Stereotactic Radiosurgery for Multiple Brain Metastases From Renal-Cell Carcinoma

Treatment with radiosurgery prevents neurocognitive decline associated with whole-brain radiotherapy. After review of data of 38 patients treated with radiosurgery for brain metastases from metastatic renal cell carcinoma, the local control at 1 year was 92%. There was no difference in survival on the basis of number of brain metastases. With therapeutic advancements, a greater number of patients might be candidates for radiosurgery. BACKGROUND: Brain metastases (BM) pose a significant problem in patients with metastatic renal-cell carcinoma (mRCC). Local and systemic therapies including stereotactic radiosurgery (SRS) are rapidly evolving, necessitating reassessments of outcomes for modern patient management. PATIENTS AND METHODS: The mRCC patients with BM treated with SRS were reviewed. Patient demographics, clinical history, and SRS treatment parameters were identified. RESULTS: Among 268 patients with mRCC treated between 2006 and 2015, 38 patients were identified with BM. A total of 243 BM were treated with SRS with 1 to 26 BMs treated per SRS session (median, 2 BMs). The median (range) BM size was 0.6 (0.2–3.1) cm and median (range) SRS treatment dose was 18 (12–24) Gy. Treated BM local control rates at 1 and 2 years were 91.8% (95% confidence interval, 85.7–95.4) and 86.1% (95% confidence interval, 77.1–91.7), respectively. BM control declined for larger tumors. Survival after 1-year was 57.5% (95% CI 40.2–71.4) for all patients. Survival was not statistically different between patients with < 5 BM versus ≥ 5 BM. Survival was prognostic based on International Metastatic Renal Cell Carcinoma Database (IMDC) risk groups in patients with < 5 BM. Two patients experienced grade 3 radiation necrosis requiring surgical intervention. CONCLUSION: SRS is effective in controlling BM in patients with mRCC. Over half of treated patients survive past a year, and no differences in survival were noted in patients with > 5 metastases. Prognostic risk categories based on systemic disease (IMDC) are predictive of survival in this BM population, with limited rates of symptomatic radiation necrosis.