A concise review of the efficacy of stereotactic radiosurgery in the management of melanoma and renal cell carcinoma brain metastases

Abstract

Melanoma and renal cell carcinoma have a well-documented tendency to develop metastases to the brain. Treating these lesions has traditionally been problematic, because chemotherapy has difficulty crossing the blood brain barrier and whole brain radiation therapy (WBRT) is a relatively ineffective treatment against these radioresistant tumor histologies. In recent years, stereotactic radiosurgery (SRS) has emerged as an effective and minimally-invasive treatment modality for irradiating either single or multiple intracranial structures in one clinical treatment setting. For this reason, we conducted a review of modern literature analyzing the efficacy of SRS in the management of patients with melanoma and renal cell carcinoma brain metastases. In our analysis we found SRS to be a safe, effective and attractive treatment modality for managing radioresistant brain metastases and highlighted the need for randomized trials comparing WBRT alone vs. SRS alone vs. WBRT plus SRS in treating patients with radioresistant brain metastases.

Malignant melanoma brain metastases: Treatment results and prognostic factors - a single-center retrospective study

“…Compared to untreated patients, WBRT improves survival and may mitigate neurologic symptoms (30,52,58) but so far, a significant survival benefit from WBRT could not be demonstrated (10,22,59,60).…”

“…Radiosurgery may be suitable for patients with limited size and number of cerebral lesions (particularly those <3 cm in size and with mild edema and no mass effect) but in principle is feasible for brain lesions irrespective of their location (7,11-13,22,52-54) with a low complication rate, mortality and morbidity (50,52). Evidence supports the equivalence of stereotactic radiotherapy and surgery in the treatment of solitary metastatic cerebral lesions with a reported 1-year local control rate of 82% after stereotactic radiotherapy (55).…”

Ethanolic Extract from Derris scandens Benth Mediates Radiosensitzation via Two Distinct Modes of Cell Death in Human Colon Cancer HT-29 Cells

“…Its efficacy depends on the tumor's responsiveness to the fatal effects of radiation (Coventry and Ashdown, 2012). However, several malignancies are relatively radioresistant, leading to treatment failure (Gavriel et al, 2011;Hanson et al, 2012;Mannino and Chalmers, 2011). Radiosensitizers are agents that enhance the sensitivity of cancer cells towards radiotherapy (Girdhani et al, 2005;Moding et al, 2013).…”

Estimating the Additive Benefit of Surgical Excision to Stereotactic Radiosurgery in the Management of Metastatic Brain Disease

“…10 Graded prognostic score 11 was not utilized owing to the relatively small sample size of each primary malignancy. Tumors were classified as nonradiation sensitive (renal and melanoma) 12,13 or radiation sensitive (all others). Radiographic information was extracted from magnetic resonance (MR) brain imaging reports authored by a board-certified neuroradiologist.…”