Evidence map›Paper›PMID 32902689›Full record

ArticleActa neurochirurgica2021

Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery.

M Stenman, H Benmakhlouf, P Wersäll, P Johnstone, M A Hatiboglu, J Mayer-da-Silva, U Harmenberg, M Lindskog, G Sinclair

Abstract read
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In one paragraph

Article in Acta neurochirurgica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.5field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 3 countries.

M StenmanDepartment of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden.
H BenmakhloufDepartment of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.
P WersällDepartment of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
P JohnstoneDepartment of Oncology, Oxford University Hospitals NHS Trust, Oxford, UK.
M A HatibogluDepartment of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey.
J Mayer-da-SilvaCentro Gamma Knife, CUF Infante Santo Hospital, Lisbon, Portugal.
U Harmenberg *Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
M Lindskog *Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden.
G Sinclair *Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey. georges.sinclair@gmail.com.
Karolinska Institutet · SEKarolinska University Hospital · SEUppsala University · SEBezmiâlem Vakıf Üniversitesi · TROxford University Hospitals NHS Trust · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe effects of single-fraction gamma knife radiosurgery (sf-GKRS) on patients with renal cell carcinoma (RCC) brain metastases (BM) in the era of targeted agents (TA) and immune checkpoint inhibitors (ICI) are insufficiently studied. METHODS AND MATERIALS: Clear cell metastatic RCC patients treated with sf-GKRS due to BM in 2005-2014 at three European centres were retrospectively analysed (n = 43). Median follow-up was 56 months. Ninety-five percent had prior nephrectomy, 53% synchronous metastasis and 86% extracranial disease at first sf-GKRS. Karnofsky performance status (KPS) ranged from 60 to 100%. Outcome measures were overall survival (OS), local control (LC) and adverse radiation effects (ARE).

resultsOne hundred and ninety-four targets were irradiated. The median number of targets at first sf-GKRS was two. The median prescription dose was 22.0 Gy. Thirty-seven percent had repeated sf-GKRS. Eighty-eight percent received TA. LC rates at 12 and 18 months were 97% and 90%. Median OS from the first sf-GKRS was 15.7 months. Low serum albumin (HR for death 5.3), corticosteroid use pre-sf-GKRS (HR for death 5.8) and KPS < 80 (HR for death 9.1) were independently associated with worse OS. No further prognostic information was gleaned from MSKCC risk group, synchronous metastasis, age, number of BM or extracranial metastases. Other prognostic scores for BM radiosurgery, including DS-GPA, renal-GPA, LLV-SIR and CITV-SIR, again, did not add further prognostic value. ARE were seldom symptomatic and were associated with tumour volume, 10-Gy volume and pre-treatment perifocal oedema. ARE were less common among patients treated with TA within 1 month of sf-GKRS.

conclusionsWe identified albumin, corticosteroid use and KPS as independent prognostic factors for sf-GKRS of clear cell RCC BM. Studies focusing on the prognostic significance of albumin in sf-GKRS are rare. Further studies with a larger number of patients are warranted to confirm the above analytical outcome. Also, in keeping with previous studies, our data showed optimal rates of local tumour control and limited toxicity post radiosurgery, rendering GKRS the tool of choice in the management of RCC BM.

Indexed as

Patient SelectionAdultAgedAged, 80 and overBrain NeoplasmsCarcinoma, Renal CellFemaleHumansKarnofsky Performance StatusKidney NeoplasmsMaleMiddle AgedPrognosisRadiosurgeryRetrospective StudiesRisk FactorsGamma knifeGKRSRCCRenal cell carcinomaSRSStereotactic radiosurgery

Identifiers

PMID32902689
OpenAlexW3085135282

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.