Gamma knife radiosurgery for brain metastases from renal cell carcinoma with sorafenib and/or sunitinib therapy

Seiko Hasegawa1, Kenichiro Asano2, Tomoshige Kikkawa3, Tomofumi Kumagai3, Hiroki Ohkuma2

1Aomori, Japan 2Department of Neurosurgery, Hirosaki University Graduate School of Medicine 3Department of Neurosurgery, Kuroishi General Hospital

Keywords: brain metastasis, gamma knife, renal cancer, radiosurgery, outcome

Interactive Manuscript

Ask Questions of this Manuscript:



     The high incidence of intracerebral hemorrhage (ICH) is reported in patients with metastatic renal cell carcinoma (RCC) treated with the tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptor. 
     We retrospectively evaluated effectiveness and safety of gamma knife radiosurgery (GKS) for the treatment of brain metastases from RCC with sorafenib and/or sunitinib therapy.
     The mean patient age was 59.6 (range 42-79), and the Karnofsky Performance Scale score was 100 in all ptients. Two patients (40%) had solitary brain metastasis. All patients had extracranial diseases and received systemic anti-angiogenetic therapies. One patient was treated with sorafenib, 3 patients with sunitinib and 1 patient with both sunitinib and sequential sorafenib.
     Between July 2010 and June 2011, 5 patients (2 men and 3 women) with brain metastases from RCC were treated with GKS and followed up.  The mean tumor volume was 0.5cm3 (range 0.001–2.6 cm3), and the mean marginal dose prescribed was 20.9Gy (range 17–22Gy) at the 50% isodose line.
     The mean follow-up period was 5.6 months (range 3-10 months). All of the 10 treated tumors were controlled (tumor disappearance, 40%; tumor regression, 50%; and stable disease, 10%). Repeated GKS for newly developed lesion was conducted in one patient. No patient developed radiation necrosis and ICH.
     This was a retrospective review.
     GKS seems to be a safe and effective treatment for brain metastases from RCC with sorafenib and/or sunitinib therapy for a short term.
     Longer-term follow-up is indispensable and more data is required.


Project Roles:

S. Hasegawa (), K. Asano (), T. Kikkawa (), T. Kumagai (), H. Ohkuma ()