Radiosurgery in patients with renal cell carcinoma metastasis to the brain: long-term outcomes and prognostic factors influencing survival and local tumor control

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  • 1 Department of Neurological Surgery, University of Pittsburgh, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania; and Department of Neurological Surgery, University of Virginia, Health Sciences Center, Charlottesville, Virginia
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Object. Renal cell carcinoma is a leading cause of death from cancer and its incidence is increasing. In many patients with renal cell cancer, metastasis to the brain develops at some time during the course of the disease. Corticosteroid therapy, radiotherapy, and resection have been the mainstays of treatment. Nonetheless, the median survival in patients with renal cell carcinoma metastasis is approximately 3 to 6 months. In this study the authors examined the efficacy of gamma knife surgery in treating renal cell carcinoma metastases to the brain and evaluated factors affecting long-term survival.

Methods. The authors conducted a retrospective review of 69 patients undergoing stereotactic radiosurgery for a total of 146 renal cell cancer metastases. Clinical and radiographic data encompassing a 14-year treatment interval were collected. Multivariate analyses were used to determine significant prognostic factors influencing survival.

The overall median length of survival was 15 months (range 1–65 months) from the diagnosis of brain metastasis. After radiosurgery, the median survival was 13 months in patients without and 5 months in those with active extracranial disease. In a multivariate analysis, factors significantly affecting the rate of survival included the following: 1) younger patient age (p = 0.0076); 2) preoperative Karnofsky Performance Scale score (p = 0.0012); 3) time from initial cancer diagnosis to brain metastasis diagnosis (p = 0.0017); 4) treatment dose to the tumor margin (p = 0.0252); 5) maximal treatment dose (p = 0.0127); and 6) treatment isodose (p = 0.0354). Prior tumor resection, chemotherapy, immunotherapy, or whole-brain radiation therapy did not correlate with extended survival.

Postradiosurgical imaging of the brain demonstrated that 63% of the metastases had decreased, 33% remained stable, and 4% eventually increased in size. Two patients (2.9%) later underwent a craniotomy and resection for a tumor refractory to radiosurgery or a new symptomatic metastasis. Eighty-three percent of patients died of progression of extracranial disease.

Conclusions. Stereotactic radiosurgery for treatment of renal cell carcinoma metastases to the brain provides effective local tumor control in approximately 96% of patients and a median length of survival of 15 months. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including radiosurgery can offer patients an extended survival.

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Contributor Notes

Address reprint requests to: Jason Sheehan, M.D., Ph.D., Box 800212, Department of Neurological Surgery, Health Sciences Center, Charlottesville, Virginia 22908. email: jps2f@virginia.edu.
  • 1.

    Adler JR, , Cox RS, & Kaplan I, et al. : Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76:444449, 1992 Adler JR, Cox RS, Kaplan I, et al: Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 76:444–449, 1992

    • Search Google Scholar
    • Export Citation
  • 2.

    Amendola BE, , Wolf AL, & Coy SR, et al. : Brain metastases in renal cell carcinoma: management with gamma knife radiosurgery. Cancer J 6:372376, 2000 Amendola BE, Wolf AL, Coy SR, et al: Brain metastases in renal cell carcinoma: management with gamma knife radiosurgery. Cancer J 6:372–376, 2000

    • Search Google Scholar
    • Export Citation
  • 3.

    Arbit E, & Wronski M: Clinical decision making in brain metastases. Neurosurg Clin N Am 7:447457, 1996 Arbit E, Wronski M: Clinical decision making in brain metastases. Neurosurg Clin N Am 7:447–457, 1996

    • Search Google Scholar
    • Export Citation
  • 4.

    Auchter RM, , Lamond JP, & Alexander E, et al. : A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:2735, 1996 Auchter RM, Lamond JP, Alexander E, et al: A multiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 35:27–35, 1996

    • Search Google Scholar
    • Export Citation
  • 5.

    Badalament R, , Gluck RW, & Wong GY, et al. : Surgical treatment of brain metastases from renal cell carcinoma. Urology 36:112117, 1990 Badalament R, Gluck RW, Wong GY, et al: Surgical treatment of brain metastases from renal cell carcinoma. Urology 36:112–117, 1990

    • Search Google Scholar
    • Export Citation
  • 6.

