Abstract
Simple SummaryBrain metastases are a commonly recognized poor prognostic factor in patients with cancer. Due to their poor prognosis, these patients were commonly excluded from the most important clinical trials that have revolutionized the oncological clinical practice. Renal cell carcinoma represents one of the most frequent neoplasia that metastasize to the brain. Due to the therapeutical advances the overall survival of brain metastatic renal cell carcinoma is improved even in the absence of tailored studies that are need to plan an adequate therapeutic strategy for these patients.Renal cell carcinoma (RCC) is one of primary cancers that frequently metastasize to the brain. Brain metastasis derived from RCC has the propensity of intratumoral hemorrhage and relatively massive surrounding edema. Moreover, it confers a grim prognosis in a great percentage of cases with a median overall survical (mOS) around 10 months. The well-recognized prognostic factors for brain metastatic renal cell carcinoma (BMRCC) are Karnofsky Performance Status (KPS), the number of brain metastasis (BM), the presence of a sarcomatoid component and the presence of extracranial metastasis. Therapeutic strategies are multimodal and include surgical resection, radiotherapy, such as stereotactic radiosurgery due to the radioresistance of RCC and systemic strategies with tyrosin kinase inhibitors (TKI) or Immune checkpoint inhibitors (ICI) whose efficacy is not well-established in this setting of patients due to their exclusion from most clinical trials. To date, in case of positive prognostic factors and after performing local radical therapies, such as complete resection of BM or stereotactic radiosurgery (SRS), the outcome of these patients significantly improves, up to 33 months in some patients. As a consequence, tailored clinical trials designed for BMRCC are needed to define the correct treatment strategy even in this poor prognostic subgroup of patients.
Highlights
Renal cell carcinoma (RCC) accounts for 3–5% of all solid malignancies diagnosed worldwide [1]
Poor prognosis might be related to the typical resistance to radiotherapy of brain metastatic renal cell carcinoma (BMRCC), the poor penetration of blood-brain barrier (BBB) by many anti-cancer agents [8,9,10], and by the frequent occurrence of symptomatic neurological impairment
63% were pre-treated with cytokines or targeted therapies (TT)
Summary
Renal cell carcinoma (RCC) accounts for 3–5% of all solid malignancies diagnosed worldwide [1]. BasedAt onthe thetime concept that might behave differently depending on the primary tumor of our analysis, current guidelines for localized RCC do not recommend type, and as a consequence, should be treated differently based on their primitive site of brain imaging evaluation unless patients present CNS symptoms [1], even if published disease In this analysis, the authors found that significant prognostic factors varied with guidelines of the National Comprehensive Cancer Network (NCCN) recommend brain imaging surveillance in other tumors with brain tropism, such as lung cancer, breast cancer and melanoma, even in asymptomatic patients.
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