Gamma surgery for intracranial metastases from renal cell carcinoma

Object. The goal of this study was to evaluate the effectiveness and limita tions of gamma surgery (GS)in the treatment of renal cell carcinoma that ha s metastasized to the brain. Methods. The authors performed a retrospective analysis of a consecutive se ries of 21 patients with 37 metastatic brain deposits from renal cell carci noma who were treated with GS at the University of Virginia from 1990 to 19 99. Clinical data were available in all patients. No patient died of progressio n of intracranial disease or deteriorated neurologically following GS. Eigh t patients clinically improved. Follow-up imaging studies were available fo r 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 i maging 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 follo wup imaging examinations because of their general conditions-all had system ic progression of disease. Of the 23 tumors that were observed posttreatmen t, one remained unchanged in volume, 16 decreased in volume, and six disapp eared. 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 eff ects were seen in only one case; freedom from progression of disease was ac hieved in all cases.