Stereotactic Ablative Radiation for Systemic Therapy–naïve Oligometastatic Kidney Cancer

Hannan, Raquibul; Christensen, Merrill J.; Christie, Alana; Garant, Aurélie; Pedrosa, Iván; Robles, Liliana; Mannala, Samantha; Wang, Chiachien; Hammers, Hans J.; Arafat, Waddah; Courtney, Kevin D.; Bowman, I. Alex; Sher, David J.; Ahn, Chul; Cole, Suzanne; Choy, Hak; Timmerman, Robert; Brugarolas, James

doi:10.1016/j.euo.2022.06.008

Cited by 30 publications

(22 citation statements)

References 38 publications

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“…Overall, both studies, despite being small, demonstrated how SRT effectively controls progressive lesions, enabling meaningful extension of ongoing systemic therapies. Hannan et al also reported a small series (23 patients) of systemic therapy-naïve oligometastatic patients managed with SRT [29]. Freedom from systemic therapy at 1 year was 91.3%, which exceeded the prespecified 60% benchmark.…”

Section: Stereotactic Radiotherapymentioning

confidence: 92%

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Metastasis-directed treatment in kidney cancer

Jackson

Franco

Wang

et al. 2023

Current Opinion in Urology

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Purpose of review To provide a critical overview of the latest evidence on the role of metastasis-direct treatment (MDT) in the management of metastatic renal cell carcinoma (mRCC). Recent findings This is a nonsystematic review of the English language literature published since January 2021. A PubMed/MEDLINE search using various search terms was conducted, including only original studies. After title and abstract screening, selected articles were grouped into two main areas which mirror the main treatment options in this setting: surgical metastasectomy (MS) and stereotactic radiotherapy (SRT). While a limited number of retrospective studies have been reported on surgical MS, the consensus of these reports is that extirpation of metastasis should be part of a multimodal management strategy for carefully selected cases. In contrast, there have been both retrospective studies and a small number of prospective studies on the use of SRT of metastatic sites. Summary As the management of mRCC rapidly evolves, and evidence on MDT – both in the form of MS and SRT – has continued to build over the past 2 years. Overall, there is growing interest in this therapeutic option, which is increasingly being implemented and seems to be safe and potentially beneficial in well selected disease scenarios.

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Section: Stereotactic Radiotherapymentioning

confidence: 92%

“…Hannan et al also reported a small series (23 patients) of systemic therapy-na€ ıve oligometastatic patients managed with SRT [29]. Freedom from systemic therapy at 1 year was 91.3%, which exceeded the prespecified 60% benchmark.…”

Section: Stereotactic Radiotherapymentioning

confidence: 93%

Metastasis-directed treatment in kidney cancer

Jackson

Franco

Wang

et al. 2023

Current Opinion in Urology

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“…Additionally, Hannan and colleagues 31▪ conducted a phase II single-arm trial powered to achieve a primary objective of freedom from systemic therapy for >1 year in >60% of patients. Twenty-three patients received SBRT to 33 initial and 57 total sites.…”

Section: Stereotactic Radiotherapy For Metastatic Renal Cell Carcinomamentioning

confidence: 99%

Radiation therapy options in kidney cancer

Zaorsky,

Louie,

Siva

2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review In this review, the authors discuss the use of stereotactic body radiation therapy (SBRT) for the treatment of primary and metastatic renal cell carcinoma (RCC). Recent findings For primary RCC treated with SBRT, local control is estimated at >95%, and grade 3–4 toxicity is limited at ≤5%. The difference in glomerular filtration rate pretreatment versus posttreatment was about 7.7 ml/min. For metastatic RCC treated with SBRT, the 1-year local control is ~90%. The incidence of any grade 3–4 toxicity is ~1%. Several ongoing trials are evaluating SBRT in combination or in lieu of systemic therapy. There are many unknowns remaining in the treatment of RCC, including tumor prognostication, treatment selection, and treatment delivery. Summary Stereotactic body radiation therapy is a safe and effective treatment option for patients with primary and metastatic RCC.

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“…In one of the first case reports about this topic, Barney and Churchill described in 1939 nephrectomy and the resection of a solitary lung metastasis, reporting rendering the patient into remission 5 years after MDT. Since then, phase 2 trials have investigated systemic therapy de-escalation for indolent and unselected populations of patients with metastatic kidney cancer by using serial MDT, defined systemic therapy breaks, and surveillance imaging alone . The only reported phase 3 study to investigate systemic therapy de-escalation was the STAR trial, which randomized patients undergoing tyrosine kinase monotherapy regimes to continuous systemic therapy (control arm) vs a planned drug-free interval (experimental arm).…”

mentioning

confidence: 99%

“…Therefore, a better understanding of the underlying biology and biomarkers of indolent vs aggressive metastatic kidney cancer is needed to select the appropriate patients for systemic therapy de-escalation. One coarse distinguishing factor is whether patients have oligometastatic vs polymetastatic disease with the former often defined as 5 or fewer radiographically visible metastatic lesions . Oligometastatic kidney cancer has been shown to be amenable to strategies such as serial MTD or surveillance in lieu of systemic therapy, albeit larger studies are needed .…”

mentioning

confidence: 99%