PD10-07 ASYMPTOMATIC BRAIN METASTASIS FROM RENAL CELL CARCINOMA - ARE WE MISSING OUR WINDOW TO CURE?

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation/Staging I1 Apr 2014PD10-07 ASYMPTOMATIC BRAIN METASTASIS FROM RENAL CELL CARCINOMA - ARE WE MISSING OUR WINDOW TO CURE? Michael Hanzly, Ahmed Aboumohamed, Terry Creighton, Christopher Foote, Diana Mehedint, Kristopher Attwood, Eric Kauffman, and Thomas Schwaab Michael HanzlyMichael Hanzly More articles by this author , Ahmed AboumohamedAhmed Aboumohamed More articles by this author , Terry CreightonTerry Creighton More articles by this author , Christopher FooteChristopher Foote More articles by this author , Diana MehedintDiana Mehedint More articles by this author , Kristopher AttwoodKristopher Attwood More articles by this author , Eric KauffmanEric Kauffman More articles by this author , and Thomas SchwaabThomas Schwaab More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.483AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Follow up guidelines for renal cell carcinoma (RCC) recommend brain imaging only in patients with central nervous system (CNS) symptoms. We hypothesized that using symptomatology as an indicator for brain imaging in patients with localized RCC would miss a substantial proportion of patients with asymptomatic brain metastases. METHODS The IRB-approved, prospectively-maintained kidney cancer data base at Roswell Park Cancer Institute was queried for all RCC patients between 1995 and 2011 who developed brain metastases on imaging (CT or MRI). Patients were divided into a cohort of patients with CNS leading CNS imaging and a cohort of patients without CNS symptoms at the time of brain metastases diagnosis. CNS symptoms were defined as any change in the patient’s baseline neurologic exam. Patient demographics, primary treatment for RCC, elapsed time between primary diagnosis and brain metastasis, presence or absence of associated CNS symptomatology, treatment of metastatic site and overall survival following diagnosis of brain metastasis were examined. Student T-Test was used for statistical analysis. RESULTS Out of 898 patients, 52 patients met these criteria. CNS symptoms were absent in 37% of patients with brain metastases. The mean number of metastases was 1.8 per patient with a mean size of 1.0 cm in the asymptomatic group, and 2.7 metastases with a mean size of 1.9 cm in patients with CNS symptoms (p<0.05). One-year overall survival (OS) of patients with CNS symptoms was 81% and 69% at three years, while the asymptomatic group had an OS of 81% 31%, respectively. Interestingly, two patients in the CNS symptom group and one in the asymptomatic group presented with no other metastatic sites. Among both groups, pulmonary metastases were present in 75% of patients at the time of brain metastasis diagnosis (p<0.005). Clinical trial enrolment was the most common reason for brain imaging in asymptomatic patients. CONCLUSIONS This is the largest series examining the presence or absence of CNS symptoms at the time of diagnosis of brain metastases following treatment for RCC. Our findings suggest that patients without CNS symptoms had smaller brain metastases and a worse overall survival. The current urologic guidelines recommending CNS imaging only in patients with symptoms may be missing a subset of the metastatic RCC population with small, potentially treatable brain metastases. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e284 Peer Review Report Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael Hanzly More articles by this author Ahmed Aboumohamed More articles by this author Terry Creighton More articles by this author Christopher Foote More articles by this author Diana Mehedint More articles by this author Kristopher Attwood More articles by this author Eric Kauffman More articles by this author Thomas Schwaab More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...