Brain metastases (BM) are frequently observed in advanced renal-cell carcinoma (RCC). Historically these individuals have been excluded from clinical trials, but recently, with better local control, many can receive aggressive therapy after treatment. We evaluate our single-institution experience over various treatment eras.
Patients undergoing evaluation for RCC BM from 2001 to 2018 were identified from our institutional database. Clinical notes, demographics, comorbidities, histology, central nervous system (CNS) treatments, systemic therapy, and outcomes were reviewed. Overall survival (OS) and CNS recurrence-free survival (RFS) were evaluated by the Kaplan-Meier method. Cumulative incidence was evaluated using a competing risk model.
We identified 158 patients with RCC BM, of whom 94.4% had clear-cell RCC, and 90.6% had extracranial metastases at diagnosis. Of these patients, 94 (60%) developed RCC BM over time, while 46 (29.1%) had RCC BM at initial presentation. Clinical symptoms were noted in 81.9% of patients. The median OS after diagnosis of RCC BM was 8.4 months, with a 3-year OS of 28.2%. The median CNS RFS was 8.5 months overall; however, those with one and more than one lesion had median CNS RFS of 12.4 and 6 months, respectively (P < .001).
The majority of RCC patients with BM are symptomatic and had prior metastatic disease that progressed to the brain. Those with a solitary RCC BM are less likely to develop CNS recurrence after local therapy and are ideal candidates for enrollment onto clinical trials.
Clinical genitourinary cancer. 2019 Aug 20 [Epub ahead of print]
Alfredo Suarez-Sarmiento, Kevin A Nguyen, Jamil S Syed, Adam Nolte, Kamyar Ghabili, Michelle Cheng, Sandy Liu, Veronica Chiang, Harriet Kluger, Michael Hurwitz, Brian Shuch
Department of Urology, Yale School of Medicine, New Haven, CT., Department of Urology, Yale School of Medicine, New Haven, CT; Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA., Department of Neurosurgery, Yale School of Medicine, New Haven, CT., Division of Hematology Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT., Department of Urology, Yale School of Medicine, New Haven, CT; Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: .