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

Abstract

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.

Role of stereotactic body radiation therapy for the management of renal cell carcinoma: tailoring treatment in the era of the “embarrassment of riches”

“…At the median follow-up of 16.1 months, the LC rate at 12 and 18 months was 90.2% in both time-points with PFS rate 46.2% and 35.0% respectively at 12 and 18 months. Such data are consistent with those of other similar reports from the literature (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Stereotactic Body Radiation Therapy for Renal Cell Carcinoma with Inferior Vena Cava Thrombus – Initial Experience Report and Literature Review

“…However, 5 grade 3 late AEs (>3 months following therapy) were reported, 2 of which were due to gastrointestinal bleeding that required surgery [10]. A recent report that focused on lung metastasis reported 1 and 3-year local control rates of 98% and 92%, respectively, also suggesting that better control rates are associated with higher radiation doses (BED ≥ 120 Gy, p = 0.054) [23].…”

Survival After Combining Stereotactic Body Radiation Therapy and Tyrosine Kinase Inhibitors in Patients With Metastatic Renal Cell Carcinoma

“…Oligometastasis has been generally accepted as an indicator for local therapy. In studies that included oligometastatic mRCC patients, the median OS of patients treated with SBRT was remarkable (median OS, 34–51 months) ( 14 , 25 , 26 ), with some not even reaching the median OS ( 13 , 27 ). The patient’s IMDC risk group may also be an indicator for treatment selection.…”