We retrospectively studied the efficacy of gamma knife surgery (GKS) for metastatic brain tumors from renal cell carcinoma (RCC). To evaluate the efficacy of GKS for control of peritumoral edema, we retrospectively studied 280 consecutive metastatic brain tumors (100 from lung cancers, 100 from breast cancers, and 80 from RCC) associated with peritumoral edema. In addition, this study included 11 patients with metastatic brain tumors from RCC who underwent direct surgery. The tumor growth control rate of GKS was 84.3%. The extent of edema of RCC metastases was significantly larger than those from lung and breast cancer. Primary site (renal or not renal) and delivered marginal dose (25 Gy or more) were significantly correlated with control of peritumoral edema. All tumors treated by direct surgery were more than 2 cm in maximum diameter. Peritumoral edema at surgery was extensive but disappeared within 1–3 months, and neurological symptoms also improved in many cases. Total removal of brain metastases from RCC was easy with little bleeding in most cases. Our results suggest that GKS is effective for growth control of metastatic brain tumors from RCC. Higher marginal dose such as 25 Gy or more is desirable to obtain peritumoral edema control, so GKS is not suitable for control of symptomatic peritumoral edema associated with relatively large tumors. Tumor removal of RCC metastases is relatively easy and rapidly reduces peritumoral edema. Treatment strategy for metastatic brain tumors from RCC depends on tumor size, number of tumors, and presence of symptomatic peritumoral edema.
This is a preview of subscription content, log in to check access.
Flickinger JC, Kondziolka D, Lunsford LD et al (1994) A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28:797–802PubMedGoogle Scholar
Mehta MP, Rozental JM, Levin AB et al (1992) Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 24:619–625PubMedGoogle Scholar
Halperin EC, Harisiadis L (1983) The role of radiation therapy in the management of metastatic renal cell carcinoma. Cancer 51:614–617CrossRefPubMedGoogle Scholar
Onufrey V, Mohiuddin M (1985) Radiation therapy in the treatment of metastatic renal cell carcinoma. Int J Radiat Oncol Biol Phys 11:2007–2009PubMedGoogle Scholar
Cannady SB, Cavanaugh KA, Lee SY et al (2004) Results of whole brain radiotherapy and recursive partitioning analysis in patients with brain metastases from renal cell carcinoma: a retrospective study. Int J Radiat Oncol Biol Phys 58:253–258. doi:10.1016/S0360-3016(03)00818-6CrossRefPubMedGoogle Scholar
Amendola BE, Wolf AL, Coy SR et al (2000) Brain metastases in renal cell carcinoma: management with gamma knife radiosurgery. Cancer J 6:372–376PubMedGoogle Scholar
Muacevic A, Kreth FW, Mack A et al (2004) Stereotactic radiosurgery without radiation therapy providing high local tumor control of multiple brain metastases from renal cell carcinoma. Minim Invasive Neurosurg 47:203–208. doi:10.1055/s-2004-818511CrossRefPubMedGoogle Scholar
Schoggl A, Kitz K, Ertl A et al (1998) Gamma-knife radiosurgery for brain metastases of renal cell carcinoma: results in 23 patients. Acta Neurochir (Wien) 140:549–555. doi:10.1007/s007010050139CrossRefGoogle Scholar
Sheehan JP, Sun MH, Kondziolka D et al (2003) Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control. J Neurosurg 98:342–349. doi:10.3171/jns.2003.98.2.0342CrossRefPubMedGoogle Scholar
Mandell L, Hilaris B, Sullivan M et al (1986) The treatment of single brain metastasis from non-oat cell lung carcinoma. Surgery and radiation versus radiation therapy alone. Cancer 58:641–649PubMedGoogle Scholar
Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500PubMedCrossRefGoogle Scholar
Goyal LK, Suh JH, Reddy CA et al (2000) The role of whole brain radiotherapy and stereotactic radiosurgery on brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 47:1007–1012. doi:10.1016/S0360-3016(00)00536-8PubMedGoogle Scholar
Yang CC, Ting J, Wu X et al (1998) Dose volume histogram analysis of the gamma knife radiosurgery treating twenty-five metastatic intracranial tumors. Stereotact Funct Neurosurg 70(Suppl 1):41–49. doi:10.1159/000056405CrossRefPubMedGoogle Scholar
Higuchi Y, Serizawa T, Nagano O et al (2009) Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors. Int J Radiat Oncol Biol Phys 74:1543–1548. doi:10.1016/j.ijrobp.2008.10.035PubMedGoogle Scholar