    Becker G, , Duffner F, & Kortmann R, et al. : Radiosurgery for the treatment of brain metastases in renal cell carcinoma. Anticancer Res 19 (2C):16111617, 1999 Becker G, Duffner F, Kortmann R, et al: Radiosurgery for the treatment of brain metastases in renal cell carcinoma. Anticancer Res 19(2C):1611–1617, 1999

    • Search Google Scholar
    • Export Citation
  • 7.

    Bennington JL: Proceedings: cancer of the kidney etiology, epidemiology, and pathology. Cancer 32:10171029, 1973 Bennington JL: Proceedings: cancer of the kidney etiology, epidemiology, and pathology. Cancer 32:1017–1029, 1973

    • Search Google Scholar
    • Export Citation
  • 8.

    Bindal RK, , Sawaya R, & Leavens ME, et al. : Surgical treatment of multiple brain metastases. J Neurosurg 79:210216, 1993 Bindal RK, Sawaya R, Leavens ME, et al: Surgical treatment of multiple brain metastases. J Neurosurg 79:210–216, 1993

    • Search Google Scholar
    • Export Citation
  • 9.

    Cairncross JG, , Kim JH, & Posner JB: Radiation therapy for brain metastases. Ann Neurol 7:529541, 1980 Cairncross JG, Kim JH, Posner JB: Radiation therapy for brain metastases. Ann Neurol 7:529–541, 1980

    • Search Google Scholar
    • Export Citation
  • 10.

    Caron JL, , Souhami L, & Podgorsak EB: Dynamic stereotactic radiosurgery in the palliative treatment of cerebral metastatic tumors. J Neurooncol 12:173179, 1992 Caron JL, Souhami L, Podgorsak EB: Dynamic stereotactic radiosurgery in the palliative treatment of cerebral metastatic tumors. J Neurooncol 12:173–179, 1992

    • Search Google Scholar
    • Export Citation
  • 11.

    Coffey RJ, , Flickinger JC, & Bissonette DJ, et al. : Radiosurgery for solitary brain metastases using the cobalt-60 gamma unit: methods and results in 24 patients. Int J Radiat Oncol Biol Phys 20:12871295, 1991 Coffey RJ, Flickinger JC, Bissonette DJ, et al: Radiosurgery for solitary brain metastases using the cobalt-60 gamma unit: methods and results in 24 patients. Int J Radiat Oncol Biol Phys 20:1287–1295, 1991

    • Search Google Scholar
    • Export Citation
  • 12.

    Cox DR: Regression models and life tables. J R Stat Soc B 34:187220, 1972 Cox DR: Regression models and life tables. J R Stat Soc B 34:187–220, 1972

    • Search Google Scholar
    • Export Citation
  • 13.

    DiBiase SJ, , Chin LS, & Ma L: Influence of gamma knife radiosurgery on the quality of life in patients with brain metastases. Am J Clin Oncol 25:131134, 2002 DiBiase SJ, Chin LS, Ma L: Influence of gamma knife radiosurgery on the quality of life in patients with brain metastases. Am J Clin Oncol 25:131–134, 2002

    • Search Google Scholar
    • Export Citation
  • 14.

    Engenhart R, , Kimmig BN, & Hover KH, et al. : Long-term follow-up for brain metastases treated by percutaneous stereotactic single high-dose irradiation. Cancer 71:13531361, 1993 Engenhart R, Kimmig BN, Hover KH, et al: Long-term follow-up for brain metastases treated by percutaneous stereotactic single high-dose irradiation. Cancer 71:1353–1361, 1993

    • Search Google Scholar
    • Export Citation
  • 15.

    Fernandez-Vicioso E, , Suh JH, & Kupelian PA, et al. : Analysis of prognostic factors for patients with single brain metastasis treated with stereotactic radiosurgery. Radiat Oncol Investig 5:3137, 1997 Fernandez-Vicioso E, Suh JH, Kupelian PA, et al: Analysis of prognostic factors for patients with single brain metastasis treated with stereotactic radiosurgery. Radiat Oncol Investig 5:31–37, 1997

    • Search Google Scholar
    • Export Citation
  • 16.

