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Intraoperative EBRT and resection for renal cell carcinoma

Twenty-year outcomes

Intraoperative EBRT und Resektion bei Nierenzellkarzinom

Ergebnisse nach 20 Jahren

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Abstract

Purpose

We report the outcomes of a multimodality treatment approach combining maximal surgical resection and intraoperative electron radiotherapy (IOERT) with or without external beam radiation therapy (EBRT) in patients with locoregionally (LR) recurrent renal cell carcinoma (RCC) after radical nephrectomy or LR advanced primary RCC.

Patients and methods

From 1983 to 2008, 25 patients with LR recurrent (n = 10) or LR advanced primary (n = 15) RCC were treated with this approach. Median patient age was 60 years (range, 16–79 years). Fifteen patients (60%) received perioperative EBRT (median dose, 44 Gy). Surgical resection was R0 (negative margins) in 6 patients (24%) and R1 (residual microscopic disease) in 19 patients (76%). The median dose of IOERT was 14 Gy (range, 9–15). Overall survival (OS) and relapse patterns were calculated using the Kaplan–Meier method.

Results

Median follow-up for surviving patients was 22.2 years (range, 3.6–26 years). OS and DFS at 5 and 10 years were 38% and 18% and 19% and 14%, respectively. LR control (tumor bed or regional lymph nodes) and distant metastases-free survival rates at 5 years were 80% and 22%, respectively. The death rate within 30 days of surgery and IOERT was 4% (n = 1). Six patients (24%) experienced acute or late toxicities of grade 3 or higher according to the National Cancer Institute Common Toxicity Criteria (NCI-CTCAE) v4.

Conclusion

In patients with LR recurrent or LR advanced primary RCC, a multimodality approach consisting of maximal surgical resection and IOERT with or without adjuvant EBRT yielded encouraging local control results, justifying further evaluation.

Zusammenfassung

Ziel

Vorgestellt werden Ergebnisse eines multimodalen Therapieansatzes, bei dem maximale chirurgische Resektion und intraoperative Elektronenstrahlentherapie (IOERT) ± externe Strahlentherapie (EBRT) bei Patienten mit lokoregional rezidivierendem Nierenzellkarzinom (RCC) nach radikaler Nephrektomie oder lokoregional fortgeschrittenem primärem RCC kombiniert wurden.

Material und Methoden

Von 1983 bis 2008 wurden 25 Patienten mit lokoregional rezidivierendem (n=10) oder lokoregional fortgeschrittenem primärem (n=15) RCC mit diesem Ansatz behandelt. Das durchschnittliche Patientenalter betrug 60 Jahre (Spanne: 16–79). Eine perioperative EBRT (mittlere Dosis: 44 Gy) erfolgte bei 15 Patienten (60%). Die chirurgische Resektion gelang bei 6 Patienten (24%) als R0-Resektion (mit negativen Rändern) und bei 19 (76%) als R1-Resektion (mikroskopische Residualerkrankung). Die mittlere IOERT-Dosis betrug 14 Gy (Spanne: 9–15). Gesamtüberleben (OS) und Rezidivmuster wurden mit der Kaplan-Meier-Methode ermittelt.

Ergebnisse

Im Durchschnitt erfolgte das Follow-up 22,2 Jahre lang (Spanne: 3,6–26 Jahre). OS und krankheitsfreies Überleben (DFS) betrugen nach 5 Jahren 38% bzw. 18% und nach 10 Jahren 19% bzw. 14%. Nach 5 Jahren lag eine lokoregionale Kontrolle (Tumorbett oder regionale Lymphknoten) in 80% und fernmetastasenfreies Überleben in 22% der Fälle vor. In 4% der Fälle (n=1) trat der Tod innerhalb von 30 Tagen nach Operation und IOERT ein. Bei 6 Patienten (24%) traten akute oder Spättoxizitäten ≥  Grad 3 nach den National Cancer Institute Common Toxicity Criteria (NCI-CTCAE), Version 4, auf.

Schlussfolgerungen

Bei Patienten mit lokoregional rezidivierendem oder lokoregional fortgeschrittenem primärem RCC führte der multimodale Ansatz aus maximaler chirurgischer Resektion und IOERT ± adjuvante EBRT zu vielversprechenden Ergebnissen bei der lokalen Kontrolle, was seine weitere Evaluation rechtfertigt.

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Acknowledgments

Supported in part by a grant from the Health Institute of Research Carlos III, Spanish Ministry of Science and Innovation (project code PI11–02908).

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Correspondence to F.A. Calvo MD, PhD.

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Calvo, F., Sole, C., Martinez-Monge, R. et al. Intraoperative EBRT and resection for renal cell carcinoma. Strahlenther Onkol 189, 129–136 (2013). https://doi.org/10.1007/s00066-012-0272-3

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  • DOI: https://doi.org/10.1007/s00066-012-0272-3

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