Extracranial stereotactic radiotherapy for primary and metastatic renal cell carcinoma

Wersäll, Peter; Blomgren, Henric; Lax, Ingmar; Kälkner, Karl Mikael; Linder, C.; Lundell, G. E. F.; Nilsson, Bo; Nilsson, Sten; Näslund, Ingemar; Pisa, Pavel; Svedman, Christer

doi:10.1016/j.radonc.2005.03.022

Cited by 203 publications

(111 citation statements)

References 16 publications

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“…Although 5-year survival for all patients is approximately 74%, survival rates are highly dependent on disease stage, declining to 67% when locoregional disease (stage III) is detected and 12% in patients with distant metastases (3,4). Most patients are diagnosed at an early stage, yet nearly one third of these patients will suffer from local or distant relapse in the course of their disease, and a similar proportion of patients present with metastatic spread at first diagnosis (5,6). Lung metastases are the most common presentation of distant disease, comprising 11-75% of cases, while hepatic metastases occur in 20-40% of patients (7)(8)(9)(10)(11)(12).…”

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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…10,11 Clinical experience mimics this conclusion with SABR showing efficacy ranges of 90-100% and 82-95% for CNS and extra-CNS metastases respectively. [28][29][30][31][32][33][34] In fact, at hypofractionated dose levels, RCC may even be more radiosensitive than other primary sites. Lung, for example, requires 54Gy in 3 fractions compared to RCC, where 36Gy in 3 fractions appears to provide adequate control.…”

Section: Discussionmentioning

confidence: 99%

“…Lung, for example, requires 54Gy in 3 fractions compared to RCC, where 36Gy in 3 fractions appears to provide adequate control. 16,33,34 Despite the extensive and growing experience with SABR in multiple cancer sites, its application to primary renal cancers has been limited to a few retrospective reviews and 2 phase I studies 34,35 all showing excellent local control rates. Three ongoing phase II clinical trials for SABR of primary RCC are currently underway (NCT 02141919, 01890590, 02138578)…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Hannan

Margulis

Chun

et al. 2015

Cancer Biology & Therapy

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Renal Cell Carcinoma (RCC) is a common malignancy world-wide that is rising in incidence. Up to 10% of RCC patients present with inferior vena cava (IVC) tumor thrombus (IVC-TT). Although surgery is the only treatment with proven efficacy for IVC-TT, the surgical management of advanced (level III and IV) IVC-TT is difficult with high morbidity and mortality, and offers a poor survival outcome. Currently, there are no treatment options in the setting of recurrent or unresectable RCC IVC-TT. Even though RCC may be resistant to conventionally fractionated radiation therapy, hypofractionated radiation has shown excellent control rates for both primary and metastatic RCC. We report our experience treating 2 RCC patients with Level IV IVC-TT -one recurrent and the other unresectable-with stereotactic ablative radiation therapy (SABR). The first patient is a 75-year-old gentleman with a level IV RCC IVC-TT who presented 9 months after his radical nephrectomy and thrombectomy with a growing level IV IVC-TT that became refractory to 4 targeted agents. He received SABR of 50Gy in 5 fractions and at 2-year follow-up is doing well with a significant decrease in the enhancement and size of the IVC-TT. The second patient is an 83-year-old gentleman who presented with metastatic RCC and level IV IVC-TT but was not a surgical candidate. After progression on temsirolimus, he received SABR of 36Gy in 4 fractions to his IVC-TT and survived 18 months post-SABR. Both patients improved symptomatically and did not experience any acute or late treatment-related toxicity. Their survival of 24 months and 18 months are comparable to the reported median survival of 20 months in patients with level IV IVC-TT that underwent surgical resection. Therefore, SABR can be a potentially safe treatment option in the unresectable setting for RCC patients with IVC-TT and should be further evaluated in prospective trials.

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“…ESRT has been tested in various settings (4)(5)(6)(7)(8)(9)(10)(11), although, there is no agreement as for the dose (total or per fraction) (12), or for the most suitable therapeutic settings in which it should be employed (13). Treatment of abdomino-pelvic (4-6), thoracic (7,11), and renal tumors (8), resulted in 80, 90 and 95% rates of local control, respectively. Encouraging results have also been published in several series of metastatic lung tumors, nasopharyngeal recurrence, and spinal metastasis (14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiotherapy in recurrent gynecological cancer: A case series

Deodato¹,

Macchia

Grimaldi

et al. 2009

Oncol Rep

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Abstract. Scarce data are available on the use of extracranial stereotactic radiotherapy in recurrent gynecological tumors. The aim of this report was to analyze the results of our preliminary experience with extracranial stereotactic radiotherapy in locally or distantly recurrent gynecological tumors. Extracranial stereotactic radiotherapy was planned by the Precise-Plan treatment planning system. Patients were immobilized using the Stereotactic Body-Frame. Five consecutive daily fractions were delivered; dose/ fraction and total dose were defined based on an institutional doseescalation protocol. A class solution with 4 non-coplanar fixed beams based on the tetrad configuration was used in all patients. Eleven patients (12 lesions), were included in the analysis. Stereotactic radiotherapy was delivered as first radiotherapy treatment (5 patients), or as retreatment (6 patients).Complete clinical response was achieved in 8/12 lesions (66.6%), while partial response was documented in 2/12 lesions (16.6%). With a median follow-up of 19 months (range, 2-37 months), 7 patients (63%) experienced local and/or distant progression of disease. The 2-year local progression-free survival was 81.8%, while the 2-year metastases-free survival was 54.4%. The 2-year overall survival was 63.6%. Acute and late toxicities were grade 2 or less. There was no difference in quality of life scores between the data collected before extracranial stereotactic radiotherapy and at first follow-up evaluation. Fractionated extracranial stereotactic radiotherapy administered up to a dose of 30 Gy in five fractions is well tolerated. Further studies of extracranial stereotactic radiotherapy and novel radiotherapy techniques are warranted in the challenging setting of recurrent gynecological tumors.

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Extracranial stereotactic radiotherapy for primary and metastatic renal cell carcinoma

Cited by 203 publications

References 16 publications

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

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

Stereotactic radiation therapy of renal cancer inferior vena cava tumor thrombus

Stereotactic radiotherapy in recurrent gynecological cancer: A case series

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