    Ferrara M, , Bizzozzero L, & Talamonti G, et al. : Surgical treatment of 100 single brain metastases. Analysis of the results. J Neurosurg Sci 34:303308, 1990 Ferrara M, Bizzozzero L, Talamonti G, et al: Surgical treatment of 100 single brain metastases. Analysis of the results. J Neurosurg Sci 34:303–308, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Flickinger JC, , Kondziolka D, & Lunsford LD, et al. : A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28:797802, 1994 Flickinger JC, Kondziolka D, Lunsford LD, et al: A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 28:797–802, 1994

    • Search Google Scholar
    • Export Citation
  • 18.

    Flickinger JC, , Lunsford LD, & Kondziolka D: Dose prescription and dose-volume effects in radiosurgery. Neurosurg Clin N Am 3:5159, 1992 Flickinger JC, Lunsford LD, Kondziolka D: Dose prescription and dose-volume effects in radiosurgery. Neurosurg Clin N Am 3:51–59, 1992

    • Search Google Scholar
    • Export Citation
  • 19.

    Fujimi M, , Akaza H, & Yoshida M, et al. : [Cerebellar metastasis from renal cell carcinoma.] Nippon Hinyokika Gakkai Zasshi 77:11641168, 1986 (Jpn) Fujimi M, Akaza H, Yoshida M, et al: [Cerebellar metastasis from renal cell carcinoma.] Nippon Hinyokika Gakkai Zasshi 77:1164–1168, 1986 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 20.

    Gay PC, , Litchy WJ, & Cascino TL: Brain metastasis in hypernephroma. J Neurooncol 5:5156, 1987 Gay PC, Litchy WJ, Cascino TL: Brain metastasis in hypernephroma. J Neurooncol 5:51–56, 1987

    • Search Google Scholar
    • Export Citation
  • 21.

    Godley PA, & Ataga KI: Renal cell carcinoma. Curr Opin Oncol 12:260264, 2000 Godley PA, Ataga KI: Renal cell carcinoma. Curr Opin Oncol 12:260–264, 2000

    • Search Google Scholar
    • Export Citation
  • 22.

    Goyal LK, , Suh JH, & Reddy CA, et al. : The role of whole brain radiotherapy and stereotactic radiosurgery on brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 47:10071012, 2000 Goyal LK, Suh JH, Reddy CA, et al: 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, 2000

    • Search Google Scholar
    • Export Citation
  • 23.

    Hall WA, , Djalilian HR, & Nussbaum ES, et al. : Long-term survival with metastatic cancer to the brain. Med Oncol 17:279286, 2000 Hall WA, Djalilian HR, Nussbaum ES, et al: Long-term survival with metastatic cancer to the brain. Med Oncol 17:279–286, 2000

    • Search Google Scholar
    • Export Citation
  • 24.

    Halperin EC, & Harisiadis L: The role of radiation therapy in the management of metastatic renal cell carcinoma. Cancer 51:614617, 1983 Halperin EC, Harisiadis L: The role of radiation therapy in the management of metastatic renal cell carcinoma. Cancer 51:614–617, 1983

    • Search Google Scholar
    • Export Citation
  • 25.

    Ikushima H, , Tokuuye K, & Sumi M, et al. : Fractionated stereotactic radiotherapy of brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 48:13891393, 2000 Ikushima H, Tokuuye K, Sumi M, et al: Fractionated stereotactic radiotherapy of brain metastases from renal cell carcinoma. Int J Radiat Oncol Biol Phys 48:1389–1393, 2000

    • Search Google Scholar
    • Export Citation
  • 26.

    Kaplan EL, & Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457481, 1958 Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958

    • Search Google Scholar
    • Export Citation
  • 27.

