Predicting the Risk of Developing New Cerebral Lesions After Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy for Brain Metastases from Renal Cell Carcinoma

Abstract

Two groups were identified with different risks of new brain metastases after SRS or FSRT alone. High-risk patients may benefit from additional whole-brain irradiation.

Estimating the Lifespan of Elderly Patients With Cerebral Metastases from Kidney Cancer

“…Approximately 10% of patients with kidney cancer develop cerebral metastases, and kidney cancer accounts for about 4% of solid tumors associated with cerebral metastases in adult cancer patients (1,2). Many patients with a limited number of cerebral metastases (mainly defined as 1-3 or 1-4 lesions) from kidney cancer receive stereotactic radiosurgery (SRS) of fractionated stereotactic radiotherapy (FSRT) (3)(4)(5)(6). The majority of kidney cancer patients with multiple (mainly defined as >3 or >4 lesions) cerebral metastases receive whole-brain irradiation (WBI) (7)(8)(9).…”

“…For patients with kidney cancer, WBI-doses higher than 30 Gy were reported to result in better survival and local (intracerebral) control than 10×3 Gy (10). Of the patients with cerebral metastases from kidney cancer, about 25% are aged ≥65 years (elderly patients) (3)(4)(5)(6)(7)(8)(9)(10). Since these patients often have poor performance scores and significant comorbidities, they may not be able to sufficiently tolerate intensive local therapies such as SRS and FSRT or WBI with higher biologically effective doses.…”

“…Since these patients often have poor performance scores and significant comorbidities, they may not be able to sufficiently tolerate intensive local therapies such as SRS and FSRT or WBI with higher biologically effective doses. Some benefits of local therapies and higherdose WBI in terms of less late toxicity and improved local control are more of an issue in patients with favorable survival prognoses (1,(3)(4)(5)(6)(7)(8)(9)(10). Moreover, patients with a poor survival are better treated with short-course WBI to keep the time spent receiving anticancer treatment to a minimum (11).…”

Estimating Survival of Patients With Metastatic Renal Cell Carcinoma Receiving Whole-brain Radiotherapy With a New Tool

“…Patients with renal cell carcinoma (RCC) account for about 5% of patients with intracerebral metastases (1,2). Since RCC is considered a less radiosensitive tumor, patients with a limited number of intracerebral lesions are preferably treated with local therapies including radiosurgery and fractionated stereotactic radiotherapy alone or combined with whole-brain irradiation (WBRT) (3)(4)(5)(6)(7)(8). Patients with multiple lesions and those with significant co-morbidities and a markedly reduced performance status are often assigned to WBRT alone (1).…”