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Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):845-853. doi: 10.1016/j.ijrobp.2018.04.006. Epub 2018 Apr 12.

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

Author information

1
Minneapolis Radiation Oncology and University of Minnesota Gamma Knife Center, Minneapolis, Minnesota. Electronic address: psperduto@mropa.com.
2
MD Anderson Cancer Center, Houston, Texas.
3
Mayo Clinic, Rochester, Minnesota.
4
Memorial Sloan Kettering Cancer Center, New York, New York.
5
Vanderbilt University Medical Center, Nashville, Tennessee.
6
Sunnybrook-University of Toronto, Toronto, Canada.
7
University of Minnesota Biostatistics, Minneapolis, Minnesota.
8
University of Minnesota Cancer Center, Minneapolis, Minnesota.
9
University of Iowa, Iowa City, Iowa.
10
Yale University, New Haven, Connecticut.
11
University of Maryland, Baltimore, Maryland.
12
Centre Hospitalier de l' Université de Montreal, Montreal, Canada.
13
Massachusetts General Hospital, Boston, Massachusetts.
14
Duke University, Durham, North Carolina.
15
University of California San Francisco, San Francisco, California.
16
Miami Cancer Institute, Miami, Florida.

Abstract

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.

PMID:
29976497
DOI:
10.1016/j.ijrobp.2018.04.006
[Indexed for MEDLINE]

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