Abstract
Melanoma and renal cell carcinoma have a well-documented tendency to develop metastases to the brain. Treating these lesions has traditionally been problematic, because chemotherapy has difficulty crossing the blood brain barrier and whole brain radiation therapy (WBRT) is a relatively ineffective treatment against these radioresistant tumor histologies. In recent years, stereotactic radiosurgery (SRS) has emerged as an effective and minimally-invasive treatment modality for irradiating either single or multiple intracranial structures in one clinical treatment setting. For this reason, we conducted a review of modern literature analyzing the efficacy of SRS in the management of patients with melanoma and renal cell carcinoma brain metastases. In our analysis we found SRS to be a safe, effective and attractive treatment modality for managing radioresistant brain metastases and highlighted the need for randomized trials comparing WBRT alone vs. SRS alone vs. WBRT plus SRS in treating patients with radioresistant brain metastases.
Highlights
The United States faces roughly 170,000 new cases of brain metastases each year, and this number is expected to increase as diagnostic technologies, such as magnetic resonance imaging (MRI), improve and as cancer patients acquire longer survival times [1,2,3]
In a sizable autopsy series, the occurrence of brain metastases resulting from renal cell carcinoma was reported to be 11% [11,12]
We present a concise review of literature analyzing the efficacy of stereotactic radiosurgery (SRS) in the management of patients with melanoma and renal cell carcinoma brain metastases
Summary
The United States faces roughly 170,000 new cases of brain metastases each year, and this number is expected to increase as diagnostic technologies, such as magnetic resonance imaging (MRI), improve and as cancer patients acquire longer survival times [1,2,3]. A study by Jensen et al [23] found SRS to be a well-tolerated and well suited treatment modality for patients with radioresistant brain metastases, reporting median survival rates of 7.4 months for patients with intracranial metastatic melanoma and 6.1 months for patients with intracranial metastatic renal cell carcinoma. A study by Mori et al [7] found that SRS is an effective and safe treatment modality for patients with intracranial metastatic melanoma, and reported a median survival of seven months following SRS. A study by Samlowski et al [5] found SRS-based treatment for patients with intracranial metastatic renal cell carcinoma to result in excellent central nervous system (CNS) control, reporting a median survival of 10.1 months after diagnosis of brain metastases. These studies are needed to help decisively determine the general standard of treatment for patients with radioresistant brain metastases
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