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Brain Metastasis in Renal Cell Carcinoma Patients

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Tumors of the Central Nervous system, Volume 3

Part of the book series: Tumors of the Central Nervous System ((TCNS,volume 3))

Abstract

The advent of “targeted” therapy directed against the VEGF or mTOR pathways has markedly increased the survival of patients with metastatic renal cell carcinoma (RCC) over the last 5 years. Since RCC ranks 3rd in incidence-proportion percentage of brain metastases, it is not surprising, that management of this complication has become an increasingly important clinical challenge. Some form of systematic CNS screening (e.g. brain MRI scans) appears reasonable, especially at the time of disease progression or in patients with long-standing metastatic disease. Historically, surgical resection was the preferred treatment of patients with one or two superficial brain metastases. Whole brain radiotherapy (WBRT) was used for palliation of multiple or deeper metastases. Unfortunately, these approaches achieved long-term survival only in a small fraction of patients. This is because the vast majority of RCC patients do not have isolated brain recurrences, but rather progress in the brain at the time of systemic cancer progression. Advances in gamma-knife (GK) or by linear accelerator based stereotactic radiosurgery (SRS) have resulted in apparent improvement in CNS control in patients with up to 5 metastases. Long-term control of treated lesions is achieved in the majority of patients with only a single GK/SRS treatment. Whether WBRT should be immediately added is controversial. It is currently reasonable to treat with primary GK/SRS and follow patients closely for progression with the intention of using salvage therapy when appropriate. This approach shortens the delay in starting systemic therapy. The use of “targeted” therapy following GK/SRS appears to be feasible without an increased risk of CNS complications. The use of systemic immunotherapy (e.g. IL-2) following GK/SRS to induce remissions is intriguing, as about 15% of patients achieve long term or longer survival. A two-compartment approach in patients with metastatic RCC and brain involvement employing GK/SRS treatment of the brain, followed by systemic therapy is likely to result in improved outcomes.

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Authors and Affiliations

  1. Section of Melanoma, Renal Cancer and Immunotherapy, Nevada Cancer Institute, Las Vegas, NV, 89135, USA

    Aida Loudyi

  2. 2435 Grassy Spring Pl, Las Vegas, NV, 89135, USA

    Wolfram E. Samlowski

Authors
  1. Aida Loudyi
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  2. Wolfram E. Samlowski
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Correspondence to Aida Loudyi .

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Editors and Affiliations

  1. , Kean University, Department of Biological Sciences, Morris Avenue 1000, UNION, 07083, New Jersey, USA

    M.A. Hayat

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Loudyi, A., Samlowski, W.E. (2011). Brain Metastasis in Renal Cell Carcinoma Patients. In: Hayat, M. (eds) Tumors of the Central Nervous system, Volume 3. Tumors of the Central Nervous System, vol 3. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1399-4_6

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  • DOI: https://doi.org/10.1007/978-94-007-1399-4_6

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  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-007-1398-7

  • Online ISBN: 978-94-007-1399-4

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