Stereotactic Body Radiotherapy for the Treatment of Oligometastatic Renal Cell Carcinoma

Ranck, M.C.; Golden, Daniel W.; Corbin, Kimberly S.; Hasselle, Michael D.; Liauw, Stanley L.; Stadler, Walter M.; Hahn, Olwen; Weichselbaum, Ralph R.; Salama, Joseph K.

doi:10.1097/coc.0b013e31825d52b2

Cited by 88 publications

(48 citation statements)

References 22 publications

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“…10,11 Clinical experience mimics this conclusion with SABR showing efficacy ranges of 90-100% and 82-95% for CNS and extra-CNS metastases respectively. [28][29][30][31][32][33][34] In fact, at hypofractionated dose levels, RCC may even be more radiosensitive than other primary sites. Lung, for example, requires 54Gy in 3 fractions compared to RCC, where 36Gy in 3 fractions appears to provide adequate control.…”

Section: Discussionmentioning

confidence: 99%

“…Lung, for example, requires 54Gy in 3 fractions compared to RCC, where 36Gy in 3 fractions appears to provide adequate control. 16,33,34 Despite the extensive and growing experience with SABR in multiple cancer sites, its application to primary renal cancers has been limited to a few retrospective reviews and 2 phase I studies 34,35 all showing excellent local control rates. Three ongoing phase II clinical trials for SABR of primary RCC are currently underway (NCT 02141919, 01890590, 02138578)…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Hannan

Margulis

Chun

et al. 2015

Cancer Biology & Therapy

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Renal Cell Carcinoma (RCC) is a common malignancy world-wide that is rising in incidence. Up to 10% of RCC patients present with inferior vena cava (IVC) tumor thrombus (IVC-TT). Although surgery is the only treatment with proven efficacy for IVC-TT, the surgical management of advanced (level III and IV) IVC-TT is difficult with high morbidity and mortality, and offers a poor survival outcome. Currently, there are no treatment options in the setting of recurrent or unresectable RCC IVC-TT. Even though RCC may be resistant to conventionally fractionated radiation therapy, hypofractionated radiation has shown excellent control rates for both primary and metastatic RCC. We report our experience treating 2 RCC patients with Level IV IVC-TT -one recurrent and the other unresectable-with stereotactic ablative radiation therapy (SABR). The first patient is a 75-year-old gentleman with a level IV RCC IVC-TT who presented 9 months after his radical nephrectomy and thrombectomy with a growing level IV IVC-TT that became refractory to 4 targeted agents. He received SABR of 50Gy in 5 fractions and at 2-year follow-up is doing well with a significant decrease in the enhancement and size of the IVC-TT. The second patient is an 83-year-old gentleman who presented with metastatic RCC and level IV IVC-TT but was not a surgical candidate. After progression on temsirolimus, he received SABR of 36Gy in 4 fractions to his IVC-TT and survived 18 months post-SABR. Both patients improved symptomatically and did not experience any acute or late treatment-related toxicity. Their survival of 24 months and 18 months are comparable to the reported median survival of 20 months in patients with level IV IVC-TT that underwent surgical resection. Therefore, SABR can be a potentially safe treatment option in the unresectable setting for RCC patients with IVC-TT and should be further evaluated in prospective trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Hannan

Margulis

Chun

et al. 2015

Cancer Biology & Therapy

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“…In the clinical setting, dose escalation has also been shown to overcome radioresistance in RCC tumors: Zelefsky and colleagues reported 3-year LC of 88% following SBRT with high fractional doses for extracranial RCC metastases, while LC dropped to only about 20% when lower doses were used (30). A few other reports have also revealed LC rates of about 80-90% for extracranial SBRT in RCC patients (5,6,28,29,31,33). However, due to the limited number of RCC patients treated with SBRT, these reports combined data form different metastatic sites of including lung, bone, liver, lymph nodes or even primary RCC tumors (5,6,28,29,31,33).…”

Section: Toxicitymentioning

confidence: 99%

“…However, available reports concerning SBRT for RCC metastases have pooled heterogeneous data from various tumor locations (lung, bone, lymph node, brain, liver, etc.) with different sensitivities to high-dose radiation (5,6,(28)(29)(30)(31)(32)(33). This multi-institutional study reports the feasibility, safety, and efficacy of SBRT for pulmonary RCC metastases.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma—a multicenter analysis of the German working group “Stereotactic Radiotherapy”

Hoerner-Rieber¹,

Duma²,

Blanck³

et al. 2017

J. Thorac. Dis.

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Background: Renal cell carcinoma (RCC) is traditionally considered to be radioresistant. Radiotherapy response rates are believed to improve with hypofractionated, high dose stereotactic body radiotherapy (SBRT).However, limited data exist regarding the role of SBRT in the treatment of pulmonary metastases. Methods: The working group "Stereotactic Radiotherapy" of the German Society of Radiation Oncology analyzed its multi-institutional database of more than 700 patients who received SBRT for pulmonary metastases. Treatment was performed at 10 centers between 2001 and 2016. Patients with metastatic RCC were included in the study. Tumor characteristics, treatment details, and follow-up data including survival, local control (LC), distant metastases, and toxicity were evaluated. Results: A total of 46 RCC patients treated with SBRT for 67 lung metastases were identified, who received a median total biologically effective dose (BED iso ) at planning target volume (PTV) isocenter of 117.0 Gy (range, 48.0-189.0 Gy). A median fractional dose of 20.8 Gy at isocenter (range, 6.0-37.9 Gy) was administered in a median number of 3 fractions (1-8 fractions). After a median follow-up time of 28.3 months for all patients, 1-and 3-year LC rates were 98.1% and 91.9%, with corresponding 1-and 3-year overall survival (OS) of 84.3% and 43.8%, respectively. Pulmonary metastases treated with BEDiso ≥130 Gy showed a trend for superior LC (P=0.054). OS was significantly improved in both uni-and multivariate analysis for patients with higher Karnofsky performance scale, lower maximum pulmonary metastasis diameter and lack of post-SBRT systemic therapy due to progression (P=0.014; P=0.049; P=0.006). Only mild acute and late toxicity was reported.

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“…This is longer than expected in a group with metastases. A prolonged interval before systemic therapy change or initiation is required may reduce side effects associated with systemic therapy initiation or change, which may have an impact on quality of life [18,19].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Ablative Body Radiotherapy for the Treatment of Spinal Oligometastases

et al. 2017

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After the embargo period via non-commercial hosting platforms such as their institutional repository  via commercial sites with which Elsevier has an agreement In all cases accepted manuscripts should: link to the formal publication via its DOI  bear a CC-BY-NC-ND license -this is easy to do, click here to find out how  if aggregated with other manuscripts, for example in a repository or other site, be shared in alignment with our hosting policy  not be added to or enhanced in any way to appear more like, or to substitute for, the published journal article This cohort warrants further investigation in clinical trials of SABR.

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Stereotactic Body Radiotherapy for the Treatment of Oligometastatic Renal Cell Carcinoma

Abstract: In metastatic RCC, SBRT produces promising LeC with minimal toxicity. Further study should be expanded beyond that of managing intracranial disease. Its selected use may delay the requirement for systemic therapies.

Cited by 88 publications

References 22 publications

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Stereotactic body radiotherapy (SBRT) for pulmonary metastases from renal cell carcinoma—a multicenter analysis of the German working group “Stereotactic Radiotherapy”

Stereotactic Ablative Body Radiotherapy for the Treatment of Spinal Oligometastases

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