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Open Access Highly Accessed Research article

Extracerebral metastases determine the outcome of patients with brain metastases from renal cell carcinoma

Ursula M Vogl1*, Marija Bojic1, Wolfgang Lamm1, Josa M Frischer1, Oskar Pichelmayer1, Gero Kramer3, Andrea Haitel4, Klaus Kitz2, Kaan Harmankaya5, Christoph C Zielinski1 and Manuela Schmidinger1

Author Affiliations

1 Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria

2 Department of Neurosurgery, Medical University Vienna, Vienna, Austria

3 Department of Urology, Medical University Vienna, Vienna, Austria

4 Department of Pathology, Medical University Vienna, Vienna, Austria

5 Department of Dermatology, Medical University Vienna, Vienna, Austria

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BMC Cancer 2010, 10:480  doi:10.1186/1471-2407-10-480

Published: 7 September 2010

Abstract

Background

In the era of cytokines, patients with brain metastases (BM) from renal cell carcinoma had a significantly shorter survival than patients without. Targeted agents (TA) have improved the outcome of patients with metastatic renal cell carcinoma (mRCC) however, their impact on patients with BM is less clear. The aim of this analysis was to compare the outcome of patients with and without BM in the era of targeted agents.

Methods

Data from 114 consecutive patients who had access to targeted agent were analyzed for response rates (ORR), progression free survival (PFS) and overall survival (OS). All patients diagnosed with BM underwent local, BM-specific treatment before initiation of medical treatment.

Results

Data of 114 consecutive patients who had access to at least one type of targeted agents were analyzed. Twelve out of 114 renal cell carcinoma (RCC) patients (10.5%) were diagnosed with BM. Systemic treatment consisted of sunitinib, sorafenib, temsirolimus or bevacizumab. The median PFS was 8.7 months (95% CI 5.1 - 12.3) and 11.4 months (95% CI 8.7 - 14.1) for BM-patients and non-BM-patients, respectively (p = 0.232). The median overall survival for patients with and without BM was 13.4 (95% CI 1- 43.9) and 33.3 months (95% CI 18.6 - 47.0) (p = 0.358), respectively. No patient died from cerebral disease progression. ECOG Performance status and the time from primary tumor to metastases (TDM) were independent risk factors for short survival (HR 2.74, p = 0.001; HR: 0.552, p = 0.034).

Conclusions

Although extracerebral metastases determine the outcome of patients with BM, the benefit from targeted agents still appears to be limited when compared to patients without BM.