Evaluation of quality of life of patients with solitary renal cancer metastases in bones before and after surgical treatment in combination with targeted therapy and without it

Background. Currently, treatment tactics for oligometastatic renal cancer are a debatable topic due to relatively localized process and high risk of skeletal-related events (SRE). Therefore, the effect of treatment on quality of life of these patients is an important subject.

Aim. To evaluate quality of life of patients with solitary renal cancer metastases in the bones before and after surgical treatment in combination with targeted therapy and without it.

Materials and methods. The study included 64 patients with solitary bone metastases and symptoms of SRE. The patients underwent surgical treatment due to solitary bone metastases of renal cancer in combination with targeted therapy (1st group; n = 25) and without targeted therapy (2^nd group; n = 39). The effects of surgical treatment on patients’ condition were evaluated using the EORTC-QLQ-C30 questionnaire.

Results. In the 1^st group, no statistically significant differences were shown for 8 of 30 indicators of the EORTC-QLQ-C30 questionnaire: restrictions in daily activities, dyspnea, appetite loss, nausea, vomiting, fatigue, tension, financial difficulties. The rest of the indicators showed statistically significant shift toward improvement. In the 2^nd group, 7 of 30 indicators did not show statistically significant differences: restrictions in daily activities, dyspnea, sleep disorders, appetite loss, diarrhea, tension, financial difficulties. The rest of the questionnaire points also showed improvement (especially in decreased pain syndrome). In patients of the 2nd group before and after surgery, need for rest, fatigue, appetite loss and restrictions in performing work were more pronounced than in the 1st group. Additionally, after surgery patients of this group required more time in the chair and had more frequent diarrhea, while prior to surgery they complained more of nausea and fatigue. The last 2 parameters evaluating overall quality of life were higher in the 1^st group before and after surgery which shows better baseline condition of these patients which was not affected by the treatment.

Conclusion. Therefore, surgical treatment of renal cancer bone metastases both in combination with targeted therapy and without it significantly improves quality of life according to the results of quality of life evaluation using the EORTC-QLQ-C30 questionnaire in patients of the studied groups.

1. Dudani S., de Velasco G., Wells J.C. et al. Evaluation of clear cell, papillary, and chromophobe renal cell carcinoma metastasis sites and association with survival. JAMA Netw Open 2021;4;4(1):e2021869. DOI: 10.1001/jamanetworkopen.2020.21869

2. Wood S.L., Brown J.E. Skeletal metastasis in renal cell carcinoma: current and future management options. Cancer Treat Rev 2012;38(4):284–91. DOI: 10.1016/j.ctrv.2011.06.011

3. Owari T., Miyake M., Nakai Y. et al. Clinical features and risk factors of skeletal-related events in genitourinary cancer patients with bone metastasis: a retrospective analysis of prostate cancer, renal cell carcinoma, and urothelial carcinoma. Oncology 2018;95(3):170–8. DOI: 10.1159/000489218

4. Milano M.T., Biswas T., Simone C.B.2nd, Lo S.S. Oligometastases: history of a hypothesis. Ann Palliat Med 2021;10(5):5923–30. DOI: 10.21037/apm.2020.03.31

5. Okuno Y., Tanaka R., Mikami K., Takeuchi T. Renal cancer tissue after nivolumab/ipilimumab combination therapy for metastatic renal cell carcinoma. Hinyokika Kiyo 2020;66(1):13–7. DOI: 10.14989/ActaUrolJap_66_1_13

6. Mottet N., Bellmunt J., Bolla M. et al. EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2017;71(4): 618–29. DOI: 10.1016/j.eururo.2016.08.003

7. Semkov A.S., Makhson A.N., Peterson S.B. et al. Surgical treatment for bone metastases of kidney cancer. Onkourologiya = Cancer Urology 2010;6(4):10–5. (In Russ.). DOI: 10.17650/1726-9776-2010-6-4-10-15

8. Mendez L.C., Raman S., Wan B.A. et al. Quality of life in responders after palliative radiation therapy for painful bone metastases using EORTC-QLQ-C30 and EORTC-QLQ-BM22: results of a Brazilian cohort. Ann Palliat Med 2017;6(Suppl. 1):S65–70. DOI: 10.21037/apm.2017.04.06

9. Azawi N.H., Tesfalem H., Dahl C., Lund L. Do the different types of renal surgery impact the quality of life in the postoperative period? Int Urol Nephrol 2015;47(2):263–9. DOI: 10.1007/s11255-014-0893-9

10. De Groot S., Redekop W.K., Versteegh M.M. et al. Health-related quality of life and its determinants in patients with metastatic renal cell carcinoma. Qual Life Res 2018;27(1):115–24. DOI: 10.1007/s11136-017-1704-4

11. Zhao W., Wang H., Hu J.H. et al. Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis. Jpn J Clin Oncol 2018;48(8):753–9. DOI: 10.1093/jjco/hyy090

12. Herrmann E., Gerss J., Bierer S. et al. Pre-treatment global quality of health predicts progression free survival in metastatic kidney cancer patients treated with sorafenib or sunitinib. J Cancer Res Clin Oncol 2009;135(1):61–7. DOI: 10.1007/s00432-008-0438-7