title: Extracerebral metastases determine the outcome of patients with brain metastases from renal cell carcinoma.
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.
authors.affiliation: Department of Medicine I, Clinical Division of Oncology and Cancer Center, Medical University Vienna, Vienna, Austria. ursula.vogl@meduniwien.ac.at
authors.forename: Ursula M
authors.initials: UM
authors.lastname: Vogl
authors.forename: Marija
authors.initials: M
authors.lastname: Bojic
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Lamm
authors.forename: Josa M
authors.initials: JM
authors.lastname: Frischer
authors.forename: Oskar
authors.initials: O
authors.lastname: Pichelmayer
authors.forename: Gero
authors.initials: G
authors.lastname: Kramer
authors.forename: Andrea
authors.initials: A
authors.lastname: Haitel
authors.forename: Klaus
authors.initials: K
authors.lastname: Kitz
authors.forename: Kaan
authors.initials: K
authors.lastname: Harmankaya
authors.forename: Christoph C
authors.initials: CC
authors.lastname: Zielinski
authors.forename: Manuela
authors.initials: M
authors.lastname: Schmidinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000628:therapy; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
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