Abstract
Background. Renal cell carcinoma is a frequent source of brain metastasis. We present our consecutive series of patients treated with Stereotactic Radiosurgery (SRS) and analyse prognostic factors and the interplay of WBRT and surgical resection. Methods. This is a retrospective study of 66 patients with 207 lesions treated with the Cyberknife radiosurgery system in our institution. The patients were followed up with imaging and clinical examination 1 month and 2-3 months thereafter for the brain metastasis. Patient, treatment, and outcomes characteristics were analysed. Results. 51 male (77.3%) and 15 female (22.7%) patients, with a mean age of 58.9 years (range of 31–85 years) and a median Karnofsky Performance Status (KPS) of 90 (range of 60–100), were included in the study. The overall survival was 13.9 months, 21.9 months, and 5.9 months for the patients treated with SRS only, additional surgery, and WBRT, respectively. The actuarial 1-year Local Control rates were 84%, 94%, and 88% for SRS only, for surgery and SRS, and for WBRT and additional SRS, respectively. Conclusions. Stereotactic radiosurgery is a safe and effective treatment option in patients with brain metastases from RCC. In case of a limited number of brain metastases, surgery and SRS might be appropriate.
Highlights
Renal cell carcinoma is a frequent source of brain metastasis
The patients ranged in age from 31 to 85 years at the time of their initial brain metastasis diagnosis
Patients were classified into subgroups according to the Score Index for Radiosurgery (SIR) and the Basic Score for Brain Metastases (BSBM) to allow a prognostic determination of patients with brain metastasis who underwent Stereotactic Radiosurgery (SRS) and to make this data set comparable to other available literature
Summary
We present our consecutive series of patients treated with Stereotactic Radiosurgery (SRS) and analyse prognostic factors and the interplay of WBRT and surgical resection. Stereotactic radiosurgery is a safe and effective treatment option in patients with brain metastases from RCC. The median survival of patients with untreated brain metastases from primary RCC is reported to be approximately 1 to 2 months [7], whereas the median survival time after radiotherapy and corticosteroid treatment for patients with this type of malignancy was reported to be 2 to 8 months [8]. Since surgical resection is not always possible, WBRT has played an important role in the treatment of patients with RCC brain metastasis but has yielded unsatisfactory results in terms of overall survival and local tumor control in these patients due to the relative radioresistant nature of RCC to conventional radiation therapy [9]. Due to the potential neurotoxic effects of WBRT as well as the radioresistant features of this primary, WBRT may not be the treatment of choice in these patients, with oligometastatic disease [10]
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