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Cerebral metastasis after primary renal cell carcinoma
  1. S Heckl1,
  2. K Braun2,
  3. J Debus2,
  4. S Kunze3
  1. 1Department of Neuroradiology, University of Heidelberg Medical School, Kopfklinik, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
  2. 2Department of Radiation Oncology, German Cancer Research Centre, Heidelberg
  3. 3Department of Neurosurgery, University of Heidelberg
  1. Correspondence to:
 Dr med Stefan Heckl;
 s.heckl{at}dkfz-heidelberg.de

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The article by Roser et al,1 in which it was shown that the treatment of intracranial metastases originating from renal cell carcinoma can on occasion be successful, was most interesting.

We have followed the clinical course of a patient with a renal cell carcinoma with a low mitotic index since 1989. In this patient the course was distinctly more malignant but the disease has also been successfully treated to date. In the last 13 years, this patient has had four metastases surgically removed and a further nine treated with stereotactically guided percutaneous single dose convergent beam irradiation therapy (stereotactic modified linear accelerator, 6–15 MV photons, 18–20 Gy prescribed to the 80% isodose). Apart from slight mnemonic deficits, the patient is in good health.

The following factors which affect the prognosis2–4 were all met by our patient:

  • The interval between the diagnosis of renal cell carcinoma and the first detected brain metastasis exceeds 17 months (our patient, 18 months; the patient described by Roser et al,1 36 months);

  • Age below 60 years at the time of initial diagnosis;

  • Primary tumour of the left kidney, initial nephrectomy;

  • Diameter of primary metastasis < 2 cm;

  • Not more than one brain metastasis at the time of initial treatment;

  • Solely intracranial metastases;

  • Karnofsky > 70%;

  • No systemic symptoms such as fever or weight loss at the time of diagnosis;

  • Blood sedimentation rate under 50 mm/h at diagnosis of renal cell carcinoma.

Patients in whom prognostic factors predict a good outcome should be treated with intent to cure.

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