Outcomes of patients with brain metastases from melanoma and renal cell carcinoma after primary stereotactic radiosurgery.

Patients with melanoma or renal cell carcinoma (RCC) frequently have brain metastases.3,9,15,38,46,47 These patients have traditionally been treated with surgery, palliative whole-brain radiation (WBRT), or both. Surgery, even today, is generally reserved for assessable, symptomatic lesions in patients with a good Karnofsky Performance Score. Recursive partition analysis (RPA), which classifies patients on a scale of I to III based on Karnofsky Performance Score, age, and tumor control, has been used to identify patients that are expected to have the greatest clinical benefit from WBRT.10,15,40 Although WBRT is the most widely used treatment for these patients, there is a general sense among those treating these patients that melanoma and RCC are considered radioresistant.6,8,14,18,25,26 Stereotactic radiosurgery (SRS) performed using either linear acceleratoror gamma knife-based systems can achieve higher radiation doses within the tumor volume and theoretically can increase responses in these radioresistant tumors. Numerous reports have shown effective local control and prolonged patient survival after SRS for these lesions.1,6,8,16,18,30,33,35,43 Early control of brain metastases is important in these patients, because many of them also have extracranial metastases. We hypothesized that early diagnosis and aggressive treatment of brain metastases with SRS in these patients could spare many patients WBRT. In addition, it seemed likely that this would permit early systemic therapy. The ultimate goal was to achieve improvement in survival rates. We report our experience with using SRS as a primary treatment modality in patients with RCC and melanoma brain metastasis.