Brain metastasis from renal cell carcinoma

• Published in: Neuro-chirurgie 2014-02, Vol.60 (1), p.12-16
• Main Authors: Bennani, O, Derrey, S, Langlois, O, Castel, H, Laquerriere, A, Freger, P, Proust, F
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Brain metastasis; Brain Neoplasms - mortality; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Cancer du rein; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Facteur pronostique; Female; Humans; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Male; Medical sciences; Middle Aged; Métastase cérébrale; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Neurosurgery; Prognosis; Prognostic factor; Radiosurgery - methods; Renal cell carcinoma; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0028-3770; 1773-0619
• DOI: 10.1016/j.neuchi.2013.12.001

Abstract Background Patients with brain metastasis (BM) from renal cell carcinoma (RCC) have a poorly known prognosis due to the rarity of this disease. The aim of our study was to assess the outcome of patients with a BM due to RCC, and to determine the predictive factors for survival. Methods Consecutive patients who underwent treatment between 1997 and 2012 were identified retrospectively from a database ( n = 28, median age of 57.8 years, sex ratio M/F: 3.7). Main criteria collected concerned survival time. Other data collected were relative to initial histology, clinical findings at the time of BM diagnosis (diagnosis circumstances, KPS), radiological findings and BM characteristics (number, size and localization), treatment of BM (including surgery, stereotactic radiosurgery [SRS], systemic treatments, whole brain radiotherapy [WBRT]) and the outcome of surgery if performed. Statistical analysis of survival was performed using the Kaplan-Meier method. Results Median survival was 13.3 months, 1-year survival was 60.2%, 2-year survival was 16.4%. Univariate analysis showed the existence of intracranial hypertension ( P = 0.01), other systemic metastasis ( P = 0.049), the absence of deep metastasis ( P = 0.03) which are all linked to shorter survival. Age, KPS, initial histology of RCC, number, size, localization, and hemorrhage in BM were not correlated to survival. The median survival in the surgical resection group was 25.3 months versus 8.6 months ( P = 0.02). The main criteria for the selection of the surgical group were a single BM ( P = 0.04), and superficial metastasis ( P = 0.02). Conclusions Three predictive factors for longer survival in BMRCC were the absence of intracranial hypertension, the absence of acute metastasis and the absence of extracranial metastasis. Surgical removal, when possible, seems to benefit patient survival.