Multidisciplinary treatment of brain metastases derived from clear cell renal cancer incorporating stereotactic radiosurgery

Authors

  • Wolfram E. Samlowski MD,

    Corresponding author
    1. Section of Melanoma, Renal Cancer and Immunotherapy of the Nevada Cancer Institute, Las Vegas, Nevada
    • Section of Melanoma, Renal Cancer and Immunotherapy, Nevada Cancer Institute, One Breakthrough Way, 10441 W. Twain Avenue, Las Vegas, NV 89135===

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    • Fax: (702) 944-2347.

  • Martin Majer MD,

    1. Huntsman Cancer Institute, Salt Lake City, Utah
    2. Division of Oncology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
    Current affiliation:
    1. Corvalis Oncology Clinic, Corvalis, Oregon
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  • Kenneth M. Boucher PhD,

    1. Huntsman Cancer Institute, Salt Lake City, Utah
    2. Department of Oncological Sciences, University of Utah, Salt Lake City, Utah
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  • Annabelle F. Shrieve MA,

    1. Huntsman Cancer Institute, Salt Lake City, Utah
    2. Department of Radiation Therapy, University of Utah, Salt Lake City, Utah
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  • Christopher Dechet MD,

    1. Huntsman Cancer Institute, Salt Lake City, Utah
    2. Department of Urology, University of Utah, Salt Lake City, Utah
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  • Randy L. Jensen MD, PhD,

    1. Huntsman Cancer Institute, Salt Lake City, Utah
    2. Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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  • Dennis C. Shrieve MD, PhD

    1. Huntsman Cancer Institute, Salt Lake City, Utah
    2. Department of Radiation Therapy, University of Utah, Salt Lake City, Utah
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Abstract

BACKGROUND

Brain metastases are a frequent complication in patients with metastatic clear cell renal cancer. Survival after whole-brain radiotherapy (WBRT) is disappointing. A retrospective analysis of multimodality treatment was performed in patients who had received linear accelerator (LINAC)-based stereotactic radiosurgery (SRS).

METHODS

Thirty-two patients underwent SRS-based treatment for 71 metastatic foci between 2000 and 2006. All patients had a Karnofsky performance status ≥70 and all 32 patients had extracranial metastatic disease (Radiation Therapy Oncology Group recursive partitioning analysis [RPA] Class 2). Survival was calculated from the time of diagnosis of brain metastases. The minimum potential follow-up was 1 year after SRS. Univariate and multivariate analysis of potential prognostic factors affecting survival was performed.

RESULTS

Twenty-six patients required only 1 SRS treatment (84%) to achieve central nervous system (CNS) control, whereas 5 patients received 2 to 3 treatments (16%). The median survival of renal cancer patients from the diagnosis of brain metastases was 10.1 months (95% confidence interval, 6.4-14.8 months). One-year and 3-year survival rates were 43% and 16%, respectively. The addition of surgery or WBRT did not appear to prolong survival. Immunotherapy after control of brain metastases with SRS appeared to result in significantly improved survival. Survival was also found to be strongly influenced by prognostic stratification of metastatic disease using Motzer or modified risk criteria.

CONCLUSIONS

The results of the current study demonstrated that SRS-based treatment of patients with up to 5 brain metastases from clear cell renal cancer is feasible and results in excellent CNS control. Survival beyond 3 years from the time of diagnosis of brain metastases was achievable in 16% of patients and was associated with the use of systemic immunotherapy with interleukin-2 and interferon but not antiangiogenic agents. Cancer 2008. © 2008 American Cancer Society.

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