Brain metastases from renal cell carcinoma
Brain metastases from renal cell carcinoma refer to the spread of cancerous cells from the kidneys to the brain. Renal cell carcinoma (RCC) is known for its tendency to metastasize to various organs, including the brain. When RCC metastasizes to the brain, it can form tumors or lesions within the brain tissue, which can lead to symptoms such as headaches, neurological deficits, seizures, and other manifestations depending on the location and size of the metastases.
Renal cell carcinoma is the most common kidney cancer which tends to metastasize to the brain in about 4–11% of cases with an average interval from nephrectomy to brain metastasis of 1–5 years 1) 2))
The metastatic tumor from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema compared with other metastatic tumors. These characteristics make an emphasis on the surgical resection in the management of metastatic tumor. However, the surgery is not always possible due to the characteristics of tumor and patient. The outcome of conventional whole brain radiotherapy is unsatisfactory due to the resistant feature of RCC to the radiation, although it plays an important role in other malignancies. The stereotactic radiosurgery (SRS) including various modalities have showed the excellent outcomes in the control of tumor itself and surrounding edema. The repeatability of SRS is also attractive merit, because the new brain metastasis can be encountered in anytime regardless of the first-line treatment modalities. A few adverse effects following SRS have been reported however, incidence and severity could be acceptable without severe morbidity. Therefore, SRS must be emphasized in the management of brain metastasis from RCC and individual various combined treatment strategies could be suggested 3).
Treatment
Case reports from the HGUA
Q11864
Age: 59 years Relevant Medical History: Hypertension (HTA), Type 2 Diabetes Mellitus (DM2).
Current Medications:
Bisoprolol 5mg, 1 tablet every 24 hours.
Metformin 1000mg, 1 tablet every 12 hours.
Omeprazole 20mg, 1 capsule every 24 hours.
Ferbisol (Iron) 100mg, 1 capsule every 24 hours.
Escitalopram 10mg, 1 tablet every 24 hours.
Oncological History:
Stage IV clear cell carcinoma with pulmonary metastases.
Previous treatments: Right nephroureterectomy, SBRT RADICAL TOTAL DOSE 60Gy, Nivolumab-Ipilimumab, Cabozantinib.
Clinical Presentation:
Progressive weakness and asthenia. Dizziness, instability, intense holocranial headache.
Radiological Findings:
Brain MRI: Space-occupying lesion in the right frontal lobe suggestive of brain metastasis.
TAP CT: Findings secondary to known oncological history, without significant progression signs. Postoperative Brain CT: Post-right frontal craniotomy changes without clear evidence of residual tumor. Surgical Procedure:
Craniotomy and resection of the brain tumor.
Postoperative Evolution:
Improvement of preoperative clinical status. Conscious, oriented, without new neurological focal deficits. Autonomous ambulation
Afebrile, no signs of wound infection. Postoperative images without complications or significant tumor remnants.
Management Plan:
Referral to Oncology and Radiotherapy for evaluation and management on the surgical bed. Hospital discharge with follow-up in Neurosurgery outpatient clinics. Comment: The patient has experienced a favorable evolution after the resection of the brain tumor, without significant postoperative complications. Multidisciplinary follow-up is planned to address the primary and secondary diseases.