Synchronous brain metastases as a poor prognosis factor in clear cell renal carcinoma: a strong argument for systematic brain screening.

Valentine Ruste,Guillaume Moriceau,Camille Schiffler,Mélodie Carbonnaux,Helen Boyle,Aude Fléchon,Sophie Robin,Eve-Marie Neidhardt,Sylvie Négrier,Emmanuel Jouanneau,Marie Pierre Sunyach,Ronan Tanguy

doi:10.1007/s11060-021-03751-5

Abstract

Brain metastases (BM) usually represent a poor prognostic factor in solid tumors. About 10% of patients with renal cancer (RCC) will present BM. Local therapies such as stereotactic radiotherapy (SRT), whole brain radiotherapy (WBRT), and surgery are used to achieve brain control. We compared survival between patients with synchronous BM (SynBM group) and metachronous BM (MetaBM group). It is a retrospective study of patients with clear cell renal cell carcinoma (ccRCC) and BM treated with TKI between 2005 and 2019 at the Centre Léon Bérard in Lyon. We collected prognostic factors: The International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score, the TNM stage, the histological subtypes and the Fuhrman grade. Overall survival (OS) was defined from diagnosis of metastatic ccRCC to death. Brain progression-free survival (B-PFS) was defined from focal brain therapy to brain progression or death. 99 patients were analyzed, 44 in the SynBM group and 55 in the MetaBM group. OS in the MetaBM group was 49.4months versus 19.6months in the SynBM group, p = 0.0002. The median time from diagnosis of metastasic disease to apparition ofBM in the MetaBM group was 22.9months (4.3; 125.7). SRT was used for 101 lesions (66.4%), WBRT for 25 patients (16.4%), surgery for 21 lesions (13.8%), surgery followed by radiation for 5 lesions (3.3%). B-PFS for all patients was 7months (IC95% [5.0-10.5]). Survival of patients with synchronous BM is inferior to that of patients with metachronous BM. Outcome is poor in both cases after diagnosis of BM. Brain screening should be encouraged at time of diagnosis of metastatis in ccRCC.

Highlights

Brain metastases (BM) usually represent a poor prognostic factor in solid tumors and overall survival in these patients seems to be limited [1]
We compared survival between patients with synchronous BM (SynBM group) and metachronous BM (MetaBM group). It is a retrospective study of patients with clear cell renal cell carcinoma and BM treated with tyrosine kinase inhibitors (TKI) between 2005 and 2019 at the Centre Léon Bérard in Lyon
Brain screening should be encouraged at time of diagnosis of metastatis in clear cell renal cell carcinoma (ccRCC)

Summary

Introduction

Brain metastases (BM) usually represent a poor prognostic factor in solid tumors and overall survival in these patients seems to be limited [1]. When surgery is not possible and for patients with up to 3 small lesions, SRT alone compared to SRT followed by WBRT has shown less cognitive deterioration without impact on overall survival with worse local control [8]. The total volume represented by BM, more than their number, should be a decision criteria for the use of SRT versus WBRT [9]. Despite these different treatment modalities some BM will present local progression or relapse

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Results

Conclusion