Purpose: Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions. This paper reports the authors’ initial experience with image-guided SBRT in treating primary and metastatic RCC. Materials and methods: The image-guided Brainlab Novalis stereotactic system was used. Fourteen patients with 23 extra-cranial metastatic RCC lesions (orbits, head and neck, lung, mediastinum, sternum, clavicle, scapula, humerus, rib, spine and abdominal wall) and two patients with biopsy-proven primary RCC (not surgical candidates) were treated with SBRT (24-40 Gy in 3-6 fractions over 1-2 weeks). All patients were immobilised in body cast or head and neck mask. Image-guidance was used for all fractions. PET/CT images were fused with simulation CT images to assist in target delineation and dose determination. SMART (simultaneous modulated accelerated radiation therapy) boost approach was adopted. 4D-CT was utilised to assess tumour/organ motion and assist in determining planning target volume margins. Results: Median follow-up was nine months. Thirteen patients (93%) who received SBRT to extra-cranial metastases achieved symptomatic relief. Two patients had local progression, yielding a local control rate of 87%. In the two patients with primary RCC, tumour size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There were no significant treatment-related side effects. Conclusion: Image-guided SBRT provides excellent symptom palliation and local control without any significant toxicity. SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC.

Background: Non-traumatic intracerebral hemorrhage (ICH) represents the most devastating subtype of stroke, charac terized by spontaneous bleeding into the brain parenchyma. This neurological emergency carries a burden of mortality and long-term disability worldwide. Timely identification causal pathways is priority objective for adequate primary and secondary prevention of ICH. Risk factors may differ between ICH subtypes, and stratified approaches to management may be appropriate. Aim: This study is to identify cause and risk factors of ICH. Materials and Methods: A single centre descriptive study was carried out in Stroke Center of the State Third Central Hospital, Mongolia, including 718 consecutive acute patients with ICH during October 2022 to September 2024. Patients were classified using SMASH-U, an etiological based classification system. Results: Out of a total of 718 cases diagnosed with ICH, hypertension caused 75.3%, amyloid angiopathy 12%, undetermined 7%, structural lesions 2.92%, systemic disease 2.37%, medication 0.48% in 718 ICH patients. The mean age of the cases was 57.5 жил, and was the most common in men of the 50-59 age group (p<0.001). The main risk factor in hypertension and amyloid angiopathy groups was arterial hypertension (93.7%), in undetermined group alcohol consumption (48%), in structural group AVM and other vascular causes (23.8%), in systemic group chronic kidney insufficiency (29.4%), in medication group atrial fibrillation (100%), respectively. Conclusion 1. ICH was mostly caused by hypertension, amyloid angiopathy, systemic disease. 2. Arterial hypertension, heart disease, atrial fibrillation, previous stroke, oral anticoagulants, smoking, alcohol consumption, obesity/BMI≥25, liver cirrhosis, chronic kidney insufficiency, AVM and other structural anomalies were the most common risk factors.