Pooled analysis of stereotactic ablative radiotherapy for primary renal cell carcinoma: A report from the International Radiosurgery Oncology Consortium for Kidney (IROCK)

Siva, Shankar; Louie, Alexander V.; Warner, Andrew; Muacevic, Alexander; Gandhidasan, Senthilkumar; Ponsky, Lee; Ellis, Rodney J.; Kaplan, Irving; Mahadevan, Anand; Chu, William; Swaminath, Anand; Oda, Hiroshi; Teh, Bin S.; Correa, Rohann J.M.; Lo, Simon S.; Staehler, Michael

doi:10.1002/cncr.31156

Cited by 133 publications

(110 citation statements)

References 28 publications

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“…As a result of recent improvements in radiotherapy techniques, X‐ray stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy (SABR) provide highly focused hypofractionated irradiation of tumors. These novel radiotherapy techniques have shown favorable local control rates (97.8%‐100% at 2 years) and few severe adverse events . However, to the best of our knowledge, there are no long‐term follow‐up data of SBRT/SABR for primary RCC.…”

Section: Introductionmentioning

confidence: 99%

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Kasuya

Tsuji

Nomiya³

et al. 2018

Cancer Science

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Long‐term oncological outcomes for primary renal cell carcinoma (RCC) treated with carbon‐ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12 or 16‐fraction CIRT at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease‐free, cancer‐specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7‐16.5) years; 9 of these patients were inoperable because of comorbidities or advanced‐stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre‐CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non‐renal adverse events. Local control rate, and disease‐free, cancer‐specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long‐term follow‐up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre‐CIRT, and yield favorable treatment outcomes, even in inoperable cases.

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Section: Introductionmentioning

confidence: 99%

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Kasuya

Tsuji

Nomiya³

et al. 2018

Cancer Science

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“…Furthermore, safety, efficacy and survival were assessed in a multi-institutional setting in 223 patients from nine institutions. Both single-fraction SABR and multi-fraction SABR were given [32]. …”

Section: Stereotactic Ablative Radiotherapy (Sabr)mentioning

confidence: 99%

“…Tumor sizes ranged from 2.1 to 7.5 cm in the studies, representing not only cT1 but also cT2a tumors [31, 32]. Treatment-related toxicities were defined using Common Terminology Criteria of Adverse Events: severe toxicity ranging from 1.3 to 3.8% grade 3–4.…”

Section: Stereotactic Ablative Radiotherapy (Sabr)mentioning

confidence: 99%

“…A potential explanation could be the enhanced abscopal effect of distant tumor cell eradication because of single-fraction irradiation. An alternative hypothesis is that during fractionated radiotherapy, circulating tumor cells are released in the circulation, which may still be viable after smaller doses of fractionated radiotherapy [32]. Concluding from these series, cT1 primary tumors, and even cT2 tumors, can be ablated in the unfit patient who is unable to undergo anesthesia with promising results.…”

Section: Stereotactic Ablative Radiotherapy (Sabr)mentioning

confidence: 99%

“…SABR is safe with low toxicity, has no definite size limitation, is not limited by tumor location and is thought to promote antitumor immunity. Despite the fact that the optimal dose and fractionation regimens are not yet definite and oncological results are limited, it could be the sole solution in some selected cases [31, 32]. The immunogenic effect seen in SABR is also suggested in other ablation types and the combination with immunotherapy such as immune checkpoint inhibition could be promising in the future [42].…”

Section: Considerationsmentioning

confidence: 99%

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Available ablation energies to treat cT1 renal cell cancer: emerging technologies

et al. 2018

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PurposeAn increasing interest in percutaneous ablation of renal tumors has been caused by the increasing incidence of SRMs, the trend toward minimally invasive nephron-sparing treatments and the rapid development of local ablative technologies. In the era of shared decision making, patient preference for non-invasive treatments also leads to an increasing demand for image-guided ablation. Although some guidelines still reserve ablation for poor surgical candidates, indications may soon expand as evidence for the use of the two most validated local ablative techniques, cryoablation (CA) and radiofrequency ablation (RFA), is accumulating. Due to the collaboration between experts in the field in biomedical engineering, urologists, interventional radiologists and radiation oncologists, the improvements in ablation technologies have been evolving rapidly in the last decades, resulting in some new emerging types of ablations.MethodsA literature search was conducted to identify original research articles investigating the clinical outcomes of new emerging technologies, percutaneous MWA, percutaneous IRE and SABR, in patients with primary cT1 localized renal cell cancer.ResultsDue to the collaboration between experts in the field in biomedical engineering, urologists, interventional radiologists and radiation oncologists, the improvements in ablation technologies have been evolving rapidly in the last decades. New emerging technologies such as microwave ablation (MWA), irreversible electroporation (IRE) and stereotactic ablative radiotherapy (SABR) seem to be getting ready for prime time.ConclusionThis topical paper describes the new emerging technologies for cT1 localized renal cell cancer and investigates how they compare to CA and RFA.

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On the reduction of aperture complexity in kidney SABR

Gaudreault

Offer

Kron

et al. 2021

J Applied Clin Med Phys

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Background: Stereotactic ablative body radiotherapy (SABR) of primary kidney cancers is confounded by motion. There is a risk of interplay effect if the dose is delivered using volumetric modulated arc therapy (VMAT) and flattening filter-free (FFF) dose rates due to target and linac motion. This study aims to provide an efficient way to generate plans with minimal aperture complexity. Methods: In this retrospective study, 62 patients who received kidney SABR were reviewed. For each patient, two plans were created using internal target volume based motion management, on the average intensity projection of a four-dimensional CT. In the first plan, optimization was performed using a knowledge-based planning model based on delivered clinical plans in our institution. In the second plan, the optimization was repeated, with a maximum monitor unit (MU) objective applied in the optimization. Dose-volume, conformity, and complexity metric (with the field edge metric and the modulation complexity score) were compared between the two plans. Results are shown in terms of median (first quartilethird quartile). Results: Similar dosimetry was obtained with and without the utilization of an objective on the MU. However, complexity was reduced by using the objective on the MUs (modulation complexity score = 0.55 (0.50-0.61) / 0.33 (0.29-0.36), Pvalue < 10 −10 , with/without the MU objective). Reduction of complexity was driven by a larger aperture area (area aperture variability = 0.68 (0.64-0.73) / 0.42 (0.37-0.45), P-value < 10 −10 , with/without the MU objective). Using the objective on the MUs resulted in a more spherical dose distribution (sphericity 50% isodose = 0.73 (0.69-0.75) / 0.64 (0.60-0.68), P-value < 10 −8 , with/without the MU objective) reducing dose to organs at risk given respiratory motion. Conclusions: Aperture complexity is reduced in kidney SABR by using an objective on the MU delivery with VMAT and FFF dose rate.

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Pooled analysis of stereotactic ablative radiotherapy for primary renal cell carcinoma: A report from the International Radiosurgery Oncology Consortium for Kidney (IROCK)

Cited by 133 publications

References 28 publications

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma

Available ablation energies to treat cT1 renal cell cancer: emerging technologies

On the reduction of aperture complexity in kidney SABR

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