title: Radiotherapy for brain metastases from renal cell cancer: should whole-brain radiotherapy be added to stereotactic radiosurgery?: analysis of 88 patients.
abstract: OBJECTIVE
  To evaluate the role of stereotactic radiosurgery (SRS) and whole-brain radiotherapy (WBRT) for the treatment of brain metastases in patients with renal cell cancer (RCC).
  
  
  METHODS
  88 patients were treated with either SRS (n = 51) or SRS + WBRT (n = 17) for one to three lesions, or with WBRT (n = 20) for more than three brain metastases. Overall survival (OS), intracerebral control (IC) and local control (LC) were retrospectively analyzed. Six potential prognostic factors were assessed: age, gender, number of brain metastases, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from tumor diagnosis to irradiation.
  
  
  RESULTS
  The median times for OS, IC, and LC from the time of diagnosis were 11, 9, and 10 months. The median OS times for SRS, SRS + WBRT, and WBRT were 12, 16, and 2 months. Addition of WBRT to the SRS improved IC (p = 0.032) but not OS (p = 0.703). On multivariate analyses, improved OS was associated with the absence of extracerebral metastases (p < 0.001) and RPA class (p = 0.04), and IC with treatment (p = 0.019). SRS provided a 1-year, 2-year, and 3-year LC probability of 81%, 78%, and 55%, respectively. No association between LC and any of the potential prognostic factors was observed. The results of the subgroup analyses, regarding treatment modality, were similar to the entire cohort, particularly for RPA class I patients.
  
  
  CONCLUSIONS
  Addition of WBRT to SRS offers better IC and should be considered for RCC patients with one to three brain metastases, especially in RPA class I group. SRS offers excellent LC rates, while WBRT should be reserved for patients with multiple metastases and poor prognosis.
authors.affiliation: Department of Radiotherapy and Radiation Oncology, Philipps University Marburg, Marburg, Germany. emmanouil.fokas@rob.ox.ac.uk
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Fokas
authors.forename: Martin
authors.initials: M
authors.lastname: Henzel
authors.forename: Klaus
authors.initials: K
authors.lastname: Hamm
authors.forename: Gunnar
authors.initials: G
authors.lastname: Surber
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kleinert
authors.forename: Rita
authors.initials: R
authors.lastname: Engenhart-Cabillic
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis