Goyal L K, Suh J H, Reddy C A, Barnett G H
Departments of Radiation Oncology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):1007-12. doi: 10.1016/s0360-3016(00)00536-8.
We reviewed our experience with patients who have undergone stereotactic radiosurgery (SRS) for brain metastases secondary to renal cell carcinoma (RCC). Analysis was performed to determine the survival, local control, distant brain failure (DBF), and then to define which tumors may not require upfront whole-brain radiotherapy (WBRT).
Twenty-nine patients with 66 tumors underwent SRS from 1991 to 1998. Median follow-up from time of brain metastases diagnoses relative to each tumor was 12.5 months and 6.8 months from the time of SRS. Median SRS dose was 1,800 cGy to the 60% isodose line. Three patients had undergone SRS for previously treated tumors.
Median survival time from diagnosis was 10.0 months. Overall survival was not affected by age, addition of WBRT, number of lesions, tumor volume, or the presence of systemic disease. Of the 23 patients with follow-up neuroimaging, 4 of 47 (9%) tumors recurred. The addition of WBRT did not improve local control. Of the 13 patients who presented with a single lesion, 3 went on to develop DBF (23%), while 6 of the 10 patients who presented with multiple metastases developed DBF (60%).
Patients with brain metastases secondary to RCC treated by SRS alone have excellent local control. The decision of whether or not to add WBRT to SRS should depend on whether the patient has a high likelihood of developing DBF. Our study suggests that patients who present with multiple brain lesions may be more likely to benefit from the addition of WBRT because they appear to be more than twice as likely to develop DBF as compared to patients with a single lesion.
我们回顾了对肾细胞癌（RCC）继发脑转移患者进行立体定向放射外科治疗（SRS）的经验。进行分析以确定生存率、局部控制情况、远处脑转移（DBF），并确定哪些肿瘤可能不需要先行全脑放疗（WBRT）。
1991年至1998年，29例患者的66个肿瘤接受了SRS治疗。从脑转移诊断时间到每个肿瘤的中位随访时间为12.5个月，从SRS治疗时间起为6.8个月。SRS的中位剂量为1800 cGy至60%等剂量线。3例患者曾因先前治疗过的肿瘤接受SRS治疗。
从诊断开始的中位生存时间为10.0个月。总生存率不受年龄、是否加用WBRT、病灶数量、肿瘤体积或全身疾病的影响。在23例接受随访神经影像学检查的患者中，47个肿瘤中有4个（9%）复发。加用WBRT并未改善局部控制。在13例单发病灶患者中，3例发生了DBF（23%），而在10例多发转移患者中，6例发生了DBF（60%）。
单独接受SRS治疗的RCC继发脑转移患者具有良好的局部控制。是否在SRS基础上加用WBRT的决定应取决于患者发生DBF的可能性是否高。我们的研究表明，出现多发脑病灶的患者可能更有可能从加用WBRT中获益，因为他们发生DBF的可能性似乎是单发病灶患者的两倍多。
