Palliative radiotherapy for brain metastases in renal carcinoma

Between 1968 and 1985, 46 patients with renal cell carcinoma metastatic to the brain parenchyma were treated with radiation. Thirty-nine received whole-brain radiation, mostly 30 Gy in ten fractions. Symptoms improved in 30% of evaluable patients. Partial regression of metastases was documented in two of 11 available sequential computed tomographs (CT) of the brain. Seven patients were treated with surgery and postoperative radiation. In five the excision was complete and associated with clinical improvement. All 46 patients have subsequently died. The median survival time of the entire group was 8 weeks. The ten patients who improved after radiotherapy survived for a median of 17 weeks. Two additional patients were treated in 1986 with fast neutrons; both had a documented maintained complete response. Brain metastasis in renal carcinoma carries a poor prognosis. It is usually unresponsive to conventional photon therapy. In selected cases an alternative treatment with surgery or neutron therapy should be considered.