K.

AU - Bourland, J. Daniel

AU - Urbanic, James J.

AU - McMullen, Kevin P.

AU - Shaw, Edward G.

AU - Tatter, Stephen B.

AU - Ellis, Thomas L.

PY - 2012/5

Y1 - 2012/5

N2 - 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.

AB - 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.

KW - Brain metastasis

KW - Renal cell carcinoma

KW - Stereotactic radiosurgery

KW - Targeted agent

UR - http://www.scopus.com/inward/record.url?scp=84860740117&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860740117&partnerID=8YFLogxK

U2 - 10.3171/2012.2.JNS111353

DO - 10.3171/2012.2.JNS111353

M3 - Article

C2 - 22385005

AN - SCOPUS:84860740117

VL - 116

SP - 978

EP - 983

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 5

ER -