# A Survey of Oncologists’ Perceptions and Opinions Regarding Brain Imaging in Metastatic Renal Cell Carcinoma Within the UK

## TL;DR

UK oncologists have varied opinions on brain imaging for advanced kidney cancer patients, with most not following specific guidelines and a strong interest in adopting evidence-based practices.

## Contribution

The study reveals significant variability in CNS imaging practices and highlights oncologists' willingness to adopt routine imaging if proven beneficial.

## Key findings

- Most UK oncologists do not follow specific guidelines for brain imaging in advanced renal cell carcinoma.
- Nearly half perform brain imaging only when patients show neurological symptoms.
- 92% of respondents would adopt routine brain imaging if evidence showed improved outcomes.

## Abstract

Brain metastases are an important cause of morbidity and mortality in patients with advanced renal cell carcinoma (aRCC). Despite emerging evidence suggesting a clinically meaningful prevalence of asymptomatic brain metastases, there remains no consensus regarding routine central nervous system (CNS) imaging in this population. This questionnaire study aimed to explore current opinions and management practices relating to brain imaging for aRCC across the UK.

A nationwide, web-based survey was conducted using Google Forms between June and October 2025, targeting UK oncology consultants with a subspecialist interest in renal cell carcinoma (RCC). The questionnaire assessed demographics, guideline use, current CNS imaging practices, and willingness to change practice. Fifty consultants were invited to participate, and 25 responses were received, representing a 50% response rate from multiple centres across the UK.

Most respondents (68%) reported not following any specific guideline for CNS imaging in patients with aRCC. Considerable variation in clinical practice was observed. Nearly half of respondents (48%) reported performing CNS imaging only in the presence of neurological symptoms, while 28% performed routine surveillance imaging in asymptomatic patients. Smaller proportions reported imaging patients with high-risk features at diagnosis (12%), incorporating CNS imaging into baseline staging for metastatic disease (4%), or performing imaging only at disease progression or change in systemic therapy (8%). Imaging modality and surveillance frequency also varied widely. Notably, 92% of respondents stated they would consider adopting routine CNS imaging for all patients with aRCC if evidence demonstrated improved clinical outcomes.

This survey demonstrates substantial variability in CNS imaging practices for patients with aRCC among UK oncology consultants, reflecting the absence of standardised guidance. The strong willingness to change practice highlights the need for prospective studies to clarify the clinical value, optimal timing, and cost-effectiveness of routine brain imaging. Robust evidence is required to inform evidence-based guidelines, reduce practice variation, and support consistent, patient-centred care for patients with aRCC.