A concise review of the efficacy of stereotactic radiosurgery in the management of melanoma and renal cell carcinoma bra
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REVIEW
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
A concise review of the efficacy of stereotactic radiosurgery in the management of melanoma and renal cell carcinoma brain metastases Peter W Hanson1,2, Ameer L Elaimy1,2, Wayne T Lamoreaux1,2, John J Demakas1,3, Robert K Fairbanks1,2, Alexander R Mackay1,4, Blake Taylor1,2, Barton S Cooke1, Sudheer R Thumma1,2 and Christopher M Lee1,2,5*
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.
Background The United States faces roughly 170,000 new cases of brain metastases each year, and this number is expected to increase as diagnostic technologies, such as magnetic resonance imaging (MRI), improve and as cancer patients acquire longer survival times [1-3]. The average survival of patients with brain metastases is one to two months with corticosteroid treatment alone, and four to seven months with whole brain radiotherapy (WBRT) alone [4]. The Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA), which categorizes patients into one of three classes based on the patient’s Karnofsky Performance Score (KPS), age, number of extracranial metastases, and status of primary cancer, with a higher class statistically indicating a worse prognosis, is the most common method for stratifying patients with brain metastases [4]. Out of all new brain metastases cases, approximately 1,200 to 5,100 originate from renal cell carcinoma annually, while roughly 10% originate from melanoma annually [5,6]. * Correspondence: [email protected] 1 Gamma Knife of Spokane, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA 2 Cancer Care Northwest, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA Full list of author information is available at the end of the article
Both melanoma and renal cell carcinoma have a welldocumented tendency to cause brain metastases. Melanoma represents the third most common primary origin of brain metastases, following non-small-cell lung cancer and breast cancer [7]. The reported clinical occurrence of brain metastases is 8 to 46% in patients diagnosed with mel
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