title: Multidisciplinary treatment of brain metastases derived from clear cell renal cancer incorporating stereotactic radiosurgery.
abstract: BACKGROUND
  Brain metastases are a frequent complication in patients with metastatic clear cell renal cancer. Survival after whole-brain radiotherapy (WBRT) is disappointing. A retrospective analysis of multimodality treatment was performed in patients who had received linear accelerator (LINAC)-based stereotactic radiosurgery (SRS).
  
  
  METHODS
  Thirty-two patients underwent SRS-based treatment for 71 metastatic foci between 2000 and 2006. All patients had a Karnofsky performance status >or=70 and all 32 patients had extracranial metastatic disease (Radiation Therapy Oncology Group recursive partitioning analysis [RPA] Class 2). Survival was calculated from the time of diagnosis of brain metastases. The minimum potential follow-up was 1 year after SRS. Univariate and multivariate analysis of potential prognostic factors affecting survival was performed.
  
  
  RESULTS
  Twenty-six patients required only 1 SRS treatment (84%) to achieve central nervous system (CNS) control, whereas 5 patients received 2 to 3 treatments (16%). The median survival of renal cancer patients from the diagnosis of brain metastases was 10.1 months (95% confidence interval, 6.4-14.8 months). One-year and 3-year survival rates were 43% and 16%, respectively. The addition of surgery or WBRT did not appear to prolong survival. Immunotherapy after control of brain metastases with SRS appeared to result in significantly improved survival. Survival was also found to be strongly influenced by prognostic stratification of metastatic disease using Motzer or modified risk criteria.
  
  
  CONCLUSIONS
  The results of the current study demonstrated that SRS-based treatment of patients with up to 5 brain metastases from clear cell renal cancer is feasible and results in excellent CNS control. Survival beyond 3 years from the time of diagnosis of brain metastases was achievable in 16% of patients and was associated with the use of systemic immunotherapy with interleukin-2 and interferon but not antiangiogenic agents.
authors.affiliation: Section of Melanoma, Renal Cancer and Immunotherapy of the Nevada Cancer Institute, Las Vegas, Nevada 89135, USA. wsamlowski@nvcancer.org
authors.forename: Wolfram E
authors.initials: WE
authors.lastname: Samlowski
authors.forename: Martin
authors.initials: M
authors.lastname: Majer
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boucher
authors.forename: Annabelle F
authors.initials: AF
authors.lastname: Shrieve
authors.forename: Christopher
authors.initials: C
authors.lastname: Dechet
authors.forename: Randy L
authors.initials: RL
authors.lastname: Jensen
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Shrieve
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D007376:Interleukin-2 / Q000627:therapeutic use; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D016898:Interferon-alpha; D007376:Interleukin-2