LOW INCIDENCE OF ASYMPTOMATIC BRAIN METASTASES IN PATIENTS WITH RENAL CELL CARCINOMA M. ERNEST MARSHALL, M.D. TOM PEARSON, M.D. WILLIAM SIMPSON, M.D.
KAREN BUTLER, R.N. WILLIAM McROBERTS, M.D.
From the Division of Hematology/Oneology and Division of Urology, University of Kentucky Medical Center, Lexington, Kentucky
ABSTRACT--Brain metastases from renal cell carcinoma are uncommon. The present study was! undertaken to determine the value of routine computerized tomographic (CT) scanning of thel)!!!i! brain in patients with renal cell carcinoma. A review oj 106 patients with renal cell carcinoma whO had undergone C T scan of the brain revealed brain metastases in only 13.2 percent. Brain metastases were accompanied by central nervous system (CNS) symptoms in 78.6 percent of patients; ~ with headaches constituting the most common presenting symptom (64.3 %). Brain metastases were detected in only 3.3 percent of patients who had no CNS symptoms at the time of evaluation. It concluded that CT scanning of the brain should be performed routinely only for those patients who report CNS symptoms at the time of evaluation.
~:iii!i!
Metastatic renal cell carcinoma (RCC) is an incurable disease with a highly variable course. Common sites of metastatic, or recurrent, disease include the nephreetomy bed, adrenals, lung, liver, bone, and lymphatics. Brain metastases from renal cell carcinoma are relatively infrequent. From a review of 926 patients with renal cell carcinoma, Gay, Litehy, and Caseino 1 reported that brain metastases developed in only 36 patients (3.9%). When present, however, brain metastases usually portend a poor prognosis, especially when untreated. Decker et al. 2 have demonstrated that brain metastases from renal cell eareinoma ean be effectively palliated by radiation therapy for multiple metastases and by surgical resection followed by radiation therapy for solitary metastases. The value of routine computerized tomographic (CT) brain scanning of patients with renal cell carcinoma to detect metastases has not been established previously. In the staging of patients with recurrent breast cancer, Muss, White, and Cowan a reported that 2 percent of asymptomatic patients had positive brain scans 300
while 30 percent of patients with CNS syrup, toms had metastases demonstrated by bral' n i~ scan. They concluded that routine brain scans) i are of no value in the staging of breast cancer pat#nts who lack CNS symptoms. The purposei; u~u~,, ,~,~,~,p s t review is to determine the yield off:!: routine CT seannmg of the brain among p tients with renal cell carcinoma and, partieu:; larly, to determine the value of CT scanning of'~~ patients who lack CNS symptoms that m i g h t suggest the presence of metastases. ii
Material and Methods To determine the value of routine CT scan, ning for the detection of brain metastases in patients with renal cell carcinoma a retrospective review was eondueted of the medical records of: 106 patients with renal cell eareinoma who had: undergone CT scanning of the brain. All pa, ; tients had a histologically confirmed diagnosiS: of renal cell eareinoma. Recorded parameterS;: included age, sex, Eastern Cooperative Oncol! ogy Group (ECOG) p e r f o r m a n c e statUS, !!i
UROLOGY
/
OCTOBER 1990
/
VOLUME XXXVI, N U M B E t l 4
TABLE I.
Patient characteristics
Number of patients Mean age (range i Male:female (ratio) Performanee status (ECOG) 0 1 2 3 4 Mean Nephreetomy status Nephreetomized Nonnephreetomized Duration of disease*
106 52.7 yrs. (25-72) 77:20 (2.7:1) 41 46 15 4 0
KAREN BUTLER, R.N. WILLIAM McROBERTS, M.D.
From the Division of Hematology/Oneology and Division of Urology, University of Kentucky Medical Center, Lexington, Kentucky
ABSTRACT--Brain metastases from renal cell carcinoma are uncommon. The present study was! undertaken to determine the value of routine computerized tomographic (CT) scanning of thel)!!!i! brain in patients with renal cell carcinoma. A review oj 106 patients with renal cell carcinoma whO had undergone C T scan of the brain revealed brain metastases in only 13.2 percent. Brain metastases were accompanied by central nervous system (CNS) symptoms in 78.6 percent of patients; ~ with headaches constituting the most common presenting symptom (64.3 %). Brain metastases were detected in only 3.3 percent of patients who had no CNS symptoms at the time of evaluation. It concluded that CT scanning of the brain should be performed routinely only for those patients who report CNS symptoms at the time of evaluation.
~:iii!i!
Metastatic renal cell carcinoma (RCC) is an incurable disease with a highly variable course. Common sites of metastatic, or recurrent, disease include the nephreetomy bed, adrenals, lung, liver, bone, and lymphatics. Brain metastases from renal cell carcinoma are relatively infrequent. From a review of 926 patients with renal cell carcinoma, Gay, Litehy, and Caseino 1 reported that brain metastases developed in only 36 patients (3.9%). When present, however, brain metastases usually portend a poor prognosis, especially when untreated. Decker et al. 2 have demonstrated that brain metastases from renal cell eareinoma ean be effectively palliated by radiation therapy for multiple metastases and by surgical resection followed by radiation therapy for solitary metastases. The value of routine computerized tomographic (CT) brain scanning of patients with renal cell carcinoma to detect metastases has not been established previously. In the staging of patients with recurrent breast cancer, Muss, White, and Cowan a reported that 2 percent of asymptomatic patients had positive brain scans 300
while 30 percent of patients with CNS syrup, toms had metastases demonstrated by bral' n i~ scan. They concluded that routine brain scans) i are of no value in the staging of breast cancer pat#nts who lack CNS symptoms. The purposei; u~u~,, ,~,~,~,p s t review is to determine the yield off:!: routine CT seannmg of the brain among p tients with renal cell carcinoma and, partieu:; larly, to determine the value of CT scanning of'~~ patients who lack CNS symptoms that m i g h t suggest the presence of metastases. ii
Material and Methods To determine the value of routine CT scan, ning for the detection of brain metastases in patients with renal cell carcinoma a retrospective review was eondueted of the medical records of: 106 patients with renal cell eareinoma who had: undergone CT scanning of the brain. All pa, ; tients had a histologically confirmed diagnosiS: of renal cell eareinoma. Recorded parameterS;: included age, sex, Eastern Cooperative Oncol! ogy Group (ECOG) p e r f o r m a n c e statUS, !!i
UROLOGY
/
OCTOBER 1990
/
VOLUME XXXVI, N U M B E t l 4
TABLE I.
Patient characteristics
Number of patients Mean age (range i Male:female (ratio) Performanee status (ECOG) 0 1 2 3 4 Mean Nephreetomy status Nephreetomized Nonnephreetomized Duration of disease*
106 52.7 yrs. (25-72) 77:20 (2.7:1) 41 46 15 4 0
