SEARCH

SEARCH BY CITATION

Keywords:

  • brain metastasis;
  • gamma-knife radiosurgery;
  • renal cell carcinoma

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References

Background: The present study provides data from clinical experience with gamma-knife radiosurgery (GK) in patients with brain metastasis from renal cell carcinoma (RCC) and shows the value of this less invasive treatment modality.

Methods: Forty-two patients received GK. Twenty of the 42 cases had multiple brain metastases. Extracranial metastases were observed in the lung (38 cases), bone (12 cases), liver (9 cases), lymph node (5 cases) and skin (6 cases).

Results: Neurological symptoms seen in 40 patients were rapidly improved after GK in 32 patients (80%). Magnetic resonance imaging (MRI) evaluation after GK in 32 patients showed the disappearance of brain tumor in 9 patients (28%). Complete response was obtained by GK in tumors up to 30 mm in diameter. Repeated GK for newly developed lesions was conducted in 11 patients. Extracranial tumor resection was conducted in 7 cases (lung: 3, skin: 2, liver: 1, adrenal: 1). Chemo-radiotherapy or immunotherapy was effective in 8 cases (lung: 5, liver: 2, bone: 1). The actual one-, two- and three-year survival rates were 44.9%, 16.8%, and 11.2%, respectively. The median survival time was 12.5 months. In univariate analysis, the patients with successfully treated extracranial metastases had significantly better prognosis. In multivariate analysis, the patients with Karnofsky performance scale (KPS) ≥ 80%, who were treated by GK more than once and obtained complete response (CR) or partial response (PR) by GK, had significantly better prognosis.

Conclusion: Gamma-knife radiosurgery for RCC is an effective non-invasive modality of treatment. It offers a high local control rate and an improved quality of life and survival rate.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References

Radiosurgery is a stereotactically guided high-precision irradiation method focusing ionizing radiation within the target volume in a single dose application. The characteristic steep dose decrease allows the selective destruction of small intracranial lesions, while optimally protecting the surrounding brain tissue.1

Metastatic brain tumors can be an ideal target for gamma-knife radiosurgery (GK) because of their spherical shape and sharp margin compared to malignant primary brain tumors that have an irregular shape and invading nature.2,3 There are several studies on the usefulness of GK for brain metastases based on different histologic types. Local tumor control rates were reported to be 77–99%.2

In 1989, Lindquist4 first described the efficacy of GK for a patient of recurrent solitary cerebral metastasis from renal cell carcinoma (RCC). For GK, he employed a central dose of 70 Gy and a peripheral dose of 2 Gy caused progressive necrosis and shrinkage of the tumor, as verified by computed tomographic (CT) scan taken 2 and 4 months after treatment.

This study provides data from clinical experiences with GK in the treatment of patients of multiple metastases from RCC.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References

From September 1993 to December 1999, 42 patients (11 women and 31 men) with a median age of 64 years (range: 36–80), demonstrating brain metastases in magnetic resonance imaging (MRI) scans, received GK. Informed consent was obtained from each patient. Median follow-up period after radiosurgery was 9.5 months (range: 0.5–88 months depending on survival). The patient characteristics are summarized in Table 1. The Karnofsky performance scale (KPS)5 of the patients was 100% and 90% in 11 patients, 80% in 7 patients, 70% in 6 patients, 60% and 40% in 1 patient and 20% in 5 patients, in which a 100–80% scale indicates an ability to carry on normal activity and work with no special care requirements.

Table 1.   Characteristics of patients with brain metastasis from renal cell carcinoma (n = 42)
Characteristics 
  1. GK, gamma-knife radiosurgery; KPS, Karnofsky performance status.

Age (years)
 Mean63
 Range36–80
Gender
 Male31 (74%)
 Female11 (26%)
Clinical presentation
 Headache, emasis34 (81%)
 Seizure only 2 (5%)
 Neurologic deficit 4 (10%)
 Asymptomatic 1 (2%)
KPSA
 Median78
 Range20–100
Brain metastasis treated with GK
 Single22 (52%)
 Multiple20 (48%)
No. sessions of GK
  131 (74%)
  2 7 (17%)
  4 2 (5%)
  5 1 (2%)
 11 1 (2%)
Surgical resection of brain tumor
 Before radiosurgery 1 (2%)
 After radiosurgery 0 (0%)
 Total 1 (2%)
Whole brain radiation therapy
 Yes 1 (2%)
 No41 (98%)
Extracranial metastasis
 Yes41 (98%)
 No 1 (2%)
Sites of extracranial metastasis
 Lung38
 Bone12
 Liver 9
 Lymph node 5
 Adrenal 4
 Skin 6
Surgical resection of extracranial metastasis
 Lung 3
 Liver 1
 Adrenal 1
 Skin 2
Arterial infusion chemotherapy   to extracranial metastasis
 Lung 1
 Liver 3
 Bone 2

