AUA 2018: Brain Metastasis from Renal Cell Carcinoma: An Institutional Study

San Francisco, CA ( Metastatic spread in renal cell carcinoma (RCC) often goes to the lungs and bones, and less commonly to the liver and brain. Prior studies1 have examined the spread of RCC utilizing population based analyses, and identified predictors of metastatic spread based on clinical features and histology. In this abstract, the authors use their institutional data to specifically focus on RCC related brain metastases, a relatively rare presentation. 

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