SURGICAL RESECTION OF BRAIN METASTASES FROM CELL-CARCINOMA IN 50 PATIENTS RENAL

Objectives. Metastases are frequently diagnosed among patients with re nal cell carcinoma (RCC). Of 709 patients with brain metastases (BMET) who were operated on at our institution between 1974 and 1993, 50 (7% ) were of renal origin. Methods. Medical records were reviewed retrosp ectively. Survival time was calculated by the Kaplan-Meier method and Cox proportional hazards model. Results. There were 38 men and 12 wome n. The median age was 60 years. The primary RCC was resected in 47 pat ients. Forty patients had a metachronous diagnosis of RCC and BMET. Me dian interval between the diagnosis of RCC and BMET was 17 months. In all 50 patients overall median survival (MS) from diagnosis of primary RCC was 31.4 months and from craniotomy was 12.6 months. Postoperativ e mortality was 10% (5 patients). In patients with primary RCC in the left kidney (n = 25) versus right kidney (n = 25) median survival from craniotomy was longer: 21.3 versus 7.4 months (P < 0.014). Twenty-thr ee patients (46%) had intratumoral hemorrhage. Eight patients had cere bellar metastasis (MS, 3.0 months) and 9 had multiple metastases resec ted (MS, 7.6 months). Thirty-eight patients had both brain and pulmona ry metastases, and 16 of them had pulmonary resection (MS, 18.6 versus 8.0 months; P < 0.03). Twenty-two patients received whole brain radia tion therapy (WBRT) after craniotomy and 18 did not receive WBRT (MS, 13.3 versus 14.5 months; P < 0.62). The 1-year, 2-year, 5-year, and 5- year survival was 51%, 24%, 22%, and 8.5%, respectively. Conclusions. Only the resection of lung metastasis, supratentorial location of BMET , left-sided localization of primary RCC, and lack of neurologic defic it before craniotomy were statistically significant prognostic factors in Cox regression analysis. In the absence of effective systemic trea tment, we suggest that patients with BMET from RCC be considered for o perative resection for treatment and palliation.