Journal article
Effect of Targeted Therapies on Prognostic Factors, Patterns of Care, and Survival in Patients With Renal Cell Carcinoma and Brain Metastases
International journal of radiation oncology, biology, physics, Vol.101(4), pp.845-853
07/15/2018
DOI: 10.1016/j.ijrobp.2018.04.006
PMCID: PMC6925530
PMID: 29976497
Abstract
To identify prognostic factors, define evolving patterns of care, and the effect of targeted therapies in a larger contemporary cohort of renal cell carcinoma (RCC) patients with new brain metastases (BM).
A multi-institutional retrospective institutional review board-approved database of 711 RCC patients with new BM diagnosed from January 1, 2006, to December 31, 2015, was created. Clinical parameters and treatment were correlated with median survival and time from primary diagnosis to BM. Multivariable analyses were performed.
The median survival for the prior/present cohorts was 9.6/12 months, respectively (P < .01). Four prognostic factors (Karnofsky performance status, extracranial metastases, number of BM, and hemoglobin b) were significant for survival after the diagnosis of BM. Of the 6 drug types studied, only cytokine use after BM was associated with improved survival. The use of whole-brain radiation therapy declined from 50% to 22%, and the use of stereotactic radiosurgery alone increased from 46% to 58%. Nonneurologic causes of death were twice as common as neurologic causes.
Additional prognostic factors refine prognostication in this larger contemporary cohort. Patterns of care have changed, and survival of RCC patients with BM has improved over time. The reasons for this improvement in survival remain unknown but may relate to more aggressive use of local brain metastasis therapy and a wider array of systemic treatment options for those patients with progressive extracranial tumor.
Details
- Title: Subtitle
- Effect of Targeted Therapies on Prognostic Factors, Patterns of Care, and Survival in Patients With Renal Cell Carcinoma and Brain Metastases
- Creators
- Paul W Sperduto - Minnesota OncologyBrian J Deegan - The University of Texas MD Anderson Cancer CenterJing Li - The University of Texas MD Anderson Cancer CenterKrishan R Jethwa - Mayo Clinic , Rochester, Minnesota.Paul D Brown - Mayo Clinic , Rochester, Minnesota.Natalie Lockney - Memorial Sloan Kettering Cancer CenterKathryn Beal - Memorial Sloan Kettering Cancer CenterNitesh G Rana - Vanderbilt University Medical CenterAlbert Attia - Vanderbilt University Medical CenterChia-Lin Tseng - Sunnybrook Health Science CentreArjun Sahgal - Sunnybrook Health Science CentreRyan Shanley - University of MinnesotaWilliam A Sperduto - University of MinnesotaEmil Lou - University of MinnesotaAmir Zahra - University of IowaJohn M Buatti - University of IowaJames B Yu - Yale UniversityVeronica Chiang - Yale UniversityJason K Molitoris - University of Maryland, BaltimoreLaura Masucci - Centre Hospitalier de l’Université de MontréalDavid Roberge - Centre Hospitalier de l’Université de MontréalDiana D Shi - Massachusetts General HospitalHelen A Shih - Massachusetts General HospitalAdam Olson - Duke UniversityJohn P Kirkpatrick - Duke UniversitySteve Braunstein - University of California, San FranciscoPenny Sneed - University of California, San FranciscoMinesh P Mehta - Miami Cancer Institute, Miami, Florida.
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.101(4), pp.845-853
- DOI
- 10.1016/j.ijrobp.2018.04.006
- PMID
- 29976497
- PMCID
- PMC6925530
- NLM abbreviation
- Int J Radiat Oncol Biol Phys
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Publisher
- Elsevier Inc
- Grant note
- P30 CA077598 / NCI NIH HHS UL1 TR000114 / NCATS NIH HHS UL1 TR002494 / NCATS NIH HHS P30 CA008748 / NCI NIH HHS
- Language
- English
- Date published
- 07/15/2018
- Academic Unit
- Radiation Oncology; Neurosurgery; Otolaryngology
- Record Identifier
- 9984303904002771
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