Stereotactic ablative body radiotherapy for inoperable primary kidney cancer: a prospective clinical trial

Pham, Daniel; Kron, Tomas; Bressel, Mathias; Lam, Jacqueline; Tan, T H; Chesson, Brent; Shaw, Margaret; Chander, Sarat; Gill, Suki; Brook, Nicholas R.; Lawrentschuk, Nathan; Murphy, Declan; Foroudi, Farshad

doi:10.1111/bju.13811

Cited by 99 publications

(71 citation statements)

References 33 publications

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“…As a result of recent improvements in radiotherapy techniques, X‐ray stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) provide highly focused hypofractionated irradiation of tumors. These novel radiotherapy techniques have shown favorable local control rates (97.8%‐100% at 2 years) and few severe adverse events . However, to the best of our knowledge, there are no long‐term follow‐up data of SBRT/SABR for primary RCC.…”

Section: Introductionmentioning

confidence: 99%

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Kasuya

Tsuji

Nomiya³

et al. 2018

Cancer Science

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Long‐term oncological outcomes for primary renal cell carcinoma (RCC) treated with carbon‐ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12 or 16‐fraction CIRT at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease‐free, cancer‐specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7‐16.5) years; 9 of these patients were inoperable because of comorbidities or advanced‐stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre‐CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non‐renal adverse events. Local control rate, and disease‐free, cancer‐specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long‐term follow‐up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre‐CIRT, and yield favorable treatment outcomes, even in inoperable cases.

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Section: Introductionmentioning

confidence: 99%

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Kasuya

Tsuji

Nomiya³

et al. 2018

Cancer Science

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“…In patients with medically inoperable, early-stage RCC, SBRT to the primary tumour results in very high local control rates. 86,87 Similar high local control rates of ~ 90% are observed when using SBRT to treat RCC metastases in various body sites (thoracic, abdominal, soft tissue, bone, brain). 88,89 Such data refutes the previously held notion that RCC is radio-resistant.…”

Section: Role Of Local Therapy In Oligometastasesmentioning

confidence: 72%

Management of advanced kidney cancer: Canadian Kidney Cancer Forum (CKCF) consensus update 2017

North

Basappa

Bjarnason

et al. 2017

CUAJ

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“…Radiotherapy may also change the tumour microenvironment by releasing cytokines which increase its responsiveness to local radiotherapy increasing the likelihood of further systemic responses via the 'abscopal' effect [34][35][36]. Indeed, a prospective clinical trial of SBRT for inoperable primary RCC has demonstrated freedom from local progression, distant progression and overall survival at 2 years of 100%, 89% and 92%, respectively [37], with baseline neutrophil to lymphocyte ratio being predictive of immune-mediated response offering a potential future biomarker of response to radiotherapy, though this needs further investigation.…”

Section: Discussionmentioning

confidence: 99%

Intensity Modulated Radiotherapy is a Well-Tolerated and Effective Treatment for the Long-Term Control of Intra-Abdominal and Retroperitoneal Oligometastatic Renal Cell Cancer

Maund

Al-Naeeb

Welsh

et al. 2018

KCA

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Abstract.Background: The use of conventionally fractionated intensity modulated radiotherapy (IMRT) in the management of oligometastatic renal cell carcinoma (RCC) is currently poorly characterised in the literature. Objective: To evaluate the safety and effectiveness of IMRT for intraabdominal and retroperitoneal RCC oligometastases. Methods: Retrospective analysis of 14 patients with oligometastatic RCC treated with IMRT with the aim of inducing longterm control. Indications for radiotherapy included bleeding abdominal mass (5 patients), solitary renal bed recurrence (5 patients) and isolated, asymptomatic pancreatic mass (4 patients). The prescribed radiotherapy dose was 50 Gray in 20 to 25 fractions. Patients were followed up long-term using regular cross-sectional imaging and clinical review to assess local and distant disease control and treatment related toxicity. Results: At median follow up of 33.5 (6-68) months, 12 patients remain alive (86%), of whom 11 (92%) have no evidence of local recurrence. Six patients (43%) developed further metastatic disease, of whom 4 (67%) received systemic treatment. Median duration of local control was 33.5 months, and 1-and 3-year overall survival (OS) was 92.9% and 85.7% respectively. No treatment-related toxicities ≥ grade 3 and no long-term sequelae were observed. Conclusions: IMRT to intra-abdominal and retroperitoneal metastasis in oligo-metastatic RCC can be delivered safely, provide durable responses and excellent longer-term survival if given to a sufficiently high dose over a conventionally fractionated course. Our study is the first to date with long-term follow up to evaluate the role of IMRT in such cases and has important implications for treatment of oligometastatic RCC.

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Stereotactic ablative body radiotherapy for inoperable primary kidney cancer: a prospective clinical trial

Cited by 99 publications

References 33 publications

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Management of advanced kidney cancer: Canadian Kidney Cancer Forum (CKCF) consensus update 2017

Intensity Modulated Radiotherapy is a Well-Tolerated and Effective Treatment for the Long-Term Control of Intra-Abdominal and Retroperitoneal Oligometastatic Renal Cell Cancer

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