The Role of Stereotactic Ablative Body Radiotherapy in Renal Cell Carcinoma

Ali, Muhammad; Mooi, Jennifer; Lawrentschuk, Nathan; McKay, Rana R.; Hannan, Raquibul; Hall, William A.

doi:10.1016/j.eururo.2022.06.017

Cited by 56 publications

(29 citation statements)

References 50 publications

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“…Radiotherapy using conventionally fractionated doses did not show acceptable results for RCC in the past [ 22 , 23 ]. In contrast, SBRT resulted in excellent LC rates in several studies and is being adopted for inoperable patients in SBRT experienced centres [ 24 ]. So far, there are few prospective trials that have evaluated the role of SBRT for RCC [ 25 , 26 , 27 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Renal Cell Carcinoma in Patients with Von Hippel–Lindau Disease—Results of a Prospective Trial

Kirste

Rühle

Zschiedrich

et al. 2022

Cancers

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Von Hippel–Lindau disease (VHL) is a hereditary disorder associated with malignant tumors including clear cell renal cell carcinoma (ccRCC). Partial nephrectomy is complicated by multilocular tumor occurrence and a high recurrence rate. The aim of this study was to evaluate the potential of stereotactic body radiotherapy (SBRT) as an alternative treatment approach in VHL patients with multiple ccRCC. Patients with VHL and a diagnosis of ccRCC were enrolled. SBRT was conducted using five fractions of 10 Gy or eight fractions of 7.5 Gy. The primary endpoint was local control (LC). Secondary endpoints included alteration of renal function and adverse events. Seven patients with a total of eight treated lesions were enrolled. Median age was 44 years. Five patients exhibited multiple bilateral kidney cysts in addition to ccRCC. Three patients underwent at least one partial nephrectomy in the past. After a median follow-up of 43 months, 2-year LC was 100%, while 2-year CSS, 2-year PFS and 2-year OS was 100%, 85.7% and 85.7%, respectively. SBRT was very well tolerated with no acute or chronic toxicities grade ≥ 2. Mean estimated glomerular filtration rate (eGFR) at baseline was 83.7 ± 13.0 mL/min/1.73 m2, which decreased to 76.6 ± 8.0 mL/min/1.73 m2 after 1 year. Although the sample size was small, SBRT resulted in an excellent LC rate and was very well tolerated with preservation of kidney function in patients with multiple renal lesions and cysts.

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Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiotherapy for Renal Cell Carcinoma in Patients with Von Hippel–Lindau Disease—Results of a Prospective Trial

Kirste

Rühle

Zschiedrich

et al. 2022

Cancers

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“…The most well-studied, noninvasive local approach is radiotherapy, mostly in the form of stereotactic body radiation (SBR). A large amount of prospective and retrospective studies and meta-analyses support the activity of this approach for treating oligometastatic disease in combination with TKIs or ICIs ( 75 ). Local control rates usually exceed 90%, even for intracranial disease, with severe toxicity being uncommon (<10%) ( 75 ).…”

Section: Local Therapies For Oligoprogressive Diseasementioning

confidence: 99%

“…A large amount of prospective and retrospective studies and meta-analyses support the activity of this approach for treating oligometastatic disease in combination with TKIs or ICIs ( 75 ). Local control rates usually exceed 90%, even for intracranial disease, with severe toxicity being uncommon (<10%) ( 75 ). Although prospective evaluation of SBR plus nivolumab did not add any systemic benefit with respect to ORR (17%) and median OS (20 months) compared to historical controls of nivolumab alone in the NIVES study, more prospective trials such as the RAPPORT study are further investigating this with molecular correlates to provide insights into the underlying biology of combination SBR and ICI therapy ( 76 , 77 ).…”

Section: Local Therapies For Oligoprogressive Diseasementioning

confidence: 99%

Current Options for Second-Line Systemic Therapy in Metastatic Renal Cell Carcinoma

Mitsogiannis

Mitsogianni²,

Papathanassiou³

et al. 2022

jkcvhl

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Standard systemic therapy of advanced renal cell carcinoma (RCC) involves targeting angiogenesis, mainly through tyrosine kinase inhibitors (TKI) against the vascular endothelial growth factor receptor (VEGFR) pathway and targeting the immune checkpoints, namely, programmed death-1 (PD-1) or its ligand (PD-L1), and cytotoxic T-lymphocyte-associated protein 4 (CTLA4). With current strategies of combining these two approaches in the front-line setting, less is known about optimal selection of therapy upon development of resistance in the second and later lines of treatment for progressive disease. This review discusses currently available therapeutic options in patients who have progressive RCC after prior treatment with double immune checkpoint inhibitors (ICIs) or ICI-TKI combinations.

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“…Given its noninvasive nature, SBRT has been increasingly used in metastatic RCC and may be helpful in both metastatic disease to the brain and spine as well as extra-cranial metastatic disease [36]. SBRT may also be indicated alongside systemic treatment to provide a potential additive effect [36].…”

Section: History and Current Trendsmentioning

confidence: 99%

“…Patients with larger RCC tumors, such as those classified as T1b or greater, are often limited in their treatment options given a decreased effectiveness with thermal ablation in this setting. This is often a result of an increased risk of local recurrence and complications [ 35 , 36 ]. In patients who are poor surgical candidates, such as elderly patients, those on long-term anticoagulation, or those with multiple competing comorbidities, stereotactic body radiation therapy (SBRT) provides a viable alternative [ 35 , 36 ].…”

Section: Reviewmentioning

confidence: 99%

Cryoablation for the Treatment of Kidney Cancer: Comparison With Other Treatment Modalities and Review of Current Treatment

Bisbee¹,

Zhang²,

Owens³

et al. 2022

Cureus

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With cancer among the leading causes of death worldwide and kidney cancer among the more common cancers in the United States, it has become increasingly important to ensure that first-line treatments remain validated and supported in recent literature. Surgical intervention has long remained the gold standard for intervention but with newer techniques and technology on the horizon, there must be a constant review of other options that may provide improved outcomes and reduction of associated risks. Ablative techniques have gained traction and are becoming a valuable intervention for multiple different types of cancers, kidney cancer included. Cryoablation, a newer ablative technique taking advantage of extreme cold to freeze and destroy abnormal tissue, provides a promising option for treatment. Currently, no review article, to our knowledge, compares all the different treatment options for kidney cancer. Additionally, while some literature has addressed cryoablation in comparison to other methods of management, there has not been an extensive review to combine our current understanding of these comparisons. In this review article, we provide an overview of each of the commonly used treatments for kidney cancer and summarize the current literature regarding the advantages and disadvantages of each intervention. Finally, we seek to compare cryoablation, a newer option for treatment, to each of the approaches with the goal of evaluating the best methods for management and determining cryoablation's role alongside these current interventions.

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The Role of Stereotactic Ablative Body Radiotherapy in Renal Cell Carcinoma

Cited by 56 publications

References 50 publications

Stereotactic Body Radiotherapy for Renal Cell Carcinoma in Patients with Von Hippel–Lindau Disease—Results of a Prospective Trial

Stereotactic Body Radiotherapy for Renal Cell Carcinoma in Patients with Von Hippel–Lindau Disease—Results of a Prospective Trial

Current Options for Second-Line Systemic Therapy in Metastatic Renal Cell Carcinoma

Cryoablation for the Treatment of Kidney Cancer: Comparison With Other Treatment Modalities and Review of Current Treatment

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