Gamma knife radiosurgery for renal cell carcinoma brain metastases

Abstract

Object. The purpose of this study was to clarify the effectiveness of gamma knife radiosurgery (GKS) in achieving a partial or complete remission of so-called radioresistant metastases from renal cell carcinoma (RCC) and to propose guidelines for optimal treatment Methods. During a 5-year period, 29 patients (19 male and 10 female) with 92 brain metastases from RCC underwent GKS. The median tumor volume was 4.7 cm3 (range 0.5–14.5 cm3). Fourteen patients (48%) also underwent whole-brain radiotherapy (WBRT) before GKS, and two patients (6.8%) after GKS. The mean GKS dose delivered to the 50% isodose at the tumor margin was 16.8 Gy (range 13–30 Gy). All cases were categorized according to the Recursive Partitioning Analysis (RPA) classification for brain metastases. Univariate analysis was performed to determine significant prognostic factors and survival. The overall median survival was 7 months after GKS treatment. Age, sex, Karnofsky Performance Scale score, and controlled primary disease were not predictors of survival. Combined WBRT/GKS resulted in median survival of 18, 8.5, and 5.3 months for RPA Classes I, II, and III, respectively, compared with the median survival 7.1, 4.2, and 2.3 months for patients treated with WBRT alone. Conclusions. These results suggest that WBRT combined with GKS may improve survival in patients with brain metastases from RCC. Furthermore, this improvement in survival was seen in all RPA classes.

Radiotherapy for Brain Metastases from Renal Cell Cancer: Should Whole-Brain Radiotherapy Be Added to Stereotactic Radiosurgery?

“…Similar survival and control results have been found between SRS and OP for selected RCC patients with brain metastases [23]. SRS, therefore, represents a valuable alternative choice characterized by a high response rate, low morbidity and acceptable side-effect profile, as in our present work [1,13,17,22,23,25,31,33].…”

“…Stereotactic radiosurgery (SRS) offers an improved local control (LC) as well as prolonged overall survival (OS) in RCC patients with brain metastases [1,4,13,17,18,22,23,25,33,34]. Surgery has failed to improve survival, even though mixed findings have been reported [14,31].…”

The pathogenesis and treatment of brain metastases: a comprehensive review

“…SRS is particularly useful for patients unable to tolerate surgery and for patients with lesions inaccessible to surgery. SRS is reportedly effective in the treatment of brain metastases that tend to be resistant to conventional radiation therapy, such as melanoma and renal cell carcinoma [49,50]. Furthermore, SRS is an effective and safe tool for re-irradiating and, potentially, saving patients for whom conventional WBRT and craniotomy have failed [51][52][53].…”

What?s new in the management of renal cell carcinoma. Therapeutic strategy in 2003

“…Pour les localisations cérébrales de cancers du rein, la radiochirurgie est promue par certaines équipes chez des patients en progression tumorale cérébrale après radiothérapie encéphalique totale ou en présence de localisations céré-brales inextirpables et fonctionnellement symptomatiques [15,40]. En comparaison des survies spontanées attendues de ces patients dans les séries propres à ces équipes, il y aurait un gain de survie avec une médiane de survie de 13 mois [40] ou un doublement de la survie attendue [15].…”

“…En comparaison des survies spontanées attendues de ces patients dans les séries propres à ces équipes, il y aurait un gain de survie avec une médiane de survie de 13 mois [40] ou un doublement de la survie attendue [15].…”