Cerebral metastasis after primary renal cell carcinoma
1 Department of Neuroradiology, University of Heidelberg Medical School, Kopfklinik, Im Neuenheimer Feld 400, 69120 Heidelberg, Germanyw'(x/1, 百拇医药
2 Department of Radiation Oncology, German Cancer Research Centre, Heidelbergw'(x/1, 百拇医药
3 Department of Neurosurgery, University of Heidelbergw'(x/1, 百拇医药
Keywords: brain metastases; renal cell cancerw'(x/1, 百拇医药
The article by Roser et al,1 in which it was shown that the treatment of intracranial metastases originating from renal cell carcinoma can on occasion be successful, was most interesting.w'(x/1, 百拇医药
We have followed the clinical course of a patient with a renal cell carcinoma with a low mitotic index since 1989. In this patient the course was distinctly more malignant but the disease has also been successfully treated to date. In the last 13 years, this patient has had four metastases surgically removed and a further nine treated with stereotactically guided percutaneous single dose convergent beam irradiation therapy (stereotactic modified linear accelerator, 6–15 MV photons, 18–20 Gy prescribed to the 80% isodose). Apart from slight mnemonic deficits, the patient is in good health.
The following factors which affect the prognosis2–4 were all met by our patient:a&7n, 百拇医药
The interval between the diagnosis of renal cell carcinoma and the first detected brain metastasis exceeds 17 months (our patient, 18 months; the patient described by Roser et al,1 36 months);a&7n, 百拇医药
Age below 60 years at the time of initial diagnosis;a&7n, 百拇医药
Primary tumour of the left kidney, initial nephrectomy;a&7n, 百拇医药
Diameter of primary metastasis < 2 cm;a&7n, 百拇医药
Not more than one brain metastasis at the time of initial treatment;a&7n, 百拇医药
Solely intracranial metastases;a&7n, 百拇医药
Karnofsky > 70%;a&7n, 百拇医药
No systemic symptoms such as fever or weight loss at the time of diagnosis;a&7n, 百拇医药
Blood sedimentation rate under 50 mm/h at diagnosis of renal cell carcinoma.a&7n, 百拇医药
Patients in whom prognostic factors predict a good outcome should be treated with intent to cure.a&7n, 百拇医药
Referencesa&7n, 百拇医药
Roser F, Rosahl SK, Samii M. Single cerebral metastasis 3 and 19 years after primary renal cell carcinoma: case report and review of the literature. J Neurol Neurosurg Psychiatry 2002;72:257–8.a&7n, 百拇医药
Decker DA, Decker VL, Herskovic A, et al. Brain metastases in patients with renal cell carcinoma, prognosis and treatment. J Clin Oncol 1984;2:169–73.a&7n, 百拇医药
Wronski MD, Maor MH, Davis BJ, et al. External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M D Anderson Cancer Center. Int J Radiat Oncol Biol Phys 1997;37:753–9.a&7n, 百拇医药
Culine S, Bekradda M, Kramar A, et al. Prognostic factors for survival in patients with brain metastases from renal cell carcinoma. Cancer 1998;83:2548–53.(S Heckl K Braun J Debus and S Kunze)
2 Department of Radiation Oncology, German Cancer Research Centre, Heidelbergw'(x/1, 百拇医药
3 Department of Neurosurgery, University of Heidelbergw'(x/1, 百拇医药
Keywords: brain metastases; renal cell cancerw'(x/1, 百拇医药
The article by Roser et al,1 in which it was shown that the treatment of intracranial metastases originating from renal cell carcinoma can on occasion be successful, was most interesting.w'(x/1, 百拇医药
We have followed the clinical course of a patient with a renal cell carcinoma with a low mitotic index since 1989. In this patient the course was distinctly more malignant but the disease has also been successfully treated to date. In the last 13 years, this patient has had four metastases surgically removed and a further nine treated with stereotactically guided percutaneous single dose convergent beam irradiation therapy (stereotactic modified linear accelerator, 6–15 MV photons, 18–20 Gy prescribed to the 80% isodose). Apart from slight mnemonic deficits, the patient is in good health.
The following factors which affect the prognosis2–4 were all met by our patient:a&7n, 百拇医药
The interval between the diagnosis of renal cell carcinoma and the first detected brain metastasis exceeds 17 months (our patient, 18 months; the patient described by Roser et al,1 36 months);a&7n, 百拇医药
Age below 60 years at the time of initial diagnosis;a&7n, 百拇医药
Primary tumour of the left kidney, initial nephrectomy;a&7n, 百拇医药
Diameter of primary metastasis < 2 cm;a&7n, 百拇医药
Not more than one brain metastasis at the time of initial treatment;a&7n, 百拇医药
Solely intracranial metastases;a&7n, 百拇医药
Karnofsky > 70%;a&7n, 百拇医药
No systemic symptoms such as fever or weight loss at the time of diagnosis;a&7n, 百拇医药
Blood sedimentation rate under 50 mm/h at diagnosis of renal cell carcinoma.a&7n, 百拇医药
Patients in whom prognostic factors predict a good outcome should be treated with intent to cure.a&7n, 百拇医药
Referencesa&7n, 百拇医药
Roser F, Rosahl SK, Samii M. Single cerebral metastasis 3 and 19 years after primary renal cell carcinoma: case report and review of the literature. J Neurol Neurosurg Psychiatry 2002;72:257–8.a&7n, 百拇医药
Decker DA, Decker VL, Herskovic A, et al. Brain metastases in patients with renal cell carcinoma, prognosis and treatment. J Clin Oncol 1984;2:169–73.a&7n, 百拇医药
Wronski MD, Maor MH, Davis BJ, et al. External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the M D Anderson Cancer Center. Int J Radiat Oncol Biol Phys 1997;37:753–9.a&7n, 百拇医药
Culine S, Bekradda M, Kramar A, et al. Prognostic factors for survival in patients with brain metastases from renal cell carcinoma. Cancer 1998;83:2548–53.(S Heckl K Braun J Debus and S Kunze)