    Kihlstrom L, , Karlsson B, & Lindquist C: Gamma knife surgery for cerebral metastases. Implications for survival based on 16 years experience. Stereotact Funct Neurosurg 61 (Suppl 1):4550, 1993 Kihlstrom L, Karlsson B, Lindquist C: Gamma knife surgery for cerebral metastases. Implications for survival based on 16 years experience. Stereotact Funct Neurosurg 61 (Suppl 1):45–50, 1993

    • Search Google Scholar
    • Export Citation
  • 28.

    Maor MH, , Frias AE, & Oswald MJ: Palliative radiotherapy for brain metastases in renal carcinoma. Cancer 62:19121917, 1988 Maor MH, Frias AE, Oswald MJ: Palliative radiotherapy for brain metastases in renal carcinoma. Cancer 62:1912–1917, 1988

    • Search Google Scholar
    • Export Citation
  • 29.

    Marshall ME, , Pearson T, & Simpson W, et al. : Low incidence of asymptomatic brain metastases in patients with renal cell carcinoma. Urology 36:300302, 1990 Marshall ME, Pearson T, Simpson W, et al: Low incidence of asymptomatic brain metastases in patients with renal cell carcinoma. Urology 36:300–302, 1990

    • Search Google Scholar
    • Export Citation
  • 30.

    Masuda F, , Arai Y, & Ohnishi T, et al. : [Brain metastasis from renal cell carcinoma.] Nippon Hinyokika Gakkai Zasshi 75:278282, 1984 (Jpn) Masuda F, Arai Y, Ohnishi T, et al: [Brain metastasis from renal cell carcinoma.] Nippon Hinyokika Gakkai Zasshi 75:278–282, 1984 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 31.

    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 24:619625, 1992 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 24:619–625, 1992

    • Search Google Scholar
    • Export Citation
  • 32.

    Mintz AH, , Kestle J, & Rathbone MP, et al. : A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with single cerebral metastasis. Cancer 78:14701476, 1996 Mintz AH, Kestle J, Rathbone MP, et al: A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with single cerebral metastasis. Cancer 78:1470–1476, 1996

    • Search Google Scholar
    • Export Citation
  • 33.

    Mori Y, , Kondziolka D, & Flickinger JC, et al. : Stereotactic radiosurgery for brain metastasis from renal cell carcinoma. Cancer 83:344353, 1998 Mori Y, Kondziolka D, Flickinger JC, et al: Stereotactic radiosurgery for brain metastasis from renal cell carcinoma. Cancer 83:344–353, 1998

    • Search Google Scholar
    • Export Citation
  • 34.

    Naoi Y, , Maehara T, & Cho N, et al. : Stereotactic radiosurgery for brain metastases using a linac system: evaluation of initial local response by imaging. Radiat Med 17:311315, 1999 Naoi Y, Maehara T, Cho N, et al: Stereotactic radiosurgery for brain metastases using a linac system: evaluation of initial local response by imaging. Radiat Med 17:311–315, 1999

    • Search Google Scholar
    • Export Citation
  • 35.

    Nieder C: Stereotactic radiosurgery for brain metastasis from renal cell carcinoma. Cancer 85:251253, 1999 Nieder C: Stereotactic radiosurgery for brain metastasis from renal cell carcinoma. Cancer 85:251–253, 1999

    • Search Google Scholar
    • Export Citation
  • 36.

    Nieder C, , Niewald M, & Schnabel K: Treatment of brain metastases from hypernephroma. Urol Int 57:1720, 1996 Nieder C, Niewald M, Schnabel K: Treatment of brain metastases from hypernephroma. Urol Int 57:17–20, 1996

    • Search Google Scholar
    • Export Citation
  • 37.

    Noyes WR, , Auchter R, & Craig B, et al. : Cost analysis of radiosurgery versus resection for single brain metastases. Radiosurgery 1:172179, 1996 Noyes WR, Auchter R, Craig B, et al: Cost analysis of radiosurgery versus resection for single brain metastases. Radiosurgery 1:172–179, 1996

    • Search Google Scholar
    • Export Citation
  • 38.

    Patchell RA, , Cirrincione C, & Thaler HT, et al. : Single brain metastases: surgery plus radiation or radiation alone. Neurology 36:447453, 1986 Patchell RA, Cirrincione C, Thaler HT, et al: Single brain metastases: surgery plus radiation or radiation alone. Neurology 36:447–453, 1986

    • Search Google Scholar
    • Export Citation
  • 39.

