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Progression of intramedullary metastasis during perioperative cessation of sunitinib

Nature Reviews Urology volume 7, pages 634–637 (2010)Cite this article

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Abstract

Background. A 57-year-old woman presented with metastatic renal cell carcinoma (RCC). She was enrolled in a clinical study, in which she received two cycles of neoadjuvant sunitinib therapy followed by cytoreductive nephrectomy. Her primary tumor and rib metastasis showed a good response to neoadjuvant therapy; however, after surgery, the patient developed neurologic symptoms, including flaccid paraparesis with paresthesia and hypoesthesia. MRI of the brain and spine revealed a leptomeningeal lesion at the T12–L1 space, which was presumed to have progressed during the 3-week treatment-free perioperative period. The patient underwent radiation therapy for the intramedullary lesion 1 month later, and sunitinib therapy was subsequently reinstated. After 6 months, her extracranial lesions remained stable and the intramedullary lesion was undetectable on MRI.

Investigations. CT of the chest and abdomen, bone scan, kidney and liver function tests, measurement of serum levels of calcium, electrolytes and lactate dehydrogenase, CBC, MRI of the brain and spine.

Diagnosis. Progression of a central nervous system metastasis linked to the interruption of neoadjuvant sunitinib therapy.

Management. Neoadjuvant sunitinib therapy followed by cytoreductive nephrectomy for the primary RCC; radiation therapy for the intramedullary lesion, followed by reinstatement of sunitinib therapy owing to a good clinical response observed in the extracranial lesions.

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Figure 1: Abdominal and chest CT performed at presentation.
Figure 2: Abdominal and chest CT performed after two cycles of neoadjuvant sunitinib therapy.
Figure 3: MRI of the spine performed 5 days after surgery (25 days after completion of the first two cycles of sunitinib).

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Acknowledgements

Written consent for publication was obtained from the patient.

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Authors and Affiliations

  1. Department of Oncology, Azienda Ospedaliera Treviglio–Caravaggio, Piazzale Ospedale 1, Bergamo, 12-24047, Treviglio, Italy

    Fausto Petrelli, Mary Cabiddu, Mara Ghilardi & Sandro Barni

  2. Department of Medicine, Neurology Unit, Azienda Ospedaliera Treviglio–Caravaggio, Piazzale Ospedale 1, Bergamo, 12-24047, Treviglio, Italy

    Marinella Carpo

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  1. Fausto Petrelli
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Contributions

F. Petrelli, M. Cabiddu and M. Ghilardi researched data for the article. F. Petrelli, M. Carpo and S. Barni made substantial contributions to discussion of content. F. Petrelli wrote the article. F. Petrelli and S. Barni performed review/editing of the manuscript before submission.

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Correspondence to Fausto Petrelli.

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Petrelli, F., Cabiddu, M., Carpo, M. et al. Progression of intramedullary metastasis during perioperative cessation of sunitinib. Nat Rev Urol 7, 634–637 (2010). https://doi.org/10.1038/nrurol.2010.161

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