Optimal control of brain metastases (BM) from renal cell carcinoma (RCC) with stereotactic radiosurgery (SRS) is critical as tyrosine kinase inhibitors (TKI) and immunotherapy has significantly prolonged overall survival (OS), emphasizing the importance of minimizing potential morbidity from treatment-associated edema. Clinically, we have observed that RCC BM-associated edema seems to be less prominent when VEGF-targeted agents (VEGFi) such as axitinib are administered contemporaneously with SRS. We therefore investigated the role of VEGFi in intracranial edema reduction in pts treated with SRS.We conducted a single institution retrospective analysis of all clear cell or unknown RCC pts with BM treated with SRS from 2013 onwards. We excluded non-clear cell RCC, lack of post-SRS imaging, and failure to complete SRS. The SRS plus VEGFi cohort was defined as VEGFi within 6 months of SRS. Volumetric data was obtained from SRS plans, edema was contoured on MR Brain T2 Flair, and paired t-test was performed. Multivariate analysis for OS performed with the Cox proportional hazards model.We identified 38 pts who received 78 courses of SRS + VEGFi and 18 pts who received 29 courses of SRS alone. For the SRS + VEGFi and SRS groups, median OS was 4.1y and 6.0y, median SRS dose was 21 Gy and 27 Gy with comparable pre-SRS steroid use of 52% and 57% (HR 0.51, P = 0.200) and baseline neurologic symptoms 50% and 74% (HR 0.943, P = 0.904), respectively. Among the SRS + VEGFi group, the mean intact tumor volume decreased from pre-SRS 1.89cc to 0.42cc at 6m post-SRS, compared to a decrease from 1.82cc to 1.28cc in the SRS group. Edema volume decreased from 17.65cc to 3.28cc in the SRS + VEGFi group with an increase from pre-SRS 5.78cc to 6.39cc at 6mo post-SRS in the SRS alone group (95% CI -3.67, 1.15, P = 0.154).Despite similar pre-SRS steroid use and increased edema volume, VEGFi appeared to improve post-SRS edema with a notable reduction of neurological symptoms. Our data suggest VEGFi may offer symptomatic benefit for significant peritumoral edema even without overt disease progression, and that re-challenge or continuation of VEGFi with SRS should be considered in such patients.