Treatment of brain metastases from renal cell cancer

Objective: To evaluate disease pattern, patient characteristics, and survival in patients treated for brain metastases from renal cell carcinoma. Methods: Retrospective analysis of all patients with brain metastases from renal cell carcinoma treated between 1983 and 2009 in northern Norway. Results: The time interval between first cancer diagnosis and brain metastases was dependent on initial TNM stage (median 42 months in stage II vs. 10 months in both stage Ill and stage IV). Only few patients did not harbor extracranial metastases. Systemic therapy after diagnosis of brain metastases has been used in only three patients. Surgical resection and/or radiosurgery have been administered in 34% of patients, but whole-brain radiotherapy (WBRT) alone remained the cornerstone. Median survival was 4.1 months (3.7 months in the WBRT alone group, 10.1 months in the surgery and/or radiosurgery group). Two factors were significantly associated with better survival: solitary brain metastasis and age <= 64 years. The prognostic impact of the recursive partitioning analysis classes was not confirmed, while the new graded prognostic assessment index performed better. Conclusions: Surgical resection and/or radiosurgery contribute to prolonged survival. As most patients harbor extracranial metastases that threaten their lives, systemic treatment theoretically might play a role in the management of these patients, but more data need to be collected to confirm the clinical impact of immunotherapy, angiogenesis inhibition, and other signal transduction inhibitor approaches. (C) 2011 Elsevier Inc. All rights reserved.