The mean period between diagnosis of primary RCC and GK treatment of brain metastasis was 36.9 months (range: 0–120 months). Brain metastases were diagnosed by CT or MRI scans.

Thirty-two patients received nephrectomy; however, 10 could not receive nephrectomy because of multiple metastases. All the patients who could not receive nephrectomy received embolization of the renal artery 0 to 13 months (median: 5 months) before GK treatment. In 7 patients, RCC and brain metastasis were diagnosed simultaneously. Gamma-knife radiosurgery was performed, followed by nephrectomy in 5 patients then renal arterial embolization in 2 patients.

At the initial GK treatment, 22 cases had one brain metastasis, 6 cases had two metastases, 6 cases had three metastases, 2 cases had four metastases, 2 cases had five metastases, 1 case had six metastases, 2 cases had 10 metastases and 1 case had 14. Median tumor diameter was 15 mm (range: 2–35). The tumor location within the brain included the frontal lobe (n = 32), temporal lobe (n = 14), parietal lobe (n = 23), occipital lobe (n = 23), cerebellum (n = 18), pons (n = 1) and intraventricular (n = 2).

Neurologically, two patients were asymptomatic and others showed signs and symptoms of intracranial hypertension, focal neurological deficits and/or symptomatic epilepsies (Table 1).

Clinical and neuroimaging follow-up was obtained for 38 patients between 6 days and 88 months (mean: 12.5 months) after radiosurgery. Magnetic resonance imaging was requested every 3 months for 1 year and then at 4–6 month intervals as indicated. Contrast enhancement was used to define tumor border and volume.

A significant change in tumor measurement (shrinkage or progression) was defined as > 25% reduction in at least one dimension. The delayed development of central necrosis was defined as loss of contrast enhancement within tumors that previously had homogenous enhancement.

Recurrence in the brain was classified as ‘local’ (defined as recurrence of the brain metastasis in the same site as the treated original lesion) or ‘distant’ (any new brain metastasis in a location distinct from the original tumor).

The brain tumors appeared as a contrast-enhancing solid or ring-enhanced mass in the parenchyma, usually associated with edema in the surrounding areas. Histologic tumor confirmation was not obtained routinely because all of the patients had typical radiographic findings in conjunction with known RCC. Intratumoral hemorrhage was identified in three patients prior to radiosurgery.

Extracranial metastases were observed in the lung (38 cases), bone (12 cases), liver (9 cases), lymph node (5 cases), adrenal (4 cases), and skin (6 cases). One case showed no extracranial metastasis. The study was closed 8 months after GK treatment of the last included patient.

Stereotactic radiosurgery

Stereotactic radiosurgery was performed by the standard gamma-knife technique.3 Axial and coronal contrast-enhanced T1-weighted MR images of 3.6 mm slice thickness and an interslice gap of 0.4 mm was performed throughout the brain to detect the smallest lesion. Prescribed dose to the enhanced margin of the tumor varied from 20 to 30 Gy (median: 25) using 50% or higher isodose line according to the volume and site of the tumors. Total treatment time including frame fixation, image acquisition, dose planning and radiation was 1 h to several hours according to the number of tumors and complexity of the three-dimensional shape of the target volume. Most patients were admitted to the hospital the day before treatment and were discharged the day after treatment.

