[Clinical background and treatment of brain metastasis from renal cell carcinoma].

OBJECTIVE The objective of this study is to evaluate the clinicopathological characteristics and the effect of therapy of brain metastasis from renal cell carcinoma. METHOD Of 306 cases with renal cell carcinoma treated at Keio University Hospital from June, 1976 to May, 1996, 20 (6.5%) developed brain metastasis. Metastasis-free rate and survival rate were evaluated by Kaplan-Meier's method and tested statistically with Long-rank test. RESULT As for the time of the brain metastasis, it was already at the time of initial diagnosis in 6 cases, and in the other 14, it was after the diagnosis of original disease. The average interval between the diagnosis of original disease and metastasis was 53.9 months. Only 2 cases have no metastasis without brain, and 17 of 20 cases (85.0%) were complicated by pulmonary metastasis and 10 (50.0%) by bone metastasis. It was considered that the brain metastasis was accompanied with other metastases. As for the treatment, cytokine therapy was performed on 18 cases without efficacy. It was supposed that in cases with pulmonary metastasis, IL-2 therapy may have the possibility of increasing the frequency of brain metastasis. 9 of 20 cases were subjected to surgical treatment with significantly better prognosis than the cases without the operation. Two cases were long-term survivors more than 5 years after the diagnosis of brain metastasis and both underwent surgical treatment to brain metastasis. CONCLUSION Cytokine therapy was not effective to brain metastasis from renal cell carcinoma. On the other hand, however, it was suggested that surgical treatment could improve prognosis if the metastatic lesions could be resected.