Role of Stereotactic Body Radiation Therapy for the Management of Oligometastatic Renal Cell Carcinoma

Franzese, Ciro; Franceschini, Davide; Brina, Lucia Di; D'Agostino, Giuseppe Roberto; Navarria, Pierina; Comito, Tiziana; Mancosu, P.; Tomatis, S.; Scorsetti, Marta

doi:10.1016/j.juro.2018.08.049

Cited by 48 publications

(35 citation statements)

References 1 publication

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“…Historically, RCC has been considered a radioresistant tumor but high radiation doses with BED >100 Gy could overcome this problem by offering other radiobiological models not yet sufficiently explored. Furthermore, high dose delivered in a few fractions could guarantee good local control as already demonstrated by the current retrospective study (22). SBRT treatment could be used in oligometastatic patients who are not candidates for radical surgery or as a non-invasive option of therapy.…”

supporting

confidence: 59%

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Stereotactic body radiation therapy could improve disease control in oligometastatic patients with renal cell carcinoma: do we need more evidence?

Agolli

2019

Ann. Transl. Med

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supporting

confidence: 59%

“…In the recently published study by Franzese et al (22), local control and progression-free survival (PFS) rates at 18-month were 90.2% and 35%, respectively, while severe treatment-related toxicities were not observed. The authors aimed to analyze outcomes in terms of disease control and survival, and side effects.…”

mentioning

confidence: 98%

Stereotactic body radiation therapy could improve disease control in oligometastatic patients with renal cell carcinoma: do we need more evidence?

Agolli

2019

Ann. Transl. Med

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“…A locoregionally controlled primary tumour is not a precondition but should be considered a prognostic parameter which is critical to report specifically. Some studies reported a better prognosis for metachronous OMD [28,86], but this was not consistently observed [25,74]. Though both synchronous and metachronous metastases are considered OMD, the prognosis, options for treatment and risk of occult disseminated metastases of these patients can differ, with the length of the DFI appearing to have a prognostic impact [46,69,87].…”

Section: Oligo-progressionmentioning

confidence: 99%

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

Lievens

Gückenberger

Gomez

et al. 2020

Radiotherapy and Oncology

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418

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Background: Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence. Methods: A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane. Subsequent consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature. Results: Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, singlecentre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported. Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival, local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed. Conclusion: While significant heterogeneity exists in the current OMD definitions in the literature, consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1-5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits.

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“…Miller et al [54] demonstrated in the multivariate competing risks regression that concurrent first-line TKI treatment was independently associated with a local control benefit (HR 0.21, p = 0.04), while patients treated with TKIs alone experienced an increased rate of local failure (HR 2.43, p = 0.03). Franzese et al [55] showed in univariate and multivariable analyses that metachronous and single metastasis but non addition of target therapy predicted better progression-free survival. However, when the analysis was restricted to cells clear RCC cases only, target therapy performed before SBRT improved local control (HR 0.15, 95% CI 0.026-0.085, p = 0.032), suggesting different biological response of cell clear RCC to the combination of SBRT and targeted agents.…”

Section: Target Therapy and High Doses Rtmentioning

confidence: 99%

Oligometastasis and local ablation in the era of systemic targeted and immunotherapy

et al. 2020

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Background: During these last years, new agents have dramatically improved the survival of the metastatic patients. Oligometastases represent a continuous field of interest in which the integration of metastases-directed therapy and drugs could further improve the oncologic outcomes. Herein a narrative review is performed regarding the main rationale in combining immunotherapy and target therapies with SBRT looking at the available clinical data in case of oligometastatic NSCLC, Melanoma and Kidney cancer. Material and method: Narrative Review regarding retrospective and prospective studies published between January 2009 to November 2019 with at least 20 patients analyzed. Results: Concerning the combination between SBRT and Immunotherapy, the correct sequence of remains uncertain, and seems to be drug-dependent. The optimal patients' selection is crucial to expect substantial benefits to SBRT/ Immunotherapy combination and, among several factors. A potential field of interest is represented by the so-called oligoprogressed disease, in which SBRT could improve the long-term efficacy of the existing target therapy. Conclusions: A low tumor burden seems to be the most relevant, thus making the oligometastatic disease represent the ideal setting for the use of combination therapies with immunological drugs.

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Role of Stereotactic Body Radiation Therapy for the Management of Oligometastatic Renal Cell Carcinoma

Abstract: SBRT can be considered a safe approach and provides effective local control of oligometastatic RCC. However future prospective studies are necessary to evaluate its impact on survival and quality of life.

Cited by 48 publications

References 1 publication

Stereotactic body radiation therapy could improve disease control in oligometastatic patients with renal cell carcinoma: do we need more evidence?

Stereotactic body radiation therapy could improve disease control in oligometastatic patients with renal cell carcinoma: do we need more evidence?

Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document

Oligometastasis and local ablation in the era of systemic targeted and immunotherapy

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