Global management of brain metastasis from renal cell carcinoma

[Display omitted] •BM from RCC has particular specific and microenvironmental characteristics.•Treatment is based on surgery, radiotherapy, and systemic therapy.•Recent progress has been made in all these areas.•Combination of these treatments seems to be promising but data are still lacking. During the last decade, major improvements have been made in the treatment of renal cell carcinoma (RCC) with the development and use of multiple tyrosine kinase inhibitors and immune checkpoint inhibitors. Brain metastases in RCC patients (BM-RCC) is associated with poor outcome and their management represents a challenge for clinicians. In most of case, brain metastases in this context require local intervention such as radiotherapy, stereotactic radiotherapy/stereotactic radiosurgery and whole brain radiation therapy. Despite efficacy in extracranial metastases, systemic therapies have modest antitumoral effect on cerebral lesions. In this review, we highlight the benefits and pitfalls of the available therapies in BM-RCC.