    Patchell RA, , Tibbs PA, & Walsh JW, et al. : A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494500, 1990 Patchell RA, Tibbs PA, Walsh JW, et al: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500, 1990

    • Search Google Scholar
    • Export Citation
  • 40.

    Payne BR, , Prasad D, & Szeifert G, et al. : Gamma surgery for intracranial metastases from renal cell carcinoma. J Neurosurg 92:760765, 2000 Payne BR, Prasad D, Szeifert G, et al: Gamma surgery for intracranial metastases from renal cell carcinoma. J Neurosurg 92:760–765, 2000

    • Search Google Scholar
    • Export Citation
  • 41.

    Posner JB: Diagnosis and treatment of metastases to the brain. Clin Bull 4:4757, 1974 Posner JB: Diagnosis and treatment of metastases to the brain. Clin Bull 4:47–57, 1974

    • Search Google Scholar
    • Export Citation
  • 42.

    Posner JB: Management of brain metastases. Rev Neurol 148:477487, 1992 Posner JB: Management of brain metastases. Rev Neurol 148:477–487, 1992

    • Search Google Scholar
    • Export Citation
  • 43.

    Rutigliano MJ, , Lunsford LD, & Kondziolka D, et al. : The cost effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of solitary metastatic brain tumors. Neurosurgery 37:445455, 1995 Rutigliano MJ, Lunsford LD, Kondziolka D, et al: The cost effectiveness of stereotactic radiosurgery versus surgical resection in the treatment of solitary metastatic brain tumors. Neurosurgery 37:445–455, 1995

    • Search Google Scholar
    • Export Citation
  • 44.

    Sawaya R, & Bindal RK: Metastatic brain tumors, in Kaye AH, & Laws ER Jr (eds): Brain Tumors: An Encyclopedic Approach. Edinburgh: Churchill Livingstone, 1995, pp 923946 Sawaya R, Bindal RK: Metastatic brain tumors, in Kaye AH, Laws ER Jr (eds): Brain Tumors: An Encyclopedic Approach. Edinburgh: Churchill Livingstone, 1995, pp 923–946

    • Search Google Scholar
    • Export Citation
  • 45.

    Schoggl A, , Kitz K, & Ertl A, et al. : Gamma-knife radiosurgery for brain metastases of renal cell carcinoma: results in 23 patients. Acta Neurochir 140:549555, 1998 Schoggl A, Kitz K, Ertl A, et al: Gamma-knife radiosurgery for brain metastases of renal cell carcinoma: results in 23 patients. Acta Neurochir 140:549–555, 1998

    • Search Google Scholar
    • Export Citation
  • 46.

    Shibui S, , Nishikawa R, & Nomura K: [Treatment for metastatic brain tumors from renal cell carcinoma.] No Shinkei Geka 18:935938, 1990 (Jpn) Shibui S, Nishikawa R, Nomura K: [Treatment for metastatic brain tumors from renal cell carcinoma.] No Shinkei Geka 18:935–938, 1990 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 47.

    Simonova G, , Liscak R, & Novotny J Jr, et al. : Solitary brain metastases treated with the Leksell gamma knife: prognostic factors for patients. Radiother Oncol 57:207213, 2000 Simonova G, Liscak R, Novotny J Jr, et al: Solitary brain metastases treated with the Leksell gamma knife: prognostic factors for patients. Radiother Oncol 57:207–213, 2000

    • Search Google Scholar
    • Export Citation
  • 48.

    Sperduto PW, & Hall WA: The cost-effectiveness for alternative treatments for single brain metastases. Radiosurgery 1:180187, 1996 Sperduto PW, Hall WA: The cost-effectiveness for alternative treatments for single brain metastases. Radiosurgery 1:180–187, 1996

    • Search Google Scholar
    • Export Citation
  • 49.

