Renal Radiosurgery: Initial Clinical Experience With Histological Evaluation

Abstract

The purpose of this study was to determine whether radiosurgical technology can be safely applied to renal tumors. Patients received radiosurgical treatment of renal lesions. At 8 weeks after radiosurgical treatment, patients underwent a partial or radical nephrectomy and histologic evaluation. The patients received a radiation dose of 4 Gy per fraction for 4 fractions. Patients were followed, and radiation-induced toxicities were noted. Three patients were treated for a minimum of 1 year of follow-up. All patients completed the treatments, tolerating each of the 4 fractions with no adverse events. No acute toxicities or changes in renal function were noted. None of the patients had any evidence of acute radiation injury or toxicity noted at the time of surgery or within the subsequent 12 months after the radiosurgical treatment. The last patient treated was found to have a cavity with no microscopic evidence of viable tumor after radiosurgical treatment; pathology was consistent with necrotic renal cell carcinoma, papillary type. The other 2 tumors demonstrated pathologic evidence of viable renal cell carcinoma (grade I and grade II). Tumor size remained relatively unchanged for 8 weeks after the radiosurgical treatment in all patients. The authors are extremely encouraged and cautiously optimistic with the initial results. Radiosurgery for renal tumors appears to be safe at this initial dose level.

Minimally Invasive Management of Upper Tract Malignancies: Renal Cell and Transitional Cell Carcinoma

“…The clinical evidence is building in favor of cryoablation and radiofrequency ablation for the treatment of small renal tumors. Other experimental techniques that could further reduce the invasiveness of treatment, such as noninvasive high-intensity focused ultrasound (HIFU) and the gamma knife, have also been explored; however, to date, clinical results have been few and disappointing [6,7].…”

Renal Cell Carcinoma

“…In contrast to other local therapeutic modalities, SBRT offers the only noninvasive, highly efficient means to eradicate discreet tumor foci either at a primary or metastatic site with radiobiologically potent dose . Table 1 shows the results of SBRT for primary and metastatic RCC (Wersall et al 2005;Svedman et al 2006;Nguyen et al 2010;Svedman et al 2008;Gerszten et al 2005;Beitler et al 2004;Ponsky et al 2007;Teh et al 2007a, b, c;Kaplan et al 2010;Zelefsky et al 2012;Jhaveri et al 2012). The reported results were encouraging.…”

“…Ponsky et al reported pathologic feature of kidney of patients treated by SBRT (Ponsky et al 2007). They treated three patients with four fractions of 4 Gy and then underwent nephrectomy.…”

New Developments in Renal Focal Therapy

“…Ponsky et al 36 reported three patients with a mean tumor size of 2 cm, candidates for surgical treatment who underwent radiosurgery followed by a partial nephrectomy after 8 weeks. The patients received a total of 16 Gy in four fractions delivered over 2 days.…”