Statistical analysis

The Kaplan–Meier method was used to calculate the survival time of patients. The log–rank test was used to compare two groups in univariate analyses of unordered categorical variables. The Cox proportional hazard model was used in analyses of ordered categorical variables and continuous variables. All statistical analyses were performed by Stat View 5.0 (SAS Institute, Cary, NC). A probability value of less than 0.05 was defined as statistically significant.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References

Local control of brain metastasis by GK

After radiosurgery, we found that the contrast-defined dimensions of a tumor may enlarge occasionally on imaging before regression occurs. In general, after the GK treatment tumors developed three layers and displayed areas with central high intensity, low-iso area and a high ring (Fig. 1). The tumors then decreased and disappeared (Fig. 2). We defined local recurrence as persistent tumor growth that occurred on imaging studies, usually 1–3 months apart.

image

Figure 1.  Serial axial magnetic resonance imaging before and after radiosurgery for metastatic renal cell carcinoma to the right frontal lobe in a 47-year-old woman. (a) 28/7/94 Radiosurgery using an 18 mm isocenter and a margin dose of 24 Gy was exposed to treat a 12 mm brain tumor. (b) 13/12/94 Five months after radiosurgery, an increase in the volume of contrast enhancement was noted, with a central low enhanced area that we suspected to be necrotic. (c) 17/5/95 Nine months after radiosurgery, the regressed 8 mm tumor remained and was again treated with 24 Gy margin dose. This tumor completely disappeared 23 months after radiosurgery but 2 new occipital metastases (12 mm and 14 mm) were found and treated with 24 Gy margin doses (26/6/96). The patient suffered slight left side hemiplegia for 2 days after the treatment.

Download figure to PowerPoint

image

Figure 2.  Serial axial magnetic resonance imaging before and after radiosurgery for metastatic renal cell carcinoma in a 69-year-old man. White arrows indicate brain tumors that were treated by gamma-knife radiosurgery (GK). (a) 4/12/98 A 12 mm frontal brain metastasis was found in December 1998, and was treated with 25 Gy margin dose of radiosurgery. (b) 15/6/99 Six months after GK, the frontal brain metastasis decreased in size. (c) 8/17/99 The tumor disappeared 8 months later. (d) 17/8/99 A new lesion at the left cerebellum was found and treated again with GK. (e) 14/12/1999 Four new brain metastases were detected and treated. (f) 9/5/2000 The brain tumors were necrotic.

Download figure to PowerPoint

Neurological symptoms seen in 40 patients were rapidly improved after GK in 32 patients (80%). There were no changes in 7 cases (18%) and progression occurred in 1 patient (2%). Magnetic resonance imaging evaluation after GK in 32 patients showed the disappearance of the brain tumor in 9 cases (28%), decrease in 13 (41%), no change in 7 (22%) and growth in 3 (9%) cases. Complete response was obtained by GK in tumors up to 30 mm in diameter.

Repeated GK was conducted in 11 patients (two in 7, four in 2, five in 1 and 11 in 1). The patient who received GK 11 times was a 57-year-old male who was treated by right nephrectomy 50 months before the first radiosurgery. Liver metastasis was treated by hepatic arterial infusion (HAI) with lipiodol SMANCS6,7 and achieved partial response (PR). Bone metastases were treated by total 110 Gy of irradiation. From October 1993 to April 1996, GK was performed for a total of 30 lesions and complete response (CR) was obtained. He died in October 1996 due to multiple lung and bone metastases.

Three patients with 10 brain metastases or more (10, 10 and 14) died. One of the patients with 10 brain tumors had only five tumors treated with GK. He had more than 25 lung metastases, the largest being 3.4 cm and had liver and adrenal metastasis as well as hypercalcemia. He died 14 days after GK treatment due to progression of lung metastasis. Two other patients died 3 and 4 months, respectively, after GK. One of these patients had 10 brain tumors after treatment of right femur metastasis by irradiation and surgical fixation. All 10 brain tumors were treated and neurological symptom (convulsion) was improved. He died due to deterioration of neurological symptom 4 months after GK treatment.

Four patients died within 1 month after GK. Karnofsky performance scale of these four cases were 70% in two cases, 80% in one and 20% in one, respectively. One case treated with anticoagulant (warfarin) for a history of cerebral infarction died 6 days after the second GK treatment due to bleeding from the tumor. One patient received resection of brain tumor 12 months before GK treatment. He had six new brain metastases when he received GK and died 13 days after GK. The remaining patient had cerebral infarct 2 months before GK treatment with a KPS of 20%. She died 18 days after GK. One had 10 brain metastases and received GK treatment for only five tumors as stated in the previous paragraph.

