title: Gamma knife radiosurgery for renal cell carcinoma brain metastases.
abstract: OBJECTIVE
  The purpose of this study was to clarify the effectiveness of gamma knife radiosurgery (GKS) in achieving a partial or complete remission of so-called radioresistant metastases from renal cell carcinoma (RCC) and to propose guidelines for optimal treatment
  
  
  METHODS
  During a 5-year period, 29 patients (19 male and 10 female) with 92 brain metastases from RCC underwent GKS. The median tumor volume was 4.7 cm3 (range 0.5-14.5 cm3). Fourteen patients (48%) also underwent whole-brain radiotherapy (WBRT) before GKS, and two patients (6.8%) after GKS. The mean GKS dose delivered to the 50% isodose at the tumor margin was 16.8 Gy (range 13-30 Gy). All cases were categorized according to the Recursive Partitioning Analysis (RPA) classification for brain metastases. Univariate analysis was performed to determine significant prognostic factors and survival. The overall median survival was 7 months after GKS treatment. Age, sex, Karnofsky Performance Scale score, and controlled primary disease were not predictors of survival. Combined WBRT/GKS resulted in median survival of 18, 8.5, and 5.3 months for RPA Classes I, II, and III, respectively, compared with the median survival 7.1, 4.2, and 2.3 months for patients treated with WBRT alone.
  
  
  CONCLUSIONS
  These results suggest that WBRT combined with GKS may improve survival in patients with brain metastases from RCC. Furthermore, this improvement in survival was seen in all RPA classes.
authors.affiliation: Department of Neurological Surgery, Wayne State University, Detroit, Michigan 48201, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Hernandez
authors.forename: Lucia
authors.initials: L
authors.lastname: Zamorano
authors.forename: Andrew
authors.initials: A
authors.lastname: Sloan
authors.forename: James
authors.initials: J
authors.lastname: Fontanesi
authors.forename: Simon
authors.initials: S
authors.lastname: Lo
authors.forename: Kenneth
authors.initials: K
authors.lastname: Levin
authors.forename: Qinghang
authors.initials: Q
authors.lastname: Li
authors.forename: Fernando
authors.initials: F
authors.lastname: Diaz
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery