Stereotactic Radiosurgery without Radiation Therapy Providing High Local Tumor Control of Multiple Brain Metastases from Renal Cell Carcinoma

Abstract

The aim of this study was to analyse treatment effects after stereotactic radiosurgery (SRS) without whole brain radiation therapy (WBRT) as primary treatment for patients harboring brain metastases of renal cell carcinoma (RCC). During an 8-year period, 85 patients with 376 brain metastases from RCC underwent 134 outpatient SRS procedures. 65 % of all patients had multiple brain metastases. The median tumor volume was 1.2 cm³ (range: 0.1 - 14.2 cm³). Mean prescribed tumor dose was 21.2 (± 3.2) Gy. Local/distant tumor recurrences were treated by additional SRS in cases of stable systemic disease. Overall median survival was 11.1 months after SRS. The local tumor control rate after SRS was 94 %. Most patients (78 %) died because of systemically progressing cancer. A KPS > 70 and RTOG class I were related to prolonged survival time. Patients of the RTOG groups I, II and III survived for 24.2 months, 9.2 months and 7.5 months, respectively. There was no permanent morbidity after SRS. 11 patients (12.9 %) showed transient radiogenic complications and 3 patients (3.5 %) died because of intratumoral bleedings after SRS. Stereotactic radiosurgery alone achieves excellent local tumor control rates for patients with small brain metastases from renal cell carcinoma.

Brain metastases - stereotactic radiosurgery - gamma knife - renal cell carcinoma

