title: Gamma surgery for intracranial metastases from renal cell carcinoma.
abstract: OBJECTIVE
  The goal of this study was to evaluate the effectiveness and limitations of gamma surgery (GS) in the treatment of renal cell carcinoma that has metastasized to the brain.
  
  
  METHODS
  The authors performed a retrospective analysis of a consecutive series of 21 patients with 37 metastatic brain deposits from renal cell carcinoma who were treated with GS at the University of Virginia from 1990 to 1999. Clinical data were available in all patients. No patient died of progression of intracranial disease or deteriorated neurologically following GS. Eight patients clinically improved. Follow-up imaging studies were available for 23 tumors in 12 patients. Nine patients did not undergo follow-up imaging. One patient lived 17 months and succumbed to systemic disease: no brain imaging was performed in this case. Another patient refused further imaging and lived 7 months. Seven patients lived up to 4 months after the procedure; however, their physicians did not require these patients to undergo follow-up imaging examinations because of their general conditions-all had systemic progression of disease. Of the 23 tumors that were observed posttreatment, one remained unchanged in volume, 16 decreased in volume, and six disappeared. No tumor progressed at any time, and there were no radiation-induced changes on follow-up imaging an average of 21 months after GS (range 3-63 months).
  
  
  CONCLUSIONS
  Gamma surgery provides an alternative to surgical resection of metastatic brain deposits from renal cell carcinoma. Neurological side effects were seen in only one case; freedom from progression of disease was achieved in all cases.
authors.affiliation: Department of Neurological Surgery, Lars Leksell Center for Gamma Surgery, University of Virginia, Charlottesville, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Payne
authors.forename: D
authors.initials: D
authors.lastname: Prasad
authors.forename: G
authors.initials: G
authors.lastname: Szeifert
authors.forename: M
authors.initials: M
authors.lastname: Steiner
authors.forename: L
authors.initials: L
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D007680:Kidney Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome