Shuch et al identified patients with renal cell carcinoma and brain metastases who have a better prognosis and who should be treated aggressively. The authors are from the University of California at Los Angeles (UCLA).
Features of a patient with brain metastases from a renal cell carcinoma who may have a better prognosis (4 S's):
(1) single lesion
(2) small (< 2 cm)
(3) symptoms from the brain metastasis absent (asymptomatic)
(4) status good (ECOG performance score 0)
where:
• Patients without CNS symptoms had smaller lesions, with mean diameter 1.3 cm.
• A patient with 2 or more brain metastases is more likely to have a recurrence after therapy (hazard ratio 3.7).
Recommendations:
(1) A patient with a renal cell carcinoma that may be metastatic should have the brain imaged for evidence of metastatic disease.
(2) If a single lesion is found then it should be considered for resection.
(3) The patient should receive aggressive therapy.
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