Stereotactic radiosurgery for brain metastasis from renal cell carcinoma

The authors evaluated results after stereotactic radiosurgery (SR) for brain metastases from renal cell carcinoma (RCC) and identified factors associated with improved survival and tumor control.

The authors reviewed the management results from a total of 52 RCC brain metastases in 35 consecutive patients who underwent stereotactic radiosurgery (SR) during a 9-year interval. Twenty-eight patients also underwent whole brain radiation therapy (WBRT). The mean tumor volume was 2.4 mL (range, 0.1-14.1 mL). The mean dose delivered to the tumor margin was 17 gray (Gy) (range, 13-20 Gy). Univariate and multivariate testing was performed to determine significant prognostic factors.

The median survival was 11 months after SR and 14 months after brain tumor diagnosis. Only 2 patients (8%) died of progression of the irradiated tumor. Age < 55 years, lack of active systemic disease, and use of chemotherapy and/or immunotherapy after SR were significant favorable prognostic factors in multivariate testing. Post-SR imaging was evaluated in 26 patients (39 tumors). The local control rate from the 39 treated tumors imaged was 90% (tumor disappearance, 21%; tumor regression, 44%; and stable disease, 26%). Local recurrence developed in 3 patients (4 lesions) and remote brain disease in 12 patients. No patient developed a new focal neurologic deficit due to SR. Patients were classified into two groups: SR with and SR without WBRT. The addition of WBRT to SR did not improve survival. Distant failure occurred similarly in both groups (46% vs. 50%). WBRT combined with SR may contribute to local control, but did not prevent the development of new remote tumors.

SR for brain metastasis from RCC results in brain disease control in the majority of patients and was associated with few complications. Early detection of brain metastases and treatment with SR provides extended quality survival.