Results of control of extracranial metastasis

Chemo-radiotherapy and immunotherapy were effective in 8 cases (lung: 5, liver: 2, bone: 1). Lung metastases were resected in 3 cases before GK treatment. Interferon-α or interferon-α cimetidine8 was administered for lung metastasis and PR was obtained in 4 cases. In 4 liver metastasis cases, extirpation was performed in 1 case. Hepatic arterial infusion and embolization9,10 were performed in 3 cases and PR was obtained in 2 cases. In 11 cases of bone metastasis, 4 cases received irradiation, and 2 cases underwent arterial infusion and embolization. Contra-lateral adrenalectomy was performed in 1 case. Subcutaneous metastasis in 2 of 6 cases were resected.

Prognosis

At the end of the study, 9 patients were alive at 9, 14, 14, 14, 15, 19, 20, 28, and 88 months respectively, while 33 patients died within 38 months. The actual one-, two-, and three-year survival rates were 44.9%, 16.8% and 11.2%, respectively (Fig. 3). The median survival time was 12.5 months. There was no significant difference in the survival rates between the 32 patients with and the 10 without nephrectomy (Fig. 4). The renal tumors in the 10 cases without nephrectomy were controlled by renal arterial embolization.

image

Figure 3.  Kaplan–Meier survival curve of 42 brain metastases in renal cell carcinoma patients treated by gamma-knife radiosurgery. The actual one-, two-, and three-year survival rates were 44.9%, 16.8% and 11.2%, respectively. The median survival period was 12.5 months.

Download figure to PowerPoint

image

Figure 4.  Kaplan–Meier survival curves of 32 patients with and 10 without nephrectomy who were treated by the gamma-knife radiosurgery for renal cancer. (—) Nephrectomy performed, n = 32; (---) nephrectomy could not be performed, n = 10. P = 0.27.

Download figure to PowerPoint

In univariate analysis, the patients with successfully treated extracranial metastases had significantly better prognosis than patients without or with ineffective treatment (P < 0.05). Patients with a KPS ≥ 80% had better prognosis than those with KPS < 80% (P < 0.001). Patients treated by GK more than once and those who obtained CR or PR by GK had significantly better prognosis (P < 0.001, P < 0.001). In multivariate analysis, the patients with KPS ≥ 80%, who were treated by GK more than once and obtained CR or PR by GK, had significantly better prognosis (Table 2).

Table 2.   Univariate and multivariate analysis of prognostic variables for survival in 42 renal cell carcinoma (RCC) patients with brain metastasis treated by gamma-knife radiosurgery (GK)
 Univariate (P-value)Multivariate (P-value)Tested for favorable status
  1. GK, gamma-knife radiosurgery; KPS, Karnofsky performance status.

Age (≤ 60 vs > 60 years)0.41520.6148≤ 60(n = 29)
Gender0.25880.1574Male(n = 31)
KPS (≥ 80 vs < 80)0.00050.0125≥ 80(n = 29)
Control of extracranial metastases0.04860.5292Yes(n = 11)
Nephrectomy0.22930.4145Yes(n = 32)
Response of brain metastases0.00020.0024Yes(n = 22)
Single vs multiple GK sessions0.00420.0324Multiple(n = 11)

Complications

In some cases, temporary enlargement of the brain tumor associated with aggravation of edema was observed after GK treatment. However, chronic steroid dependence for increased brain edema did not appear to be common.2

One patient died due to bleeding from the tumor 6 days after second GK treatment. He had a 2 cm frontal metastasis and had suffered from cerebral infarct one year before, and had been treated with anticoagulant (warfarin) which may caused brain bleeding.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References

The goal of radiosurgery for brain metastases is local disease control resulting in stabilization or improvement of clinical symptoms, enhanced survival and reduced risks. Death from progression of brain disease (7%) was relatively uncommon in our series. We noted 2 cases (4%) of fetal bleeding from the tumor after radiosurgery.

Surgical resection of brain metastasis

Surgical excision remains an important therapy for selected patients with large brain tumors. There are limited reports including a large series on resection of RCC brain metastases. The best outcomes after surgical resection were achieved in patients with a solitary, surgically accessible tumor and in patients without systemic disease. Wronski et al.11 reported results from 50 patients who had undergone surgical resection. They included 18% with multiple brain metastases. The postoperative mortality rate was 10% and the postoperative complication rate was 28%. The median survival was 12 months from the diagnosis of brain metastasis. Although 22 patients had whole-brain radiotherapy postoperatively, brain recurrence occurred in 49% of 45 patients who survived more than 1 month after craniotomy, including 20% with local recurrence. Approximately 42% of patients died of neurogenic causes and 51% died of systemic disease. In our GK treated cases, median survival was 12.5 months, the management mortality was 2/42, and higher local control rate (93%) was noted.

