Purpose/Objective(s): Utilization of stereotactic radiotherapy in the management of renal cell carcinoma is increasing internationally (Siva et al, Nat Rev Urol, 2017). Our objectives are to assess the efficacy and safety of stereotactic radiotherapy for metastatic renal cell carcinoma (RCC). We hypothesized that local control is >85% and significant toxicity is <15%. Materials/Methods: A PICOS/PRISMA/MOOSE selection protocol was utilized to select studies published between 1998 and 2019. The primary outcome was 1-year local control (LC) and 1-year overall survival (OS); secondary outcome was incidence of any acute or late Common Terminology Criteria for Adverse Events (CTCAE) grade 3-4 toxicity. Each outcome was stratified by extra-or intracranial RCC involvement. Weighted random effects meta-analyses were conducted, where the Der-Simonian and Laird method was used to calculate between study variance for each of the primary and secondary outcomes. Heterogeneity was assessed using the I 2 statistic and Cochran's Q-Test. Publication bias was assessed using funnel plots and the Egger Test, where publication bias was considered absent if the p-value was < 0.05. Results: A total of 265 studies were initially screened. A total of 28 studies (27 retrospective, 1 prospective) from 8 countries, were included in the meta-analysis. There were a total of 1,602 mutually exclusive patients (679 extracranial/923 intracranial) and 3,892 lesions (1,159 extracranial/2,733 intracranial). The median patient age was 62 years (range: 55-56 years). The median treatment volume was 59.7 cc for extracranial lesions (interquartile range: 31.1-71.4) and 2.3 cc for intracranial lesions (interquartile range: 1.3 e 4.3). Under the random effects model, the summary effect size for 1-year LC was 89.1% (95% confidence interval [CI]: 83.6%-93.7%, I 2 Z71%) and 90.1% (95% CI: 83.5%-95.3%, I 2 Z74%) for extracranial and intracranial disease, respectively. For 1-year OS: 86.8% (95% CI: 62%-99.8%, I 2 Z95%) and 49.7% (95% CI: 41.1%-58.3%, I 2 Z74%) for extracranial and intracranial disease, respectively. The incidence of any grade 3-4 toxicity was 0.7% (95% CI: 0%-2.1%, I 2 Z0%) and 1.1% (95% CI: 0%-7.4%, I 2 Z53%) for extracranial and intracranial disease, respectively. There was no publication bias present for any of the outcomes (Egger Test: p>0.05), regardless of site. Conclusion: Stereotactic radiotherapy is safe and efficacious in the management of extracranial and intracranial RCC oligometastases, with LC at 90% and any significant toxicity at 1%. Patients with intracranial metastases have worse survival than those with extracranial disease, despite smaller treatment volumes. Further prospective studies are needed.
biopsy of any target lesions. Patients undergo transrectal ultrasound-guided catheter placement followed by MRI-based treatment planning and HDR treatment. The planning target volume (PTV) is a 0-5 mm expansion around the gross tumor volume (GTV) avoiding surrounding critical structures. The prescription is to the periphery with the highest dose possible up to 30 Gy while not violating critical structure constraints and prioritizing GTV > PTV coverage. We performed a descriptive analysis of patient characteristics, dosimetry, and the acute EPIC-26 patient-reported quality of life of patients currently enrolled on the trial. Results: 11 of a planned 24 patients have been treated on trial and the initial safety lead-in has been completed, with enrollment ongoing. Prior definitive treatment included external beam radiotherapy (nZ8), low dose rate brachytherapy (nZ2), and stereotactic body radiotherapy (nZ1), with a median of 67 months from the completion of prior radiotherapy. Median pre-salvage PSA was 6.3 (range: 2.6-13.5). The median number of HDR catheters was 17 (range: 13-22), and the median prescribed peripheral dose was 19 Gy (19-22). Median GTV was 5.4 cc (2.01-44.72). Median PTV was 23.7 cc (8.78-76.69). Median GTV D90 was 21.3 Gy (17.13-35.91), PTV D90 was 19.6 Gy (16.3-23.9) Conclusion: Accrual to the FSHARP trial is ongoing. Future studies will correlate dosimetric findings with clinical outcomes. The table describes the baseline and follow-up median EPIC-26 scores up to 6 months with median follow-up of 6.23 months (0.8-12.2).
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