EXTERNAL RADIATION OF BRAIN METASTASES FROM RENAL-CARCINOMA - A RETROSPECTIVE STUDY OF 119 PATIENTS FROM THE MD-ANDERSON-CANCER-CENTER

Purpose: Approximately 10% of patients with metastatic renal cell carc inoma are diagnosed with brain metastases. Most of these patients rece ive palliative radiotherapy and die of progressive brain metastatic di sease. This retrospective study examines the M. D. Anderson Cancer Cen ter experience with such patients who received only whole brain radiat ion therapy (WBRT). Methods and Materials: Records of 200 patients wit h brain metastases from renal carcinoma who were treated at M. D. Ande rson Cancer Center between 1976 and 1993 were reviewed. Of these patie nts, 119 received WBRT only and constitute the basis of this study. Di fferent prognostic factors were analyzed. Results: Overall median surv ival time from diagnosis of the brain metastases was 4.4 months. Multi ple brain tumors were treated in 70 patients (58.8%) who had a surviva l of 3.0 months compared with 4.4 months for patients having a single brain metastasis (p = 0.043). Among 117 patients the causes of death w ere neurologic in 90 (76%), systemic cancer in 19 (16%), and unknown i n 9 (8%). Survival rates at 6 months, 1 year, and 2 years, were 33.6, 16.8, and 5.9%, respectively. Patients in whom brain metastases were d iagnosed synchronously with a renal primary (n = 24) had a median surv ival time of 3.4 months compared with 3.2 months for those 95 who were diagnosed metachronously (p < 0.79, NS). In the Cox multivariate anal ysis of 13 possible prognostic factors, only a single brain metastasis (p = 0.0329), lack of distant metastases at the time of diagnosis (p = 0.0056), and tumor diameter less than or equal to 2 cm (p < 0.0016) were statistically significant. Conclusion: These unsatisfactory resul ts with WBRT suggest that more aggressive approaches, such as surgery or radiosurgery should be applied whenever possible. (C) 1997 Elsevier Science Inc.