BRAIN METASTASES IN RENAL-CELL CANCER - R ESULTS OF TREATMENT AND PROGNOSIS

Brain metastases develop as a late manifestation of renal cell cancer (RCC) and pose an increasing challenge to urologists as a result of th e more frequent prolonged survival of patients with advanced RCC, Ther apeutic options. including surgical resection and radiotherapy, were a nalyzed retrospectively to assess survival and to identify factors inf luencing prognosis in a group of 90 patients treated either by brain m etastasectomy (n = 64) or radiotherapy (n = 26). The analysis confirme d that the overall median survival was a disappointing 461 days and th e 1-year survival rate was 31 % for patients treated by surgical resec tion and 310 days and 15 % respectively for patients treated by radiot herapy. However, a subgroup of patients who benefitted significantly f rom aggressive treatment of metastases could be defined. The following favorable prognostic factors showed a trend toward improved survival: (1) metachronous appearance of brain metastases more than 1 year afte r nephrectomy (P < 0.0001), (2) good patient performance (Karnofsky > 70) (P < 0.0002), (3) patient's age under 50 years (P < 0.05), (4) sol itary lesions (P < 0.05), (5) minimal or no neurological deficit (P < 0.05), and (6) the absence of/or minimal extracranial metastases (P < 0.05), No influence of lesion size and localization (infratentorial vs supratentorial) on survival was detected, Surgical treatment of recur rent brain tumors(n = 17) yielded an additional median survival advant age of 8 months as compared to untreated patients (n = 16), Our result s suggest that, especially in patients with good prognostic criteria, a radical metastasectomy plus vigorous surgery of local recurrences an d, if required, subsequent systemic immuno- or chemoimmunotherapy shou ld be performed. In patients with poor prognosis, stereotactic radiosu rgery is recommended for palliation and survival prolongation.