The role of whole brain radiotherapy and stereotactic radiosurgery on brain metastases from renal cell carcinoma

Purpose: We reviewed our experience,vith patients who have undergone stereo tactic radiosurgery (SRS) for brain metastases secondary to renal cell carc inoma (RCC), Analysis was performed to determine the survival, local contro l, distant brain failure (DBF), and then to define which tumors may not req uire upfront whole-brain radiotherapy (WBRT). Methods and Materials: Twenty-nine patients with 66 tumors underwent SRS fr om 1991 to 1998, Median follow-up from time of brain metastases diagnoses r elative to each tumor was 12.5 months and 6.8 months from the time of SRS, Median SRS dose was 1,800 cGy to the 60% isodose line, Three patients had u ndergone SRS for previously treated tumors. Results: Median survival time from diagnosis was 10.0 months. Overall survi val was not affected by age, addition of WBRT, number of lesions, tumor vol ume, or the presence of systemic disease. Of the 23 patients with follow-up neuroimaging, 4 of 47 (9%) tumors recurred. The addition of WBRT did not i mprove local control. Of the 13 patients who presented with a single lesion , 3 went on to develop DBF (23%), while 6 of the 10 patients who presented with multiple metastases developed DBF (60%). Conclusion: Patients with brain metastases secondary to RCC treated by SRS alone have excellent local control, The decision of whether or not to add W BRT to SRS should depend on whether the patient has a high likelihood of de veloping DBF. Our study suggests that patients who present with multiple br ain lesions may be more likely to benefit from the addition of WBRT because they appear to be more than twice as likely to develop DBF as compared to patients with a single lesion. (C) 2000 Elsevier Science Inc.