Whole-brain radiotherapy (WBRT)

Wronski et al.12 reported 119 RCC cases of brain metastasis treated by WBRT. Survival rates were 33.6 at 6 months, 16.8 at 1 year, and 5.9% at 2 years. They concluded that more aggressive approaches, such as surgery or radiosurgery, should be applied whenever possible. Hall et al.13 stated that GK did not significantly influence survival and that WBRT and chemotherapy were associated with prolonged survival. On the other hand, Amendola et al.14 reported GK treatment in 11 cases who received previous WBRT. The local control of brain metastasis was 98.5%. So, GK treatment can be applied in the cases who were previously treated with WBRT.

The role of WBRT with GK remains unresolved. Amendola et al.,14 Schoggl et al.15 and Mori et al.16 did not find a reduction of distant failure after WBRT (Table 3). This failure rate might be influenced by extracranial disease activity, i.e. new dissemination of tumor cells, rather than survival of clonogenic subclinical deposits present at time of WBRT. The latter hypothesis is consistent with the high rate of patients with active visceral metastasis and uncontrolled primary tumors. Therefore, reduction of distant failure might be achieved only in patients with controlled extracranial disease.17 GK treatment for new lesions is easy and effective. Our 11 cases undergoing repeated GK for new brain metastasis survived longer than those receiving single GK treated cases. Early diagnosis of new lesion and treatment by GK are essential and may contribute to longer survival when extracranial metastasis is controlled.

Table 3.   Summary of gamma-knife radiosurgery for brain metastasis of renal cell carcinoma
AuthorCasesGK aloneGK + WBRT (%)CR (%)Local tumor control (%)Median survival (months)
  1. CR, complete response; GK, gamma-knife radiosurgery; WBRT, whole-brain radiotherapy.

Schoggl et al.152314 9179611
Mori et al.1635 728219011
Amendola et al.14221111 91 8.4
Present study4241 1279312.5

Brain tumor control rate by GK

In larger studies from different groups around the world, brain tumor control rates of 85–95%, recurrence rates of 6–15% and side-effect rates of 3–15% have been attained, independent of the system used.2 Patients with good prognosis had volume of metastases < 10 mL, applied dose > 18 Gy, only one or two metastases, absence of extracranial metastases, and good patient performance with a KPS > 70%.1,18

Recently, low dose radiotherapy was used for brain metastasis from RCC. Renal cell carcinoma is believed to be radio-resistant. However, many reports including ours showed that relatively low doses of radiotherapy are effective. Boyd et al.2 summarizes and analyzes 21 independent reports of GK or linear accelerator-based radiosurgery, representing over 1700 patients and more than 2700 lesions. The composite data reveal an average local control rate of 83% and median survival of 9.6 months. The exact impact of the dose has not been clarified, but a dose–response relationship, especially for ≥ 18 Gy, is emerging.19

Suzuki et al.20 reported 24 patients with 10 or more simultaneous metastatic brain tumors. Of 12 patients who had brain metastasis-related symptoms, five improved, six were unchanged, and one deteriorated, as reflected by the KPS scores. The median survival time was 11 weeks. In our 3 patients with 10 or more simultaneous brain tumors, one died within 1 month, one survived 3 months and one survived 4 months. Multiple brain metastases of more than 10 has limited indication for GK.

Mehta et al.21 reported a lower complete response rate (11%) in patients with RCC brain metastases. Mori et al.16 and Schoggl et al.15 reported rates of 21 and 17%, respectively. In our case, 9 of 33 patients (27%) obtained complete response. Repeated GK may have contributed to the high CR rate.

Amendola et al.14 reported seven administrations of GK for brain metastasis from RCC. Our case received GK 11 times. The patient survived 38 months after the first GK. Gamma-knife radiosurgery for a total 30 of lesions was performed and CR was obtained. He died with multiple lung and bone metastases.

