A prospective Phase II trial of using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma

Svedman, Christer; Sandström, Per; Pisa, Pavel; Blomgren, Henric; Lax, I.; Kälkner, Karl Mikael; Nilsson, Sten; Wersäll, Peter

doi:10.1080/02841860600954875

Cited by 174 publications

(85 citation statements)

References 19 publications

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“…69 Additionally, ablative techniques and SRS have resulted in eff ective local control of small liver metastases. [70][71][72] Cumulative data suggest that pancreatic metastasectomy might be benefi cial in patients with good performance status and one metastatic site. 73 However, 2·8% inhospital mortality after extensive surgery, done as pancreaticoduodenectomy in 35·8% of patients and total pancreatectomy in 19·9% of patients, suggests that morbidity and mortality might outweigh the potential benefi t. In view of the overall low quality of the data, and the substantial surgical morbidity, patients with a short interval to pancreatic metastasis after nephrectomy may be best treated with systemic therapy.…”

Section: Discussionmentioning

confidence: 99%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

283

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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Section: Discussionmentioning

confidence: 99%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

283

205

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“…In the clinical setting, dose escalation has also been shown to overcome radioresistance in RCC tumors: Zelefsky and colleagues reported 3-year LC of 88% following SBRT with high fractional doses for extracranial RCC metastases, while LC dropped to only about 20% when lower doses were used (30). A few other reports have also revealed LC rates of about 80-90% for extracranial SBRT in RCC patients (5,6,28,29,31,33). However, due to the limited number of RCC patients treated with SBRT, these reports combined data form different metastatic sites of including lung, bone, liver, lymph nodes or even primary RCC tumors (5,6,28,29,31,33).…”

Section: Toxicitymentioning

confidence: 99%

“…However, some RCC patients are medically inoperable due to reduced performance status or comorbidities and some pulmonary metastases are technically not accessible or resectable. For these patients, stereotactic body radiotherapy (SBRT) which utilizes highly conformal ablative local doses to the tumor while sparing surrounding organs, has shown encouraging results (5,(28)(29)(30). However, available reports concerning SBRT for RCC metastases have pooled heterogeneous data from various tumor locations (lung, bone, lymph node, brain, liver, etc.)…”

Section: Introductionmentioning

confidence: 99%

“…However, available reports concerning SBRT for RCC metastases have pooled heterogeneous data from various tumor locations (lung, bone, lymph node, brain, liver, etc.) with different sensitivities to high-dose radiation (5,6,(28)(29)(30)(31)(32)(33). This multi-institutional study reports the feasibility, safety, and efficacy of SBRT for pulmonary RCC metastases.…”

Section: Introductionmentioning

confidence: 99%

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

Hoerner-Rieber¹,

Duma²,

Blanck³

et al. 2017

J. Thorac. Dis.

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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.

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“…20,21,[24][25][26][27][28][29] No randomized trials to date have evaluated SBRT in primary kidney cancer.…”

Section: Clinical Evidence Of Sbrt In Rccmentioning

confidence: 99%

Stereotactic body radiotherapy for the treatment of medically inoperable primary renal cell carcinoma: Current evidence and future directions

Swaminath

Chu

2015

CUAJ

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The incidence of renal cell carcinoma (RCC) is steadily rising due to an aging population and more frequent imaging of the abdomen for other medical conditions. While surgery remains the standard of care treatment for localized disease, many patients are unfit due to their advanced age and medical comorbidities. In these patients, an active surveillance strategy or ablative therapies, including radiofrequency/microwave ablation or cryotherapy, can be offered. Such options have limitations particularly with fast growing, or larger tumors. A promising ablative therapy option to consider is stereotactic body radiotherapy (SBRT). SBRT refers to high dose, focally ablative radiation delivered in a short time (3-5 fractions), and is safe and effective in many other cancer sites, including lung, liver and spine. SBRT offers potential advantages in the primary kidney cancer setting due to its ablative dosing (overcoming the notion of "radio-resistance"), short treatment duration (important in an elderly population), low toxicity profile (enabling SBRT to treat larger RCCs than other ablative modalities), and non-invasiveness. To date, there is limited long-term prospective data on the outcomes of SBRT in primary RCC. However, early evidence is intriguing with respect to excellent local control and low toxicity; however, most studies vary in terms of technique and radiation dosing used. Welldesigned prospective cohort studies with clearly defined and standardized techniques, dosing, follow-up, and integration of quality of life outcomes will be essential to further establish the role of SBRT in management of inoperable, localized RCC.

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A prospective Phase II trial of using extracranial stereotactic radiotherapy in primary and metastatic renal cell carcinoma

Cited by 174 publications

References 19 publications

Local treatments for metastases of renal cell carcinoma: a systematic review

Local treatments for metastases of renal cell carcinoma: a systematic review

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

Stereotactic body radiotherapy for the treatment of medically inoperable primary renal cell carcinoma: Current evidence and future directions

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