Progression of intramedullary metastasis during perioperative cessation of sunitinib

Nat Rev Urol. 2010 Nov;7(11):634-7. doi: 10.1038/nrurol.2010.161. Epub 2010 Oct 12.


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.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / administration & dosage*
  • Carcinoma, Renal Cell / drug therapy*
  • Carcinoma, Renal Cell / secondary*
  • Disease Progression
  • Female
  • Humans
  • Indoles / administration & dosage*
  • Kidney Neoplasms / drug therapy*
  • Kidney Neoplasms / pathology*
  • Middle Aged
  • Pyrroles / administration & dosage*
  • Spinal Neoplasms / secondary*
  • Sunitinib


  • Antineoplastic Agents
  • Indoles
  • Pyrroles
  • Sunitinib