Radiation therapy following targeted therapy in oligometastatic renal cell carcinoma

Abstract

Abstract. Up to 40% of patients with renal cell carcinoma (RCC) with initially localized disease eventually develop metastasis following nephrectomy. The current standard of care for metastatic RCC (mRCC) is targeted therapy. However, complete response remains rare. A state of oligometastatic disease may exist, in which metastases are present in a limited number of locations; such cases may benefit from metastasis-directed local therapy, based on the evidence supporting resection of limited-volume metastases, allowing for improved disease control. We retrospectively analyzed 7 cases of response of RCC metastases, in patients treated with targeted therapies followed by radiation therapy (RT) of residual metastatic lesions in Paoli-Calmettes Institute (Marseille, France). We analyzed disease response rates, response to sequential strategy, relapse at the irradiated locations and disease evolution. The median follow-up was 34.1 months (range, 19.2-54.5 months). No progression at the irradiated sites was observed. A total of 5 patients had stable disease at the irradiated locations at the last follow-up; 3 remained in complete remission at the assessment, and 2 were stable. Excellent local response and clinical benefit may be achieved without added toxicity. In conclusion, sequential therapeutic strategies with RT following systemic treatment using sunitinib appear to be highly effective in patients with progressive mRCC and prompt the conduction of further confirmatory trials. IntroductionOne-third of patients diagnosed with renal cell carcinoma (RCC) present with metastasis at initial diagnosis and up to 40% of patients with initially localized RCC eventually develop metastasis following radical or partial nephrectomy (1). The current standard of care for patients with metastatic RCC (mRCC) is targeted therapy, which may reduce tumor burden and improve survival rates compared with historical treatments (2). However, complete response to systemic therapy alone remains extremely rare (3). mRCC has long been a disease for which the resection of metastatic deposits has been considered for patient treatment (4). Patients who undergo metastasectomy tend to exhibit a better outcome, independently of their risk score (5).However, in several cases, patients with metastatic disease are either unfit for surgery or have technically unresectable disease and, therefore, non-invasive metastasis-directed therapy for selected patients may be recommended.For patients with metastatic disease progression and for those who present with distant disease, the median survival is ~20 months, with an expected 5-year survival rate of 30% (6).Among patients with mRCC, certain subgroups have been identified with improved prognosis and a prolonged disease course (7). For these patients, management of limited metastatic disease may be beneficial. A state of oligometastasis may exist, in which metastases are present in a limited number of locations and may benefit from metastasis-directed local therapy, based on the evidence supporting resection ...

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