Stereotactic body radiation therapy (SBRT) on renal cell carcinoma, an overview of technical aspects, biological rationale and current literature

Detti, Beatrice; Ingrosso, Gianluca; Desideri, Isacco; Becherini, Carlotta; Carta, G; Pezzulla, D.; G, Caramia; Dominici, Luca; Maragna, V.; Teriaca, Maria Ausilia; Bottero, Marta Carla; Livi, Lorenzo

doi:10.1016/j.critrevonc.2018.08.010

Cited by 26 publications

(16 citation statements)

References 44 publications

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“…To the best of our knowledge, this is the first series of patients treated for primary RCC using MRgRT with routine daily plan re-optimization. We applied a commonly used fractionation scheme of 40 Gy in five fractions [ 18 , 23 , 24 ] in an overall treatment time of two weeks. Only a single patient reported nausea as acute toxicity, and no grade ≥ 2 late toxicity was observed.…”

Section: Discussionmentioning

confidence: 99%

The Role of Daily Adaptive Stereotactic MR-Guided Radiotherapy for Renal Cell Cancer

Tetar

Bohoudi

Senan

et al. 2020

Cancers

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Novel magnetic-resonance-guided radiotherapy (MRgRT) permits real-time soft-tissue visualization, respiratory-gated delivery with minimal safety margins, and time-consuming daily plan re-optimisation. We report on early clinical outcomes of MRgRT and routine plan re-optimization for large primary renal cell cancer (RCC). Thirty-six patients were treated with MRgRT in 40 Gy/5 fractions. Prior to each fraction, re-contouring of tumor and normal organs on a pretreatment MR-scan allowed daily plan re-optimization. Treatment-induced toxicity and radiological responses were scored, which was followed by an offline analysis to evaluate the need for such daily re-optimization in 180 fractions. Mean age and tumor diameter were 78.1 years and 5.6 cm, respectively. All patients completed MRgRT with an average fraction duration of 45 min. Local control (LC) and overall survival rates at one year were 95.2% and 91.2%. No grade ≥3 toxicity was reported. Plans without re-optimization met institutional radiotherapy constraints in 83.9% of 180 fractions. Thus, daily plan re-optimization was required for only a minority of patients, who can be identified upfront by a higher volume of normal organs receiving 25 Gy in baseline plans. In conclusion, stereotactic MRgRT for large primary RCC showed low toxicity and high LC, while daily plan re-optimization was required only in a minority of patients.

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Section: Discussionmentioning

confidence: 99%

The Role of Daily Adaptive Stereotactic MR-Guided Radiotherapy for Renal Cell Cancer

Tetar

Bohoudi

Senan

et al. 2020

Cancers

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“…An aggressive SBRT regimen of at least 45 Gy showed efficacy in achieving local control that is comparable to more radiosensitive cancer types [43]. Treatment schedule delivering up to 48 Gy in 3 to 4 fractions have been found to be effective and safe in renal cell carcinoma with little specific data on sRCC [45]. Therefore, the role of radiation therapy in either sarcomatoid or non-sarcomatoid RCC is largely limited to localized treatment of symptomatic metastatic disease particularly to the brain and bone but may be applied to soft tissue lesions as well [44,46].…”

Section: Role For Radiation Therapymentioning

confidence: 99%

Sarcomatoid Renal Cell Carcinoma: The Present and Future of Treatment Paradigms

Candelario

Geiger

Flaig

2021

KCA

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Sarcomatoid renal cell carcinoma (sRCC) is an aggressive form of kidney cancer that is associated with poor prognosis. It can arise from any histologic type of renal cell carcinoma. The majority of cases will present with advanced or metastatic disease requiring systemic therapy. Nephrectomy is the treatment of choice in locally resectable disease. The therapeutic options for sRCC have evolved in the past decade. Cytotoxic chemotherapy and monotherapy with targeted therapy (VEGF and mTOR) have historically shown poor response rates and survival in the treatment of metastatic sRCC. The use of checkpoint inhibitors and their combination with targeted therapy against VEGF has changed the landscape and outcomes for renal cell carcinoma. Given the rarity of sRCC most of the data on treatment is from small cohorts or extrapolation from larger clinical trials. The benefit from the combination of checkpoint inhibitors and targeted therapy to VEGF has shown promise in the sRCC population in post hoc analysis of large clinical trials. Future research focusing on further characterizing the unique biologic and clinical features of sRCC is critical in advancing the knowledge and developing effective therapy to improve clinical outcomes and survival.

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“…This method also has shown low toxicity and good control of local tumors and may be a promising strategy to target primary tumors or manage metastases in patients. 18 The use of stereotactic body radiation therapy is a current area of investigation with multiple trials being Figure 2. Current targeted therapies for RCC.…”

Section: New Treatment Options and Strategies For Rccmentioning

confidence: 99%

Potential New Therapeutic Approaches for Renal Cell Carcinoma

Yang

Chen

2020

Seminars in Nephrology

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Renal cell carcinoma (RCC) is increasing in incidence and one third of newly diagnosed cases already are metastatic. The metastatic spread of solid tumors renders RCC incurable by surgical resection and consequently more difficult to treat. New molecular-targeted therapies have played a pivotal role in RCC treatment. Unfortunately, tumors frequently develop resistance to these targeted therapies by activating bypass pathways in which alternative signaling or biochemical pathways are activated in response to targeted inhibition of a signaling pathway, allowing cancer cells to continue to survive. Although the advent of immunotherapy with checkpoint inhibitors has led to significant changes in the treatment landscape for advanced RCC, many issues remain to be resolved. For these reasons, there is an urgent need to develop novel therapies and new treatment paradigms for patients with RCC. Much research has been performed thus far in identifying novel targets and treatment strategies in RCC and many of these currently are under investigation and/or in clinical trials. In this article, we discuss therapeutic options in the management of RCC with a focus on the new therapeutic approaches currently investigated in research and for use in the clinic. We divide these potential novel therapies into five groups: nonbiologics, small-molecule drugs, biologics, immunomodulatory therapies, and peptide drugs. We also present some therapeutics and treatment paradigms.

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Stereotactic body radiation therapy (SBRT) on renal cell carcinoma, an overview of technical aspects, biological rationale and current literature

Cited by 26 publications

References 44 publications

The Role of Daily Adaptive Stereotactic MR-Guided Radiotherapy for Renal Cell Cancer

The Role of Daily Adaptive Stereotactic MR-Guided Radiotherapy for Renal Cell Cancer

Sarcomatoid Renal Cell Carcinoma: The Present and Future of Treatment Paradigms

Potential New Therapeutic Approaches for Renal Cell Carcinoma

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