A phase II trial of palliative radiotherapy for metastatic renal cell carcinoma

Abstract

BACKGROUNDRenal cell carcinoma (RCC) has previously been described as being less responsive to radiotherapy (RT) than other tumor types. The authors conducted a prospective study to assess the effect of RT on symptoms and quality of life (QOL) in patients with metastatic RCC.METHODSBetween 1996 and 2002, patients with symptomatic metastatic RCC were entered into a prospective study in two cancer centers. Symptomatic sites of disease were treated with 30 grays (Gy) in 10 fractions. Patients reported pain, analgesic use, symptoms, and QOL using validated questionnaires before RT, 1 month and 3 months after treatment, and every 3 months to 1 year thereafter.RESULTSThirty‐one patients (19 males and 12 females) were entered into the trial. The median age of the patients was 61 years (range, 35–81 yrs). The most common indication for RT was bone pain (n = 24). The median duration of follow‐up was 4.3 months (range, 1–15 mos). Of 23 evaluable patients treated for pain, 83% (n = 19) experienced site‐specific pain relief after RT, and 48% (n = 11) did not have an associated increase in analgesic medication use. The median duration of site‐specific pain response was 3 months (range, 1–15 mos). The global pain response rate was only 15% (n = 3) because many patients developed other painful metastases. Global QOL was found to improve in 33% (n = 8) of the evaluable patients.CONCLUSIONSA palliative radiotherapy dose of 30Gy in 10 fractions can result in a significant response rate and the relief of local symptoms in patients with bone metastases from RCC. Improvements in global pain and QOL appear to be limited by the effects of progressive systemic disease. Cancer 2005. © 2005 American Cancer Society.

Patterns of Practice in the Prescription of Palliative Radiotherapy for the Treatment of Bone Metastases at the Rapid Response Radiotherapy Program between 2005 and 2012

“…They showed that a total dose ranging between about 30 Gy and 40 Gy controlled bone pain within normal tissue tolerance and that higher doses were not necessary for achieving bone pain palliation in this patient population. Another prospective study conducted by Lee et al 35 also revealed that a dose of 30 Gy/10 for patients with renal cell cancer metastatic to bone resulted in significant relief from local symptoms. Those findings reflect the rationale behind the prescription of 30 Gy/10 in patients with a primary renal cell cancer attending the rrrp.…”

Selective palliative transcatheter embolization of bony metastases from renal cell carcinoma

“…Historically, RCCa has been thought of as a radioresistant tumor, based on in vitro studies comparing the radiosensitivity of various tumor cell lines [26]. A more recent study reports objective palliative responses to radiation therapy of RCCa bony metastases using the modified McGill-Melzack scale with a 3 month median duration of response in 83% of patients evaluated [27]. Stereotactic radiotherapy may hold promise for both symptom and local tumor control in RCCa [28], but no experience with treatment of osseous lesions is available…”

Simultaneous anti‐angiogenic therapy and single‐fraction radiosurgery in clinically relevant metastases from renal cell carcinoma

“…Local control of the tumour is rare, rendering radiotherapy a palliative treatment for selected patients [6]. Consequently radiotherapy is considered to have only minimal effects in controlling RCC metastases [7].…”

“…The median pain score before SRS was 5 (range [1][2][3][4][5][6][7][8] and was lowered to 0 (range 0-2, P < 0.01) after SRS. There were no treatment-related deaths or late complications after SRS.…”