(S013) Spine Stereotactic Radiosurgery With Concurrent Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma

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OncologyOncology Vol 30 No 4_Suppl_1
Volume 30
Issue 4_Suppl_1

In the present investigation, we observed a significant and independent radiographic control benefit with the addition of first-line TKIs to stereotactic radiosurgery.

Jacob A. Miller, BS, Ehsan H. Balagamwala, MD, Lilyana Angelov, MD, John H. Suh, MD, Brian Rini, MD, Jorge Garcia, MD, Manmeet Ahluwalia, MD, Samuel T. Chao, MD; Cleveland Clinic
Foundation

INTRODUCTION: With the introduction of antiangiogenic tyrosine kinase inhibitors (TKIs), systemic control of metastatic renal cell carcinoma (mRCC) has substantially improved. The second most common site of metastasis in mRCC is the spine. As a radioresistant histology, these metastases require higher doses of radiation for palliation and local control. This may be achieved with spine stereotactic radiosurgery (SRS). In laboratory models, strong evidence exists for a synergistic relationship between TKIs and SRS. However, controlled studies have yet to demonstrate a corresponding clinical benefit. We hypothesized that patients undergoing spine SRS with concurrent first-line TKIs experience superior radiographic control compared with those not receiving concurrent TKI therapy.

METHODS: An institutional retrospectively collected database was queried for patients undergoing spine SRS for mRCC. Patients were divided into one of four cohorts: (A) SRS with concurrent first-line TKIs; (B) chemotherapy-naive patients; (C) patients who had failed first-line chemotherapy undergoing SRS with concurrent TKIs; and (D) patients who had failed first-line chemotherapy undergoing SRS without concurrent TKIs. The primary outcome was actuarial radiographic control. Cox proportional hazards modeling was used to control for confounding differences among cohorts.

RESULTS: A total of 151 consecutive treatments (100 patients) for mRCC were identified. At 12 months, actuarial radiographic failure was lowest (8%) among patients treated with concurrent first-line TKIs, compared with 25% to 31% radiographic failure in cohorts B–D. After adjusting for confounding differences among cohorts, patients treated with concurrent firstline TKIs experienced superior radiographic control (hazard ratio, 0.16; P < .01) compared with patients in other cohorts. No grade ≥ 3 toxicities occurred among patients receiving concurrent therapy.

CONCLUSION: In the present investigation, we observed a significant and independent radiographic control benefit with the addition of first-line TKIs to SRS. These results have significant implications in the oligometastatic and curative settings and support laboratory evidence of an interaction between SRS and TKIs.

Proceedings of the 98th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(S002) A 15-Year Review of Radiation Therapy for Keloids at Two Institutions
(S003) Single-Fraction Radiation Therapy for the Treatment of Multiple Myeloma Bony Metastases Provides Pain Control and Decreases Time to Chemotherapy
(S001) Prognostic Value of Pretreatment Serum Inflammatory Markers in Patients Receiving Radiation Therapy for Oropharyngeal Cancer
(S004) Trend in Second Malignancy Risk for Head and Neck Cancer With Increased Utilization of IMRT: Analysis of SEER Database
(S005) Comparison of Legal Needs of a Group of Patients With Cancer: Economic and Geographic Factors
(S006) Mission Improvement: Lessons From Initiating a Resident-Led Quality Improvement Project on Smoking Cessation at a County Hospital
(S007) Results of a Phase II Trial Using Cetuximab Plus Docetaxel With Low-Dose Fractionated Radiation for Recurrent Unresectable Locally Advanced Head and Neck Carcinoma
(S008) The Effect of Simulation and Treatment Delays for Patients With Oropharyngeal Cancer Receiving Definitive Radiation Therapy in the Era of Risk Stratification Using Smoking and Human Papilloma Virus Status
(S009) Intensity-Modulated Radiation Therapy With Stereotactic Body Radiation Therapy Boost for Unfavorable Prostate Cancer: A Report on Three-Year Toxicity
(S011) Comparative Study Between Ileal Conduit and Indiana Pouch After Cystectomy for Patients With Carcinoma of Urinary Bladder
(S010) Computed Tomography–Assessed Measures of Bone Mineral Density and Muscle Mass as Predictors of Survival in Men With Prostate Cancer
(S012) Quantitative Imaging to Evaluate the Malignant Potential of Pancreatic Cysts
(S013) Spine Stereotactic Radiosurgery With Concurrent Tyrosine Kinase Inhibitors for Metastatic Renal Cell Carcinoma
(S014) The Impact of Radiation Therapy on Survival in Surgically Resected, High-Risk Patients With Ampullary Adenocarcinoma: A Population-Based Analysis
(S016) The Impact of Stereotactic Body Radiation Therapy on Overall Survival in Patients With Locally Advanced Pancreatic Cancer
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