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Multidisciplinary treatment of brain metastases derived from clear cell renal cancer incorporating stereotactic radiosurgery
Version of Record online: 8 SEP 2008
Copyright © 2008 American Cancer Society
Volume 113, Issue 9, pages 2539–2548, 1 November 2008
How to Cite
Samlowski, W. E., Majer, M., Boucher, K. M., Shrieve, A. F., Dechet, C., Jensen, R. L. and Shrieve, D. C. (2008), Multidisciplinary treatment of brain metastases derived from clear cell renal cancer incorporating stereotactic radiosurgery. Cancer, 113: 2539–2548. doi: 10.1002/cncr.23857
- Issue online: 17 OCT 2008
- Version of Record online: 8 SEP 2008
- Manuscript Accepted: 12 JUN 2008
- Manuscript Revised: 25 MAY 2008
- Manuscript Received: 10 DEC 2007
- renal cancer;
- renal cell carcinoma;
- brain metastases;
- stereotactic radiosurgery;
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).
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.
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.
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.