From the Research
Renal cell carcinoma (RCC) can spread to the leptomeninges, though this is relatively rare, as reported in a case series and literature review published in 2019 1. Leptomeningeal metastasis occurs in approximately 1-2% of RCC cases, typically presenting as a late manifestation of advanced disease. When RCC spreads to the leptomeninges, patients may experience symptoms such as:
- Headaches
- Mental status changes
- Cranial nerve deficits
- Back pain
- Radicular symptoms Diagnosis typically requires MRI with gadolinium enhancement of the brain and spine, along with cerebrospinal fluid analysis looking for malignant cells. Treatment options include:
- Systemic therapy (targeted agents like tyrosine kinase inhibitors or immunotherapy)
- Intrathecal chemotherapy
- Radiation therapy to symptomatic sites The prognosis for RCC with leptomeningeal involvement is generally poor, with median survival typically measured in months, as discussed in a study on leptomeningeal carcinomatosis published in 1999 2. Early recognition of neurological symptoms in RCC patients is important as prompt diagnosis and treatment may help manage symptoms and potentially improve quality of life, even if it doesn't significantly extend survival. According to a study on radiotherapy for brain metastases from renal cell cancer published in 2010 3, addition of whole-brain radiotherapy to stereotactic radiosurgery offers better intracerebral control and should be considered for RCC patients with one to three brain metastases. Additionally, a case report published in 2007 4 demonstrated that precise high-dose radiation in the form of stereotactic radiosurgery can cause significant tumor cell death in radiation-resistant brain metastases from RCC. The exact mechanism of how cancer cells reach the leptomeninges is not fully understood, but it is thought to occur through various routes, including hematogenous spread, direct extension from pre-existing lesions, or through perineural spaces, as discussed in a study published in 1983 5. However, the most recent and highest quality study on this topic is the 2019 case series and literature review 1, which provides the most relevant and up-to-date information on the spread of RCC to the leptomeninges.