title: Clinical outcome of stereotactic radiosurgery for central nervous system metastases from renal cell carcinoma.
abstract: BACKGROUND
  Current treatment modalities for central nervous system (CNS) metastases from renal cell cancer (RCC) include surgical resection, stereotactic radiosurgery (SRS), and whole-brain radiotherapy. Existing studies describing treatment outcomes for CNS metastases include multiple tumor types and thus provide little insight into how RCC CNS metastases respond to these modalities.
  
  
  METHODS
  RCC patients with brain metastases treated with SRS at the Cleveland Clinic between 1996 and 2010 were retrospectively identified. Radiosurgery and systemic therapy characteristics were recorded. Patients were followed up radiographically at 1 to 2 months after radiosurgery and every 3 to 6 months thereafter with magnetic resonance imaging scans.
  
  
  RESULTS
  Of the 166 patients identified, local control was obtained in 90% of patients. In 38% of patients there were additional distant CNS metastases at a median of 12.8 months (95% CI, 8.5-21.1) after SRS. The median time to progression (either local or distant) was estimated to be 9.9 months (95% CI, 5.9-12.9). Higher (> 2.5) RCC-specific graded prognostic assessment (GPA) score was the only factor examined that was found to be a significant prognostic factor for improved outcome (P = .02); however, there was some suggestion that a single target lesion (P = .07) and age ≥ 60 years (P = .07) may also be associated with better CNS control.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery for a limited number of CNS metastases from RCC is associated with excellent local control and is an effective if not preferred treatment modality.
authors: Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors: D J
authors: DJ
authors: Seastone
authors: Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors: P
authors: P
authors: Elson
authors: Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors: J A
authors: JA
authors: Garcia
authors: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors: S T
authors: ST
authors: Chao
authors: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
authors: J H
authors: JH
authors: Suh
authors: Department of Neurosurgery, Cleveland Clinic, Cleveland, OH.
authors: L
authors: L
authors: Angelov
authors: Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH. Electronic address: rinib2@ccf.org.
authors: B I
authors: BI
authors: Rini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brain metastases; CNS disease; Gamma Knife; Renal cell cancer; Stereotactic radiosurgery