Detection and treatment of small brain metastases resulting from renal cell carcinoma predict improved survival after stereotactic radiosurgery
Tóm tắt
Local failure and subsequent neurologic death continue to be problematic for brain metastases resulting from renal cell carcinoma (RCC), which are highly resistant to whole brain radiation therapy. The objective of this single-institution series is to determine the outcomes of patients with RCC brain metastases treated with stereotactic radiosurgery (SRS). Between January 2005 and December 2011, 51 patients with a total of 104 brain metastases from RCC were treated with linac-based SRS. The median age of this cohort was 60 years (range, 39–82) and consisted of 39 males and 12 females. The average size of the target lesion was 1.6 cc (0.2–82.7) of which 97 (93 %) lesions were treated with a single fraction of 14–24 Gy. Median follow-up for this cohort was 37.5 months. The actuarial 6- and 12-month rates of local control were 89 and 80 %, respectively. By Cox regression analysis, volume was the only predictor of local failure (p = 0.04). Overall survival determined from the time of SRS at 6 and 12 months was 56 and 44 %, respectively. Smaller tumor volume was found to be a significant predictor of improved survival (p = 0.01). None of the patients experienced grade 3 or greater acute or late toxicities. SRS for brain metastases from renal cell carcinoma is a safe and effective treatment resulting in a high rate of local control. To our knowledge, this is the first report demonstrating a relationship between smaller tumor volume and improved outcomes.
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