Impact of early identification of brain metastases in metastatic renal cell carcinoma (mRCC).

Abstract

620 Background: Up to one-third of patients with mRCC can present with asymptomatic brain metastases (BM). Timely identification of BM allows for the delivery of early local interventions, which may lead to improved patient outcomes. To investigate the potential utility of routine intra-cranial imaging, we compared the outcomes of mRCC patients with asymptomatic versus symptomatic BM. Methods: Using the Canadian Kidney Cancer information system (CKCis) database, we identified mRCC patients diagnosed with BM between 2011 and 2018. This cohort was divided into two groups dependent on the presence or absence of neurological symptoms. Baseline patient demographics, clinico-pathological disease characteristics and survival data were extracted. Statistical analysis was through chi-square tests, analysis of variance and Kaplan-Meier method to characterize survival outcomes. Results: 269 mRCC patients with BM were identified with the majority presenting with symptomatic disease (n=163; 61%). No significant differences in clinico-pathological disease characteristics were identified. Median overall survival (OS) from mRCC diagnosis for asymptomatic patients was 33.4 months (interquartile range, IQR 27.8-64.4) versus 34.5 months (20.4-43.4) for symptomatic patients (p=0.35). Median OS from time of BM diagnosis revealed a trend favoring asymptomatic, as compared to symptomatic, patients [24.5 (17.6-24.9) vs. 13.1 months (9.0-20.6), p=0.06]. Factors associated with worse OS from time of BM diagnosis included presentation with symptomatic BM [hazard ratio, HR (95% CI): 1.40 (1.03-1.90), p=0.034] and International Metastatic Renal Cell Carcinoma Consortium Database (IMDC)-characterized intermediate/poor risk disease [HR (95% CI): 1.47 (1.01-2.13), p=0.045]. Conclusions: Routine intra-cranial imaging may lead to earlier identification of BM in mRCC. However, further investigation as to whether this practice improves survival is warranted.

An interdisciplinary consensus on the management of brain metastases in patients with renal cell carcinoma

“…Because of the rise in incidence of mRCC BMs over the past 2 decades, there is debate regarding whether to implement routine screening for BMs at initial staging of localized and/or metastatic disease. 22,25,26 Currently, the European Society of Medical Oncology does not recommend routine brain imaging for staging unless indicated by clinical symptoms. 27 However, the currently recommended initial workup of localized RCC or mRCC includes routine brain imaging (as specified by the National Comprehensive Cancer Network) 28 ; therefore, asymptomatic BMs may be detected if imaging is performed.…”

“…Because of the rise in incidence of mRCC BMs over the past 2 decades, there is debate regarding whether to implement routine screening for BMs at initial staging of localized and/or metastatic disease 22,25,26 . Currently, the European Society of Medical Oncology does not recommend routine brain imaging for staging unless indicated by clinical symptoms 27 .…”