Background: Current practice guidelines for the management of renal cell carcinoma (RCC) with brain metastases (BM) recommend a multimodal approach with systemic therapy, radiation, and/or surgery. The purpose of this study is to assess treatment patterns and identify prognostic factors for survival in this population. Methods: This retrospective, single-center study evaluated patients with RCC who were diagnosed with metastatic disease between 2015-2020 and were identified to have BM at any point in their care. Fisher's exact test and Mann-Whitney test were used to compare differences among groups. Kaplan-Meier curves were used to estimate time to events from the date of BM diagnosis. Univariate Cox proportional hazards model was used to estimate the effect of factors on survival. Results: 29 patients are included. Median follow-up was 25 months (range: 0.5-73). 16 (55%) patients presented with BM at the time of diagnosis of metastatic disease. 17 (58%) were treated with radiation. 8 (28%) were treated with surgery of which 7 also received radiation. Median overall survival was 10 months (95% CI: 7-not reached). Patients received a median of one (range 0-4) system therapy regimen after diagnosis of BM. 19 (66%) patients were exposed to at least one class of medication therapy for management of BM while 10 (34%) were exposed to two or more classes. 10 patients experienced long term survival (defined as survival ≥12 months). Patients with long term survival were more likely to have received radiation (90% vs 42%; P=0.02). However, use of radiation was not associated with survival (HR 0.47, 95% CI 0.1-1.3). Conclusions: The study is limited by sample size but suggests there is a population of patients with RCC with BM who can experience long term survival. Optimal selection for patients with BM that can be feasibly treated within radiation fields appears favorable. Most patients are not exposed to more than one systemic medication class during their care. Additional research is needed to compare efficacy in BM to guide first line systemic therapy selection.