Effect of Targeted Therapies on Prognostic Factors, Patterns of Care, and Survival in Patients With Renal Cell Carcinoma and Brain Metastases.

Journal Article (Journal Article;Multicenter Study)

PURPOSE: To identify prognostic factors, define evolving patterns of care, and the effect of targeted therapies in a larger contemporary cohort of renal cell carcinoma (RCC) patients with new brain metastases (BM). METHODS AND MATERIALS: A multi-institutional retrospective institutional review board-approved database of 711 RCC patients with new BM diagnosed from January 1, 2006, to December 31, 2015, was created. Clinical parameters and treatment were correlated with median survival and time from primary diagnosis to BM. Multivariable analyses were performed. RESULTS: The median survival for the prior/present cohorts was 9.6/12 months, respectively (P < .01). Four prognostic factors (Karnofsky performance status, extracranial metastases, number of BM, and hemoglobin b) were significant for survival after the diagnosis of BM. Of the 6 drug types studied, only cytokine use after BM was associated with improved survival. The use of whole-brain radiation therapy declined from 50% to 22%, and the use of stereotactic radiosurgery alone increased from 46% to 58%. Nonneurologic causes of death were twice as common as neurologic causes. CONCLUSIONS: Additional prognostic factors refine prognostication in this larger contemporary cohort. Patterns of care have changed, and survival of RCC patients with BM has improved over time. The reasons for this improvement in survival remain unknown but may relate to more aggressive use of local brain metastasis therapy and a wider array of systemic treatment options for those patients with progressive extracranial tumor.

Full Text

Duke Authors

Cited Authors

  • Sperduto, PW; Deegan, BJ; Li, J; Jethwa, KR; Brown, PD; Lockney, N; Beal, K; Rana, NG; Attia, A; Tseng, C-L; Sahgal, A; Shanley, R; Sperduto, WA; Lou, E; Zahra, A; Buatti, JM; Yu, JB; Chiang, V; Molitoris, JK; Masucci, L; Roberge, D; Shi, DD; Shih, HA; Olson, A; Kirkpatrick, JP; Braunstein, S; Sneed, P; Mehta, MP

Published Date

  • July 15, 2018

Published In

Volume / Issue

  • 101 / 4

Start / End Page

  • 845 - 853

PubMed ID

  • 29976497

Pubmed Central ID

  • PMC6925530

Electronic International Standard Serial Number (EISSN)

  • 1879-355X

Digital Object Identifier (DOI)

  • 10.1016/j.ijrobp.2018.04.006


  • eng

Conference Location

  • United States