title: Preoperative stereotactic body radiotherapy to a skull renal cell metastasis: an alternative to preoperative embolization?
abstract: BACKGROUND
  This is the first case study to report on using stereotactic body radiotherapy as an alternative and novel treatment modality for embolization to reduce the risk of operative bleeding for a metastatic renal cell tumor.
  
  
  METHODS
  A 58-year-old woman presented with an asymptomatic large 7-cm tumor on the parieto-occipital vertex of the skull. Given the location of this lesion along with its vascular histology, it was a challenge to provide safe and effective treatment using conventional management strategies.
  
  
  CONCLUSIONS
  We report on a rare presentation of a metastatic renal cell cancer and the use of stereotactic body radiotherapy as an innovative radiation approach to deliver high-dose radiation safely to control this large aggressive and vascular metastasis. The success of this management strategy allowed for minimal intraoperative blood loss, and the patient continues with local control 1-year posttreatment.
authors.affiliation: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. gunita.mitera@sunnybrook.ca
authors.forename: Gunita
authors.initials: G
authors.lastname: Mitera
authors.forename: Georg A
authors.initials: GA
authors.lastname: Bjarnason
authors.forename: Farhad
authors.initials: F
authors.lastname: Pirouzmand
authors.forename: Juan
authors.initials: J
authors.lastname: Bilbao
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
mesh_terms: D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000556:secondary* / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007668:Kidney / Q000473:pathology*; D007680:Kidney Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011829:Radiation Dosage; D011859:Radiography; D016634:Radiosurgery; D012888:Skull Neoplasms / Q000473:pathology*