Patients with a single non-small-cell lung cancer, breast cancer, melanoma, RCC, and ovarial carcinoma brain metastasis have the best chance for long-time survival.21 Amendola et al.14 reported a patient surviving at 63 months after the first GK. The patient had no extracranial metastasis. We have a similar case, who had one brain metastasis and no extracranial metastasis, alive at 88 months after GK.

Management of extracranial metastases

Kinouchi et al.8 examined the effect of a combination of human lymphoblastoid interferon-α and cimetidine, and found the objective response was 41%. The lung metastasis showed the best response to combined therapy. In our cases, four patients with lung metastases responded favorably to interferon-α and cimetidine.

Cytoreductive surgery was also useful for metastatic tumors in RCC. For metastatic RCC to the lung, tumor reduction surgery is effective in some selected slow-growing cases.9

Vascular tumors can be treated by embolization or chemoembolization, with high expectation of response. We observed metastatic renal tumor to the bone could be detected by angiography, because metastatic renal tumors are hypervascular.10 Bone metastasis from RCC can be treated by intra-arterial infusion chemotherapy using vinblastine and epirubicine.22 Some metastatic liver tumors from colorectal and esophageal cancer are successfully treated HAI.23 Nakajima et al.24 reported 9 patients with liver metastases from esophageal squamous cell carcinoma using HAI. Hepatic arterial infusion was effective in 5 patients (56%) with a CR in 2 patients. We tried HAI chemotherapy in 3 cases and obtained partial response in 2 cases.

Of our 11 patients who received repeated GK, seven also underwent lung tumor resection, and five received chemo-embolization to liver and bone metastases. These 11 patients survived longer than those who received only one GK. Accordingly, patient KPS is good after GK, and not only systemic therapy to extracranial metastases, but also local treatments such as dissection of tumor or irradiation and/or arterial infusion chemotherapy should be considered.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References

Even in the presence of multiple brain metastasis long-time survival may be achieved by aggressive treatment of both intracranial and extracranial metastasis. Gamma-knife radiosurgery for RCC is an effective non-invasive modality of treatment. It offers high local control rate and improved quality of life and survival.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References

We thank the following doctors and nurse for their valuable cooperation and assistance in gathering patient data for this study:

Fumihiko Soma md, Department of Urology, Hachinohe Municipal Hospital

Isao Numata md, Department of Urology, Furukawa Municipal Hospital

Kou Takada md, Department of Urology, Iwate Prefectural Hospital

Susumu Numasato md, Department of Urology, Iwate Red Cross Hospital

Kenji Numahata md, Department of Urology, Sendai Red Cross Hospital

Katushiko Oikawa md, Department of Urology, Iwai Hospital

Yoshitada Imai md, Department of Urology, Sendai Municipal Hospital

Kazuyuki Yoshikawa md, Department of Urology, Sendai National Hospital

Yosuke Nishimura md, Department of Urology, Sendai JR Hospital

Seiichi Kurosu md, Department of Urology, Fukushima Rosai Hospital

Shiro Mitukawa md, Izumi Chuou Hospital

Kazuhira Satoh md, Konno Hospital

Kouichi Kambe md, Department of Urology, Senseki Hospital

Hiroaki Kato md and Masayoshi Hiramatsu md, Department of Urology, Yamagata Prefectural Hospital

