Brain metastases in renal cell carcinoma: Management with gamma knife radiosurgery

PURPOSE The purpose of this study was to evaluate survival and local control of bra in metastases in patients with renal cell carcinoma. METHODS AND MATERIALS From November 1993 through March 1999, 38 radiosurgical treatments using th e Leksell gamma knife unit were performed on 22 patients with renal cell ca rcinoma. The indications for treatment were failure after whole-brain radia tion therapy or de novo treatment. All radiosurgical treatments were given on an outpatient basis. The workup included computed tomography and magneti c resonance imaging. The age of the patients ranged from 38 to 80 years (me dian age, 60 years). The mean minimum tumor dose was 18 Gy, and the mean vo lume was 3.9 cc. Previous whole-brain radiation therapy was used in 11/22 ( 50%) patients. Four of 22 patients presented with single metastasis. Thirte en patients were treated once, one patient was treated four times and one p atient seven times for new lesions. The number of lesions treated ranged fr om one to 21. RESULTS One patient is alive at 63 months of followup. Twenty-one patients died, wi th a median survival of 8 months (range, 1-38 months). Eighteen of 21 patie nts died of nonneurologic causes. Overall local control was 98.5%. One pati ent developed radiation necrosis. CONCLUSIONS The long-term survival achieved in patients with renal cell carcinoma requi res aggressive management, even in the presence of multiple brain metastase s. Gamma knife radiosurgery for renal cell carcinoma is an effective noninv asive modality of treatment. It offers high local control rate and improved quality of life and survival.