Safety and Efficacy of Robotic Radiosurgery for Visceral and Lymph Node Metastases of Renal Cell Carcinoma: A Retrospective, Single Center Analysis

Abstract

Despite rapid advances of systemic therapy options in renal cell carcinoma (RCC), local tumor or metastases treatment remains important in selected patients. Here, we assess the safety and efficacy of robotic radiosurgery (RRS) as an ablative therapy for visceral and lymph node metastases of RCC. Patients with histologically confirmed RCC and radiologically confirmed progression of visceral or lymph node metastases underwent RRS and were retrospectively analyzed. Overall survival and progression free survival were calculated by the Kaplan–Meier method and log-rank test. Sixty patients underwent RRS and were included in the analysis. Patients presented for RRS treatment with a median age at RRS treatment of 64 years (range 42–83), clear cell histology (88.3%) and favorable international metastatic renal cell carcinoma database (IMDC) risk score (58.3%). Treatment parameters differed for the number of fractions (median visceral metastases: 1, range 1–5; median lymph node metastases: 1, range 0–5; p = 0.003) and prescription dose (median visceral metastases 24 Gy, range 8–26; median lymph node metastases 18 Gy, range 7–26, p < 0.001). The median overall survival was 65.7 months (range: 2.9–108.6), the median progression free survival was 17.4 months (range: 2.7–70.0) and local tumor control was achieved in 96.7% of patients. Adverse events were limited to 8.3% of patients, with one grade 4 toxicity within 6 weeks after RRS therapy. RRS is a safe and effective treatment option in selected patients with metastatic RCC in a multimodal approach. Further research is warranted to confirm our findings prospectively.

Image-Guided Robotic Radiosurgery for the Treatment of Lung Metastases of Renal Cell Carcinoma—A Retrospective, Single Center Analysis

“…For other sites as lymph nodes and visceral metastases, we demonstrated high local recurrence free survival rates in a contemporary cohort [ 20 ]. Stereotactic radiotherapy in pulmonary metastases has been shown to have 3 year control rates of 91.9%.…”

“…A typical therapy session consists of 100 to 120 radiation beams that are delivered from 270 degrees around the patient. Organ movement is detected in real-time and therefore radiation beams are adjusted accordingly [ 20 ]. Multiple fractions were delivered on consecutive days.…”

Clearing up Clear Cell: Clarifying the Immuno-Oncology Treatment Landscape for Metastatic Clear Cell RCC

“…In a meta-analysis of 28 studies which included mRCC patients with oligometastatic disease, 90% of lesions treated with SR did not show radiographic progression at 1 year and only minimal toxicity was noted (~1%) [47]. In a more recent retrospective analysis, 60 patients with histologically confirmed RCC (88.3% with ccRCC) and radiographic evidence of visceral or lymph node metastasis who underwent robotic radiosurgery, a variant of SR, were shown to have excellent local tumor control (96.7%) and minimal adverse events (8.3%) with only one grade 4 AE noted [48]. It is thus conceivable that SR provides an effective alternative for cytoreduction in patients with metastatic disease, and in combination with combined immunotherapy, may provide a survival benefit especially in poor surgical candidates.…”