Kim Yong Hwy, Kim Jin Wook, Chung Hyun-Tai, Paek Sun Ha, Kim Dong Gyu, Jung Hee-Won
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Prog Neurol Surg. 2012;25:163-75. doi: 10.1159/000331190. Epub 2012 Jan 6.
Renal cell carcinoma (RCC) is one of primary cancers which metastasis to the brain frequently, although RCC accounts for only 1% of all cancer. 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.
肾细胞癌(RCC)是常转移至脑的原发性癌症之一,尽管RCC仅占所有癌症的1%。与其他转移性肿瘤相比,RCC的转移瘤有瘤内出血倾向和相对较大的周围水肿。这些特征使得在转移性肿瘤的治疗中强调手术切除。然而,由于肿瘤和患者的特征,手术并不总是可行的。传统全脑放疗的效果并不理想,因为RCC对放疗有抵抗性,尽管它在其他恶性肿瘤中起重要作用。包括各种方式的立体定向放射外科(SRS)在控制肿瘤本身及周围水肿方面已显示出优异的效果。SRS的可重复性也是一个吸引人的优点,因为无论一线治疗方式如何,随时都可能出现新的脑转移。然而,已有报道称SRS后有一些不良反应,但其发生率和严重程度在无严重并发症的情况下是可以接受的。因此,在RCC脑转移的治疗中必须强调SRS,并可提出个体化的各种联合治疗策略。