Kou Takada md, Department of Urology, Iwate Prefectural Hospital

Masashi Handa md, Department of Surgery, Sendai Kosei Hospital

Sato rs, Department of Urology, Tohoku University School of Medicine.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusion
  8. Acknowledgments
  9. References
  • 1
    Becker G, Duffner F, Kortmann R, Weinmann M, Grote EH, Bamberg M. Radiosurgery for the treatment of brain metastases in renal cell carcinoma. Anticancer Res. 1999; 19: 16117.
  • 2
    Boyd TS, Mehta MP. Stereotactic radiosurgery for brain metastases. Oncology 1999; 13: 1397409.
  • 3
    Jokura H, Takahashi K, Kayama T, Yoshimoto T. Gamma knife radiosurgery of a series of only minimally selected metastatic brain tumors. Acta Neurochir. (Wien) 1994; 62 (Suppl.): 7782.
  • 4
    Lindquist C. Gamma knife surgery for recurrent solitary metastasis of a cerebral hypernephroma: case report. Neurosurgery 1989; 25: 8024.
  • 5
    Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma. Cancer 1948; 1: 63456.
  • 6
    Tsuchiya K, Uchida T, Kobayashi M, Maeda H, Konno T, Yamanaka H. Tumor-targeted chemotherapy with SMANCS in lipiodol for renal cell carcinoma: longer survival with larger size tumors. Urology 2000; 55: 495500.
  • 7
    Okusaka T, Okada S, Ishii H et al. Transarterial chemotherapy with zinostatin stimalamer for hepatocellular carcinoma. Oncology 1998; 55: 27683.
  • 8
    Kinouchi T, Saiki S, Maeda O, Kuroda M, Usami M, Kotake T. Treatment of advanced renal cell carcinoma with a combination of human lymphoblastoid interferon-alpha and cimetidine. J. Urol. 1997; 157: 16047.
  • 9
    Hoshi S, Orikasa S, Yoshikawa K et al. Study on the surgical treatment for pulmonary metastasis from renal cell carcinoma. Nippon Hinyokika Gakkai Zasshi 1997; 88: 4652.
  • 10
    Hoshi S, Orikasa S, Yoshikawa K et al. Evaluation of bone metastases from renal cell carcinoma. Nippon Hinyokika Gakkai Zasshi 1991; 82: 64954.
  • 11
    Wronski M, Arbit E, Russo P, Galicich JH. Surgical resection of brain metastases from renal cell carcinoma in 50 patients. Urology 1996; 47: 18793.
  • 12
    Wronski M, Maor MH, Davis BJ, Sawaya R , Levin VA. External radiation of brain metastases from renal carcinoma: a retrospective study of 119 patients from the MD Anderson Cancer Center. Int. J. Radiat. Oncol. Biol. Phys. 1997; 37: 7539.
  • 13
    Hall WA, Djalilian HR, Nussbaum ES, Cho KH. Long-term survival with metastatic cancer to the brain. Med. Oncol. 2000; 17: 27986.
  • 14
    Amendola BE, Wolf AL, Coy SR, Amendola M, Bloch L. Brain metastases in renal cell carcinoma: management with gamma knife radiosurgery. Cancer J. 2000; 6: 3726.
  • 15
    Schoggl A, Kitz K, Ertl A, Dieckmann K, Saringer W, Koos WT. Gamma-knife radiosurgery for brain metastases of renal cell carcinoma: results in 23 patients. Acta Neurochir. (Wien) 1998; 140: 54955.
  • 16
    Mori Y, Kondziolka D, Flickinger JC, Logan T, Lunsford LD. Stereotactic radiosurgery for brain metastasis from renal cell carcinoma. Cancer 1998; 83: 34453.
  • 17
    Nieder C. Stereotactic radiosurgery for brain metastasis from renal cell carcinoma. Cancer 1999; 85: 2513.
  • 18
    Simonova G, Liscak R, Novotny J. Solitary brain metastases treated with the leksell gamma knife: prognostic factors for patients. Radiother. Oncol. 2000; 57: 20713.
  • 19
    Shiau CY, Sneed PK, Shu HK et al. Radiosurgery for brain metastases: relationship of dose and pattern of enhancement to local control. Int. J. Radiat. Oncol. Biol. Phys. 1997; 37: 37583.
  • 20
    Suzuki S, Omagari J, Nishio S, Nishiye E, Fukui M. Gamma knife radiosurgery for simultaneous multiple metastatic brain tumors. J. Neurosurg. 2000; 93 (Suppl. 3): 301.
  • 21
    Mehta MP, Rozental JM, Levin AB et al. Defining the role of radiosurgery in the management of brain metastases. Int J. Radiat. Oncol. Biol. Phys. 1992; 24: 61925.
  • 22
    Shichiri Y, Kanba T, Yoshida S, Arai Y, Jajehi Y, Yoshida O. Intra-arterial infusion chemotherapy in combination with a biscoclaurine alkaloid, Cepharanthin, to treat bone metastasis arising from renal cell carcinoma. Int. J. Urol. 1994; 1: 34951.
  • 23
    Kemeny NE, Ron IG. Liver metastases. Curr. Treat. Options. Gastroenterol. 1999; 2: 24957.
  • 24
    Nakajima Y, Nagai K, Maruyama M et al. Hepatic arterial infusion chemotherapy for liver metastasis from esophageal squamous cell carcinoma. Gan To Kagaku Ryoho 2000; 27: 19115.