References

• 1 Goyal L K, Suh J H, Reddy C A, Barnett G H. The role of whole brain radiotherapy and stereotactic radiosurgery on brain metastases from renal cell carcinoma.  Int J Radiat Oncol BioI Phys. 2000;  47 1007-1012
• 2 Mori Y, Kondziolka D, Flickinger J C, Logan T, Lunsford L D. Stereotactic radiosurgery for brain metastasis from renal cell carcinoma.  Cancer. 1998;  83 344-353
• 3 Payne B R, Prasad D, Szeifert G, Steiner M, Steiner L. Gamma surgery for intracranial metastases from renal cell carcinoma.  J Neurosurg. 2000;  92 760-765
• 4 Sheehan J P, Sun M H, Kondziolka D, Flickinger J, Lunsford L D. Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control.  J Neurosurg. 2003;  98 342-349
• 5 Culine S, Bekradda M, Kramar A, Rey A, Escudier B, Droz J P. Prognostic factors for survival in patients with brain metastases from renal cell carcinoma.  Cancer. 1998;  83 2548-2553
• 6 Wronski M, Maor M H, Davis B J, Davis B J, Sawaya R, Levin V A. External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M. D. Anderson Cancer Center.  Int J Radiat Oncol BioI Phys. 1997;  37 753-759
• 7 Maor M H, Frias A E, Oswald M J. Palliative radiotherapy for brain metastases in renal carcinoma.  Cancer. 1988;  62 1912-1917
• 8 Wowra B, Siebels M, Muacevic A, Kreth F W, Mack A, Hofstetter A I. Repeated gamma knife surgery for multiple brain metastases from renal cell carcinoma.  J Neurosurg. 2002;  97 785-793
• 9 Wowra B, Czempiel H, Cibis R, Horstmann G A. Profil der ambulanten Radiochirurgie mit dem Gamma-Knife-System. Teil 1: Methode und multizentrisches Behandlungskonzept.  Radiologe. 1997;  37 995-1002
• 10 Sturm V, Kober B, Hover K H, Schlegel W, Boesecke R, Pastyr O, Hartmann G H, Schabbert S, Winkel K zum, Kunze S. Stereotactic percutaneous single dose irradiation of brain metastasis with a linear accelerator.  Int J Radiat Oncol BioI Phys. 1987;  13 279-282
• 11 Hernandez L, Zamorano L, Sloan A, Fontanesi J, Lo S, Levin K, Li Q, Diaz F. Gamma knife radiosurgery for renal cell carcinoma brain metastases.  J Neurosurg. 2002;  97 (5 suppl) 489-493
• 12 Schoggl A, Kitz K, Ertl A, Dieckmann K, Saringer W, Koos W T. Gamma-knife radiosurgery for brain metastases of renal cell carcinoma: results in 23 patients.  Acta Neurochir. 1998;  140 549-555
• 13 Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna W G, Byhardt R. Recursive partitioning analysis (RP A) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials.  Int J Radiat Oncol BioI Phys. 1997;  37 745-751
• 14 Diener-West M, Dobbins T W, Phillips T L, Nelson D F. Identification of an optimal subgroup for treatment evaluation of patients with brain metastases using RTOG study 7916.  Int J Radiat Oncol BioI Phys. 1989;  16 669-673
• 15 Patchell R A, Tibbs P A, Regine W F, Dempsey R J, Mohiuddin M, Kryscio R J, Markesbery W R, Foon K A, Young B. Postoperative radiotherapy in the treatment of single metastases to the brain.  JAMA. 1998;  280 1485-1489
• 16 Kaplan E L, Meier P. Nonparametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 475-481
• 17 Cox D R, Oakes D. Analysis of Survival Data. New York: Chapman and Hall 1984
• 18 Brown P D, Brown C A, Pollock B E, Gorman D A, Foote R L. Stereotactic radiosurgery for patients with “radioresistant” brain metastases.  Neurosurgery. 2002;  51 656-667
• 19 Fuller B G, Kaplan ID, Adler J, Cox R S, Bagshaw M A. Stereotactic radiosurgery for brain metastasis: the importance of adjuvant whole brain irradiation.  Int J Radiat Oncol Biol Phys. 1992;  23 413-418
• 20 Sneed P K, Suh J H, Goetsch S J, Sanghavi S N, Chappell R, Buatti J M, Regine W F, Weltman E, King V J, Breneman J C, Sperduto P W, Mehta M P. A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases.  Int J Radiat Oncol BioI Phys. 2002;  53 519-526
• 21 Muacevic A, Kreth F W, Horstmann G A, Schmid-Elsaesser R, Wowra B, Steiger H J, Reulen H J. Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter.  J Neurosurg. 1999;  91 35-43
• 22 Alexander E 3rd, Moriarty T M, Davis R B, Wen P Y, Fine H A, Black P M, Kooy H M, Loeffler J S. Stereotactic radiosurgery for the definitive, noninvasive treatment of brain metastases.  J Natl Cancer Inst. 1995;  87 34-40
• 23 Auchter R M, Lamond J P, Alexander E, Buatti J M, Chappell R, Friedman W A, Kinsella T J, Levin A B, Noyes W R, Schultz C J, Loeffler J S, Mehta M P. A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis.  Int J Radiat Oncol BioI Phys. 1996;  35 27-35
• 24 Wowra B, Horstmann G A, Cibis R, Czempiel H. Profil der ambulanten Radiochirurgie mit dem Gamma-Knife-System. Teil 2: Klinischer Erfahrungsbericht.  Radiologe. 1997;  37 1003-1015
• 25 Engenhart R, Kimmig B N, Hover K H, Wowra B, Romahn J, Lorenz W J, Kaick G van, Wannenmacher M. Long-term follow-up for brain metastasis treated by percutaneous stereotactic single high-dose irradiation.  Cancer. 1993;  71 1353-1361
• 26 Flickinger J C, Kondziolka D, Lunsford L D, Coffey R J, Goodman M L, Shaw E G, Hudgins W R, Weiner R, Harsh G R 4th, Sneed P K. A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis.  Int J Radiat Oncol BioI Phys. 1994;  28 797-802
• 27 Weltman E, Salvajoli J V, Brandt R A, Morais Hanriot R de, Prisco F E, Cruz J C, Oliveira Borges S R de, Wajsbrot D B. Radiosurgery for brain metastases: a score index for predicting prognosis.  lnt J Radiat Oncol BioI Phys. 2000;  15 1155-1161
• 28 Joseph J, Adler J R, Hancock S L. Linear accelerator-based stereotaxic radiosurgery for brain metastases: the influence of number of lesions on survival.  J Clin Oncol. 1996;  14 1085-1092