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

Publication date: Available online 12 April 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Paul W. Sperduto, Brian J. Deegan, Jing Li, Krishan R. Jethwa, Paul D. Brown, Natalie Lockney, Kathryn Beal, Nitesh G. Rana, Albert Attia, Chia-Lin Tseng, Arjun Sahgal, Ryan Shanley, William A. Sperduto, Emil Lou, Amir Zahra, John M. Buatti, James B. Yu, Veronica Chiang, Jason K. Molitoris, Laura Masucci, David Roberge, Diana D. Shi, Helen A. Shih, Adam Olson, John P. Kirkpatrick, Steve Braunstein, Penny Sneed, Minesh P. Mehta
BackgroundBrain metastases (BM) are a common complication of renal cell carcinoma (RCC). Our group previously published disease-specific prognostic factors (PF) and the Renal Graded Prognostic Assessment (GPA). In our prior RCC study (n=286, 1985-2005), the only PFs significant for survival were KPS and number of BMs. Since then, outcomes have improved with the use of targeted therapies but the effect on RCC patients with BMs remains unknown. The goals of this analysis are to identify PF, define evolving patterns of care and the effect of targeted therapies in a larger contemporary cohort.MethodsA multi-institutional retrospective IRB-approved database of 711 RCC patients with new BM diagnosed from 1/1/2006-12/31/2015 was created. Clinical parameters and treatment were correlated with median survival (MS) and time from primary diagnosis to BM. Multivariable analyses were performed.ResultsThe MS for the prior/current cohorts were 9.6/12 months, respectively (p<0.01). Four PF (KPS, extracranial metastases, number of BM, and Hgb) were significant for survival after the diagnosis of BMs. Of the six 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%. Non-neurologic causes of death are twice as common as neurologic causes.ConclusionAdditional PFs 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.

Teaser

Brain metastases are common in renal cell carcinoma. In the era of targeted therapies, outcomes in patients with renal cell carcinoma (RCC) have improved but it is unknown whether outcomes or prognostic factors for RCC patients with brain metastases have changed. This multi-institutional retrospective review refines prognostic factors for these patients and confirms outcomes for RCC patients with brain metastases have improved. These data will be helpful in clinical decision-making and stratification of clinical trials.


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