As they note, brain metastases in renal cell carcinoma (RCC) patients are associated with a poor prognosis, and as such, have historically been excluded from clinical trials and aggressive treatment regimens.
Over a 20 year period at their institution, they identified just 136 patients with RCC brain metastases (BM). 95% of these patients had clear cell RCC histology and 90% had extracranial metastases at diagnosis – which is consistent with population analysis noting that isolated brain metastases are quite rare.1 A total of 36 (26.5%) patients had BM at the time of kidney cancer diagnosis – the rest developed BM later in their clinical course. A total of 85 patients (62.5%) with metastatic disease progressed to the brain, while 15 (11%) had CNS involvement at time of recurrence after nephrectomy.
Clinical symptoms were noted in 80% of patients. The total number of lesions, and interestingly, not the size of the largest lesion, was found to correlate with symptoms.
Patients with a solitary lesion were more like to receive a craniotomy (15% vs 5%), while patients with >1 lesion were more like to receive radiosurgery (32.4% vs 19.7%). This is intuitive, as radiosurgery is better able to treat a larger region without increased morbidity. A total of 55% of individuals received systemic therapy after BM treatment, likely for persistent extracranial disease.
The median overall survival after diagnosis of RCC related BM was 8.5 months with a three-year survival of 28.2%. The median survival was not different between individuals who presented with, recurred with, or progressed to BMs. The median CNS recurrence-free survival was 8 months for the whole cohort; however, those with 0-1 and >1 lesion was 12.4 months and 6 months, respectively (P <.001).
As expected, the prognosis of patients with RCC related BMs is poor, worse than patients without BMs. However, over a 20 year period, this tertiary referral center managed just 136 patients with RCC related BM’s; and isolated BMs are even rarer!
1. Chandrasekar T, Klaassen Z, Goldberg H, Kulkarni GS, Hamilton RJ, Fleshner NE. Metastatic renal cell carcinoma: Patterns and predictors of metastases-A contemporary population-based series. Urol Oncol. 2017 Nov;35(11):661.e7-661.e14. doi: 10.1016/j.urolonc.2017.06.060. Epub 2017 Jul 17.
Presented by: Alfredo Suarez-Sarmiento Jr., Yale University, New Haven, Connecticut
Co-Authors: Kevin Nguyen, Adam Nolte, Michelle Cheng, Brian Shuch, New Haven, CT
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA