Real-world Outcomes of Renal Cell Carcinoma and Intracranial Metastatic Disease

Intracranial metastatic disease (IMD) is a serious complication of renal cell carcinoma (RCC). However, large-scale data on its clinical characteristics, survival outcomes, and treatment strategies are limited, especially at the population level. To examine the clinical features, survival outcomes, and treatment patterns of RCC patients with IMD in Ontario, Canada, and provide insights to optimize patient management. This population-based retrospective cohort study included RCC patients diagnosed between 2010 and 2019 in Ontario. Demographics, treatments, and survival data were obtained from provincial healthcare records. Kaplan-Meier and Cox regression analyses assessed overall survival (OS). Propensity score matching (PSM) was used to compare survival outcomes between treatment groups. Among 13,353 RCC patients (mean age: 62 years), 4.6% developed IMD (71% metachronous, 29% synchronous), with a median time to IMD of 8.3 months [Interquartile Range: 1.3, 25.6]. Median OS was significantly shorter for patients with IMD (20.9 months) versus those without IMD (125.4 months; p < 0.001). Synchronous IMD (HR: 2.58) was linked to worse OS. Those without metastases at diagnosis had the longest OS (127.0 months), compared to patients with extracranial metastases alone (13.6 months; HR: 6.89) or synchronous IMD (4.8 months; HR: 14.71). Patients with stage 4 disease at diagnosis who developed metachronous IMD had better OS than those who never developed IMD (17.7 vs. 12.0 months). In patients with IMD, systemic therapy was associated with improved survival (HR: 0.47). Stereotactic radiosurgery (SRS) and/or neurosurgery was associated with improved survival, compared to whole-brain radiotherapy (WBRT) or no IMD-directed treatment (HR: 0.47). Propensity-matched analyses showed that receipt of SRS/neurosurgery was associated with improved OS, compared to WBRT or no IMD-directed treatment (25.9 vs. 13.1 months; HR: 0.55). This study provides large-scale, population-based insights into the impact of IMD in RCC. Our findings show that SRS/neurosurgery is protective in all subgroups of RCC patients with IMD, informing clinical decision-making and offering valuable guidance for optimizing patient outcomes and resource allocation. Additionally, these findings highlight the need for routine brain imaging in RCC to enable early detection and improve management strategies. Madison Sherman, Karim Hafazalla, Arjun Sahgal, Georg Bjarnason, Sunit Das. Real-world outcomes of renal cell carcinoma and intracranial metastatic disease [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5967.