Stereotactic ablative radiation therapy for renal cell carcinoma with inferior vena cava tumor thrombus

Freifeld, Yuval; Pedrosa, Iván; McLaughlin, Mark; Correa, Rohann M.; Louie, Alexander V.; Maldonado, J. Alberto; Tang, Chad; Kadow, Brian T.; Kutikov, Alexander; Uzzo, Robert G.; Porta, Camillo; Bucknell, Nicholas; Brugarolas, James; Margulis, Vitaly; Timmerman, Robert; Hannan, Raquibul

doi:10.1016/j.urolonc.2021.12.018

Cited by 18 publications

(10 citation statements)

References 16 publications

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“…Additionally, one patient showed an excellent oncologic prognosis of 54 months. A larger cohort was reported by Freifeld et al in 2022, which reached a radiographic rate of 58% and a signi cant symptom palliation effect (14). Recently, Castelnau-Marchand et al reported a case with IVC-TT and distant metastasis (13).…”

Section: Discussionmentioning

confidence: 89%

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Neoadjuvant Stereotactic Ablative Body Radiotherapy Combined with Surgical Treatment for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus: A Prospective Pilot Study

Chen,

Liu,

Peng

et al. 2023

Preprint

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Background Surgical treatment for renal cell carcinoma (RCC) and inferior vena cava (IVC) tumor thrombus (TT) is difficult and has a high postoperative complication rate. This study aims to explore the safety and oncologic outcomes of neoadjuvant stereotactic ablative body radiotherapy (SABR) combined with surgical treatment for RCC and IVC-TT. Methods Patients with RCC and IVC-TT were enrolled in this study. All of them received neoadjuvant SABR focused on IVC at a dose of 30 Gy with 5 fractions, followed by 2 ~ 4 weeks of rest. Then, radical nephrectomy and IVC tumor thrombectomy were performed on each patient. Adverse effects, perioperative outcomes, and long-term prognosis were recorded. Results From June 2018 to January 2019, 8 patients were enrolled, including 4 with Mayo II TT and 4 with Mayo III TT. 4 (50%) patients had complicated IVC wall invasion according to CT/MRI. All patients received neoadjuvant SABR as planned. Short-term local controls were observed in all 8 cases. Only grade 1–2 adverse events were reported. In total, 3 (37.5%) laparoscopic surgeries and 5 (62.5%) open surgeries were performed. The median operation time was 359 (IQR: 279–446) min, with a median intraoperative bleeding volume of 750 (IQR: 275–2175) ml. The median postoperative hospital stay was 7 (5–10) days. With a 26 (range: 5–41) month follow-up period, the estimated mean overall survival was 30.67 ± 5.38 months. Conclusions As the first preoperative radiotherapy study in Asia that focused on TT, this study revealed the appreciable safety of neoadjuvant SABR for RCC with IVC-TT. Trial Registration This study was registered in Chinese Clinical Trials Registry in 2018-03-08 (ChiCTR1800015118). For more information, please see the direct link (https://www.chictr.org.cn/showproj.html?proj=25747).

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Section: Discussionmentioning

confidence: 89%

“…To date, few studies have reported the application of SABR for RCC IVC-TT, and most of the published studies were case reports and small sample size studies (8, [13][14][15][16]. Major studies are presented in Additional le 2.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Stereotactic Ablative Body Radiotherapy Combined with Surgical Treatment for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus: A Prospective Pilot Study

Chen,

Liu,

Peng

et al. 2023

Preprint

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“…Neoadjuvant lenvatinib and pembrolizumab prior to IVC thrombectomy is currently being studied in an actively recruiting clinical trial (NCT05319015). A trial assessing neoadjuvant stereotactic ablative radiotherapy (SABR) prior to IVC thrombectomy trial is also recruiting ( 11 , 12 ).…”

Section: Perioperative Systemic Therapymentioning

confidence: 99%

“…Although systemic therapy is effective in IVC thrombi ( 9 ), complete response is exceedingly unlikely ( 10 ). Primary radiation treatment has also shown promise in IVC thrombi ( 11 ) but clear indications await ongoing prospective studies ( 18 ). Three recent prospective studies inform our practice of CN in patients with IVCTT: CARMENA ( 19 , 20 ), SURTIME ( 21 ), and NAXIVA ( 8 ).…”

Section: Cn With Ivc Thrombectomymentioning

confidence: 99%

Inferior vena cava thrombectomy for renal cell carcinoma: perioperative systemic therapy, cytoreductive nephrectomy, and complex cases

Ray¹,

Singer²,

Dason³

2023

Ann Transl Med

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“…For example, IVC thrombus obstruction of venous drainage can lead to venous congestion and, when involving hepatic vessels, Budd-Chiari syndrome. Radiation to the TT as either a primary or salvage therapy was shown to alleviate Budd Chiari as well as associated edema, pain, and hematuria in an international cohort analyzed by Freifeld et al [30 ▪ ] Patients were treated with a median SAbR dose of 40 Gy over five fractions. This study further demonstrated a regression in thrombus size in 58% (7/12) of patients, stable size in 25% (3/12), and increased size in 16% (2/12).…”

Section: Advances In Neoadjuvant Therapiesmentioning

confidence: 99%

Renal cell carcinoma with inferior vena cava thrombus: did we make progress in oncologic outcomes and complications?

Gold

Taylor

Margulis

2023

Current Opinion in Urology

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Purpose of reviewSurgery for renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (TT) remains one of the most complex surgeries performed with high rates of associated complications and perioperative mortality. Surgical techniques and neoadjuvant therapies have an important role to play in improving outcomes. This review provides a narrative analysis of recent literature on patients with RCC and TT. Recent findingsSeveral imaging techniques are emerging that may improve diagnostic staging of tumor thrombus level. Robotic approaches to surgical resection for all thrombi levels is feasible and safe, while longer term outcomes for higher level thrombi continues to mature. Early data on neoadjuvant immunotherapy and radiotherapy have shown improvements in complication rates and intermediate term oncologic outcomes. SummaryData suggests that neoadjuvant therapies and minimally invasive techniques may improve outcomes in patients undergoing surgical resection for RCC with tumor thrombus. Larger multiinstitutional series are needed to confirm the benefit of these techniques as well as the durable long term oncologic outcomes.

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Stereotactic ablative radiation therapy for renal cell carcinoma with inferior vena cava tumor thrombus

Cited by 18 publications

References 16 publications

Neoadjuvant Stereotactic Ablative Body Radiotherapy Combined with Surgical Treatment for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus: A Prospective Pilot Study

Neoadjuvant Stereotactic Ablative Body Radiotherapy Combined with Surgical Treatment for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus: A Prospective Pilot Study

Inferior vena cava thrombectomy for renal cell carcinoma: perioperative systemic therapy, cytoreductive nephrectomy, and complex cases

Renal cell carcinoma with inferior vena cava thrombus: did we make progress in oncologic outcomes and complications?

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