No abstract

Treatment with radiosurgery prevents neurocognitive decline associated with whole-brain radiotherapy. After review of data of 38 patients treated with radiosurgery for brain metastases from metastatic renal cell carcinoma, the local control at 1 year was 92%. There was no difference in survival on the basis of number of brain metastases. With therapeutic advancements, a greater number of patients might be candidates for radiosurgery. Background: Brain metastases (BM) pose a significant problem in patients with metastatic renal-cell carcinoma (mRCC). Local and systemic therapies including stereotactic radiosurgery (SRS) are rapidly evolving, necessitating reassessments of outcomes for modern patient management. Patients and Methods: The mRCC patients with BM treated with SRS were reviewed. Patient demographics, clinical history, and SRS treatment parameters were identified. Results: Among 268 patients with mRCC treated between 2006 and 2015, 38 patients were identified with BM. A total of 243 BM were treated with SRS with 1 to 26 BMs treated per SRS session (median, 2 BMs). The median (range) BM size was 0.6 (0.2–3.1) cm and median (range) SRS treatment dose was 18 (12–24) Gy. Treated BM local control rates at 1 and 2 years were 91.8% (95% confidence interval, 85.7–95.4) and 86.1% (95% confidence interval, 77.1–91.7), respectively. BM control declined for larger tumors. Survival after 1-year was 57.5% (95% CI 40.2–71.4) for all patients. Survival was not statistically different between patients with < 5 BM versus ≥ 5 BM. Survival was prognostic based on International Metastatic Renal Cell Carcinoma Database (IMDC) risk groups in patients with < 5 BM. Two patients experienced grade 3 radiation necrosis requiring surgical intervention. Conclusion: SRS is effective in controlling BM in patients with mRCC. Over half of treated patients survive past a year, and no differences in survival were noted in patients with > 5 metastases. Prognostic risk categories based on systemic disease (IMDC) are predictive of survival in this BM population, with limited rates of symptomatic radiation necrosis.

CRC stage and the probability of presenting as an emergency did not change with age but older patients were more likely to be female and have colon cancer. Post-operative mortality progressively increased with age. Most deaths were caused by medical complications, reflecting increased co-morbidity. Older patients were less likely to die from CRC.