Treatment of brain metastases from hypernephroma

Considering the relative radioresistance of hypernephroma, the optimum treatment schedule for its metastases is a matter of debate. This study evaluated the effects of surgery as well as different irradiation schedules in cases with brain metastases from hypernephroma. Seven patients received surgery plus radiotherapy, 2 patients fractionated stereotactic radiotherapy, and 13 patients whole-brain irradiation in either conventional or accelerated fractionation to a total dose of 30 Gy. Local results, clinical course, and survival were most favorable in the group of patients who were treated with surgery plus radiotherapy. The patients treated by stereotactic radiotherapy had a better outcome than those treated by whole-brain irradiation to a total dose of 30 Gy. Accelerated fractionation was not associated with better local control or clinical improvement. Only 4/13 patients with whole-brain irradiation improved.

In patients with brain metastases from hypernephroma standard palliative whole-brain irradiation led to unsatisfactory results. Stereotactic radiotherapy and surgery seem to be superior, but are not always available and/or indicated. Therefore, the use of higher total doses should be investigated for patients whose local disease extent makes whole-brain irradiation the treatment of choice.