MP69-20 INTENSIVE LOCAL THERAPY TO BONE LESIONS MAY IMPROVE SURVIVAL IN RENAL CELL CARCINOMA PATIENTS WITH BONE METASTASIS

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced II1 Apr 2015MP69-20 INTENSIVE LOCAL THERAPY TO BONE LESIONS MAY IMPROVE SURVIVAL IN RENAL CELL CARCINOMA PATIENTS WITH BONE METASTASIS Hiroshi Fukushima, Fumitaka Koga, Yasukazu Nakanishi, and Kenichi Tobisu Hiroshi FukushimaHiroshi Fukushima More articles by this author , Fumitaka KogaFumitaka Koga More articles by this author , Yasukazu NakanishiYasukazu Nakanishi More articles by this author , and Kenichi TobisuKenichi Tobisu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2524AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bone metastasis (BM) is a poor prognosticator in metastatic renal cell carcinoma (RCC) patients. In addition, BM is associated with severe symptoms including pain, fracture and paralysis, dramatically impairing the patients' quality of life and performance status. We investigated whether intensity of local therapy (LTx) to BM is associated with overall survival (OS) of RCC patients with BM. METHODS This retrospective study consisted of 70 RCC patients with BM treated at our institution from 2004 to 2014. Variables included age, sex, MSKCC risk category, metastasis other than BM, prior nephrectomy, any cytokine therapy, any targeted agents, curative intent to lesions other than BM, chronicity of BM, the number of BM, sites of BM, alkaline phosphatase, use of bisphosphonates or denosumab and intensity of LTx to BM. We defined surgical resection with wide margin or radiotherapy with biological effective dose (BED) ≥140 Gy (α/β = 5) to BM as intensive LTx; including metastasectomy (n = 15), intraoperative radiotherapy (IOR) (n = 15) and IOR with external beam radiotherapy (n = 4). Curretage of BM or radiotherapy with BED <140 Gy was regarded as less intensive. Patients were classified into 3 groups according to the intensity of LTx to BM and curative intent to lesions other than BM: intensive LTx to BM with curative intent to the other lesions (level 1; n = 19), intensive LTx without curative intent to the other lesions (level 2; n = 15) and less intensive or no LTx (level 3; n = 36). We explored the association of the intensity of LTx to BM with OS using Cox proportional hazards model. RESULTS Of the 70 patients, 27 (39%) had multiple BM. Sites of BM included the vertebra (n = 38; 54%), pelvis (n = 18; 25%), long bones (n = 21; 30%) and other sites (n = 23; 33%). MSKCC risk category was not different among the level 1, 2 and 3 groups. During the median followup of 13 months, 37 patients (53%) died. The median OS was 22 months. OS rates at 1 year were 84%, 70% and 51% in the level 1, 2 and 3 groups, respectively (p = 0.027). On multivariate analysis, intensive LTx to BM was an independent predictor of OS (HR 0.45, p = 0.027), along with MSKCC risk category (HR 3.37, p < 0.001) and curative intent to lesions other than BM (HR 0.42, p = 0.013). CONCLUSIONS Intensive local therapy to bone lesions may improve OS in RCC patients with bone metastasis. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e874 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroshi Fukushima More articles by this author Fumitaka Koga More articles by this author Yasukazu Nakanishi More articles by this author Kenichi Tobisu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...