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Radiotherapy for Brain Metastases from Renal Cell Cancer: Should Whole-Brain Radiotherapy Be Added to Stereotactic Radiosurgery?

Analysis of 88 Patients

Radiotherapie bei Hirnmetastasen eines Nierenzellkarzinoms: Sollte eine Ganzhirnbestrahlung zusätzlich zur stereotaktischen Radiochirurgie durchgeführt werden? Analyse von 88 Patienten

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Abstract

Purpose:

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).

Patients and 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.

Conclusion:

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.

Zusammenfassung

Ziel:

Untersuchung des Stellenwerts der stereotaktischen Radiochirurgie (SRS) und der Ganzhirnbestrahlung (WBRT) bei Patienten mit Hirnmetastasen eines Nierenzellkarzinoms.

Patienten und Methodik:

88 Patienten wurden bei Vorliegen von ein bis drei Hirnmetastasen mit primärer SRS (n = 51) oder SRS + WBRT (n = 17) und bei mehr als drei Hirnmetastasen mit einer primären WBRT (n = 20) behandelt. Gesamtüberleben (OS), intrazerebrale Kontrolle (IC) und lokale Kontrolle (LC) wurden retrospektiv evaluiert. Folgende Prognosefaktoren wurden analysiert: Alter, Geschlecht, Metastasenanzahl, extrazerebrale Kontrolle, RPA-(„recursive partitioning analysis“-)Klasse und das Zeitintervall von der Diagnosestellung bis zur Bestrahlung.

Ergebnisse:

Die medianen OS-, IC- und LC-Zeiten lagen bei 11, 9 und 10 Monaten. Das mediane OS für primäre SRS, SRS + WBRT und primäre WBRT betrug 12, 16 und 2 Monate. Die zusätzlich zur SRS durchgeführte WBRT verbesserte die IC (p = 0,032), developnicht jedoch das OS (p = 0,703). Die Multivarianzanalyse zeigte, dass das Fehlen extrazerebraler Metastasen (p < 0,001) und die RPA-Klasse (p = 0,04) prognostische Faktoren für ein verbesserte OS waren. Die Behandlungsmodalität (SRS + WBRT) war der prognostische Faktor für eine verbesserte IC (p = 0,019). Die LC 1 Jahr, 2 Jahre und 3 Jahre nach SRS betrug 81%, 78% und 55%. Hinsichtlich der LC konnten keine prognostischen Faktoren ermittelt werden. Die Ergebnisse der Subgruppenanalysen waren denen des Gesamtkollektivs vergleichbar, wobei die Patienten mit RPA-Klasse I eine verbesserte IC aufwiesen.

Schlussfolgerung:

Die ergänzende WBRT zur SRS verbessert die intrazerebrale Kontrolle und sollte daher bei Patienten mit ein bis drei Hirnmetastasen eines RCC eingesetzt werden, insbesondere bei der RPA-Klasse 1 zugeordneten Patienten. Die SRS ermöglicht eine exzellente LC, während die WBRT für Patienten mit multiplen Hirnmetastasen und schlechter Prognose eingesetzt werden sollte.

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Authors and Affiliations

  1. Department of Radiotherapy and Radiation Oncology, Philipps University Marburg, Marburg, Germany

    Emmanouil Fokas MD, Martin Henzel & Rita Engenhart-Cabillic

  2. Department for Stereotactic Neurosurgery and Radiosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany

    Klaus Hamm, Gunnar Surber & Gabriele Kleinert

  3. Department of Radiotherapy and Radiation Oncology, Philipps University Marburg, Baldingerstraße, 35043, Marburg, Germany

    Emmanouil Fokas MD

Authors
  1. Emmanouil Fokas MD
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  2. Martin Henzel
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  3. Klaus Hamm
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  4. Gunnar Surber
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  5. Gabriele Kleinert
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  6. Rita Engenhart-Cabillic
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Correspondence to Emmanouil Fokas MD.

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Both authors contributed equally to the study.

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Fokas, E., Henzel, M., Hamm, K. et al. Radiotherapy for Brain Metastases from Renal Cell Cancer: Should Whole-Brain Radiotherapy Be Added to Stereotactic Radiosurgery?. Strahlenther Onkol 186, 210–217 (2010). https://doi.org/10.1007/s00066-010-2055-z

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  • DOI: https://doi.org/10.1007/s00066-010-2055-z

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