Multimodality treatment of brain metastases from renal cell carcinoma in the era of targeted therapy

Abstract

In patients with renal cancer, brain metastasis is associated with poor survival and high morbidity. Poor life expectancy is often associated with widespread extracranial metastases. In such patients, a multidisciplinary approach is paramount. Brain metastases-specific therapies may include surgery, radiosurgery, conventional radiation and targeted therapies (TT) or a combination of these treatments. Some factors are important prognostically when choosing the best strategy: performance status, the number, size and location of brain metastases, the extension of systemic metastases and a well-controlled primary tumour. Failure of chemical therapy has always been attributed to an intact blood-brain barrier and acquired drug resistance by renal cancer cells. Recent studies have demonstrated objective responses with TT in a variety of cancer types, including renal cancer. In most cases, these agents have been used in combination and in conjunction with whole-brain radiation therapy and radiosurgery. Local control appears to be better with the combined method if the patient has a good performance status and may improve overall survival. This review summarizes current literature data on multidisciplinary approach in the management of renal brain metastasis with radiation, surgery and TT with an emphasis on potential better outcomes with a combination of current treatment methods.

Impact of Tyrosine Kinase Inhibitors (TKIs) Combined With Radiation Therapy for the Management of Brain Metastases From Renal Cell Carcinoma

“…VEGFR-TKIs and mTOR inhibitors have been associated with superior efficacy in terms of PFS, OS, and ORR, for the treatment of advanced RCC in comparison to placebo or INF-a (56). Renal cell carcinoma is one of the histology that metastasize to brain in advanced stage disease, and is associated with poor survival (57). Radiation therapy is required for treating brain metastases, and selection of proper strategy is based upon several prognostic factors (57).…”

“…Renal cell carcinoma is one of the histology that metastasize to brain in advanced stage disease, and is associated with poor survival (57). Radiation therapy is required for treating brain metastases, and selection of proper strategy is based upon several prognostic factors (57). Nonetheless, SRS has been used widely as the local treatment of choice for brain metastases in renal cell carcinoma due to radioresistance to WBRT (26).…”

Long-term Survival in a Case of Renal Cell Carcinoma With Brain Metastases: A Case Report

“…Probably, the initial radiotherapy could have helped the penetration of the small TKI molecules across the blood-brain barrier leading to the excellent response to the treatment. 9…”

Stereotactic Radiosurgery for Multiple Brain Metastases From Renal-Cell Carcinoma

“…8 Data with respect to the efficacy of other targeted therapies and mTORC1 inhibitors are nonconclusive, so some form of local therapy is standard. 9 Surgical resection of BM is associated with an improved survival over whole-brain radiotherapy (WBRT) alone. However, for patients with a greater intracranial or systemic disease burden, or for patients who are not candidates for resection, stereotactic radiosurgery (SRS) offers an alternative option with excellent control rates.…”