    Sundaresan N, & Galicich JH: Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment. Cancer 55:13821388, 1985 Sundaresan N, Galicich JH: Surgical treatment of brain metastases. Clinical and computerized tomography evaluation of the results of treatment. Cancer 55:1382–1388, 1985

    • Search Google Scholar
    • Export Citation
  • 50.

    Suzuki S, , Omagari J, & Nishio S, et al. : Gamma knife radiosurgery for simultaneous multiple metastatic brain tumors. J Neurosurg 93 (Suppl 3):3031, 2000 Suzuki S, Omagari J, Nishio S, et al: Gamma knife radiosurgery for simultaneous multiple metastatic brain tumors. J Neurosurg 93 (Suppl 3):30–31, 2000

    • Search Google Scholar
    • Export Citation
  • 51.

    Vecht CJ, , Haaxma-Reiche H, & Noordijk EM, et al. : Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583590, 1993 Vecht CJ, Haaxma-Reiche H, Noordijk EM, et al: Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery? Ann Neurol 33:583–590, 1993

    • Search Google Scholar
    • Export Citation
  • 52.

    Vendrely V, , Prie L, & Benyoucef A, et al. : [Radiosurgery of single brain metastasis without combined total cerebral irradiation: results of a consecutive series of 12 cases.] Cancer Radiother 2:375380, 1998 (Fr) Vendrely V, Prie L, Benyoucef A, et al: [Radiosurgery of single brain metastasis without combined total cerebral irradiation: results of a consecutive series of 12 cases.] Cancer Radiother 2:375–380, 1998 (Fr)

    • Search Google Scholar
    • Export Citation
  • 53.

    Walker AE, , Robins M, & Weinfeld FD: Epidemiology of brain tumors: the national survey of intracranial neoplasms. Neurology 35:219226, 1985 Walker AE, Robins M, Weinfeld FD: Epidemiology of brain tumors: the national survey of intracranial neoplasms. Neurology 35:219–226, 1985

    • Search Google Scholar
    • Export Citation
  • 54.

    Wronski M, , Arbit E, & Russo P, et al. : Surgical resection of brain metastases from renal cell carcinoma in 50 patients. Urology 47:187193, 1996 Wronski M, Arbit E, Russo P, et al: Surgical resection of brain metastases from renal cell carcinoma in 50 patients. Urology 47:187–193, 1996

    • Search Google Scholar
    • Export Citation
  • 55.

    Yamanaka K, , Gohji K, & Hara I, et al. : Clinical study of renal cell carcinoma with brain metastasis. Int J Urol 5:124128, 1998 Yamanaka K, Gohji K, Hara I, et al: Clinical study of renal cell carcinoma with brain metastasis. Int J Urol 5:124–128, 1998

    • Search Google Scholar
    • Export Citation
  • 56.

    Yamanaka K, , Iwai Y, & Yasui T, et al. : Gamma Knife radiosurgery for metastatic brain tumor: the usefulness of repeated Gamma Knife radiosurgery for recurrent cases. Stereotact Funct Neurosurg 72 (Suppl 1):7380, 1999 Yamanaka K, Iwai Y, Yasui T, et al: Gamma Knife radiosurgery for metastatic brain tumor: the usefulness of repeated Gamma Knife radiosurgery for recurrent cases. Stereotact Funct Neurosurg 72 (Suppl 1):73–80, 1999

    • Search Google Scholar
    • Export Citation
  • 57.

    Yonese J, , Kawakami S, & Ueda T, et al. : [Clinical study of renal cell carcinoma with brain metastasis.] Nippon Hinyokika Gakkai Zasshi 86:12871293, 1995 (Jpn) Yonese J, Kawakami S, Ueda T, et al: [Clinical study of renal cell carcinoma with brain metastasis.] Nippon Hinyokika Gakkai Zasshi 86:1287–1293, 1995 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 58.

    Zimm S, , Wampler GL, & Stablein D, et al. : Intracerebral metastases on solid-tumor patients: natural history and results of treatment. Cancer 48:384394, 1981 Zimm S, Wampler GL, Stablein D, et al: Intracerebral metastases on solid-tumor patients: natural history and results of treatment. Cancer 48:384–394, 1981

    • Search Google Scholar
    • Export Citation

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