Stereotactic ablative radiation therapy for oligometastatic renal cell carcinoma (SABR ORCA): a meta-analysis of 28 studies

Zaorsky, Nicholas G.; Lehrer, Eric J.; Kothari, Gargi; Louie, Alexander V.; Siva, Shankar

doi:10.1016/j.euo.2019.05.007

Cited by 113 publications

(72 citation statements)

References 49 publications

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“…Although SRT is now included as an option for local ablative treatment of mRCC lesions in international guidelines, there is only little evidence on the effects of SRT in patients who are simultaneously being treated with modern systemic therapy options such as TT or ICIs [6,10–20]. The limited available literature on this topic is disproportionate to the numerous mRCC patients receiving TT or ICIs that are increasingly treated with SRT in a multimodality approach, and is despite the observation that pausing these systemic therapies during SRT might pose a risk of disease flare [21].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiotherapy combined with immunotherapy or targeted therapy for metastatic renal cell carcinoma

et al. 2020

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Objectives To evaluate the safety and efficacy of stereotactic radiotherapy (SRT) in patients with metastatic renal cell carcinoma (mRCC) concurrently receiving targeted therapy (TT) or immunotherapy. Patients and Methods Data on patients with mRCC were extracted from a retrospective international multicentre register study (TOaSTT), investigating SRT concurrent (≤30 days) with TT/immune checkpoint inhibitor (ICI) therapy. Overall survival (OS), progression‐free survival (PFS), local metastasis control (LC) and time to systemic therapy switch were analysed using Kaplan–Meier curves and log‐rank testing. Clinical and treatment factors influencing survival were analysed using multivariate Cox regression. Acute and late SRT‐induced toxicity were defined according to the Common Terminology Criteria for Adverse Events v.4.03. Results Fifty‐three patients who underwent 128 sessions of SRT were included, of whom 58% presented with oligometastatic disease (OMD). ICIs and TT were received by 32% and 68% of patients, respectively. Twenty patients (37%) paused TT for a median (range) of 14 (2–21) days. ICI therapy was not paused in any patient. A median (range) of 1 (1–5) metastatic tumour was treated per patient, with a median (range) SRT dose of 65 (40–129.4) Gy (biologically effective dose). The OS, LC and PFS rates at 1 year were 71%, 75% and 25%, respectively. The median OS and PFS were not significantly different among patients receiving TT vs those receiving ICIs (P = 0.329). New lesions were treated with a repeat radiotherapy course in 46% of patients. After 1 year, 62% of patients remained on the same systemic therapy as at the time of SRT; this was more frequent for ICI therapy compared to TT (83% vs 36%; P = 0.035). OMD was an independent prognostic factor for OS (P = 0.004, 95% confidence interval [CI] 0.035–0.528) and PFS (P = 0.004; 95% CI 0.165–0.717) in multivariate analysis. Eastern Cooperative Oncology Group performance status (ECOG‐PS) was the other independent prognostic factor for OS (P = 0.001, 95% CI 0.001–0.351). Acute grade 3 toxicity was observed in two patients, and late grade 3 toxicity in one patient. No grade 4 or 5 toxicity was observed. Conclusion Combined treatment with TT or immunotherapy and concurrent SRT was safe, without signals of increased severe toxicity. As we observed no signal of excess toxicity, full‐dose SRT should be considered to achieve optimal metastasis control in patients receiving TT or immunotherapy. Favourable PFS and OS were observed for patients with oligometastatic RCC with a good ECOG‐PS, which should form the basis for prospective testing of this treatment strategy in properly designed clinical trials.

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Section: Discussionmentioning

confidence: 99%

Stereotactic radiotherapy combined with immunotherapy or targeted therapy for metastatic renal cell carcinoma

et al. 2020

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“…In contrast, a heterogenous patient cohort with mainly bone metastases from RCC showed local recurrence in only 2% [25]. Another meta-analysis across 28 studies with stereotactic ablative radiation therapy in oligometastatic RCC patients revealed a median one year local tumor control rate of 89.1% for extracranial metastases [26]. Grade 3 and 4 toxicity was observed in 0-5% of patients across all studies [23].…”

Section: Rrs In Metastatic Rccmentioning

confidence: 99%

“…The median age of patients undergoing RRS for oligometastatic disease is 62 across 28 studies in a meta-analysis [26], as RRS is not used to treat fragile patients as for primary RCC. Our patient cohort is 2 years older and the majority are favorable risk patients according to the IMDC risk classification.…”

Section: Rrs In Metastatic Rccmentioning

confidence: 99%

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

Rodler

Schott

Tamalunas

et al. 2021

Cancers

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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.

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“…Current studies on patients with mRCC have predominantly focused on the role of SBRT alone in oligometastatic or oligoprogressive settings ( 13 , 15 ). A few studies investigating the combined use of tyrosine kinase inhibitors (TKIs) and SBRT have only reported the results of response rates and local control ( 16 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

Survival After Combining Stereotactic Body Radiation Therapy and Tyrosine Kinase Inhibitors in Patients With Metastatic Renal Cell Carcinoma

et al. 2021

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BackgroundStereotactic body radiation therapy (SBRT) and tyrosine kinase inhibitors (TKIs) are effective treatments for metastatic renal cell carcinoma, but data on combining these two modalities are scarce. We aimed to investigate the survival outcomes of SBRT plus TKIs.MethodsData of patients treated with TKIs from December 2007 to June 2019 were collected. Patients received SBRT plus TKIs (TKI + SBRT group) or TKIs alone (TKI alone group). Local control (LC), time to change of systemic therapy (TTS), and overall survival (OS) were assessed.ResultsA total of 190 patients were included, and 85 patients received TKI + SBRT. The 2-year LC rate was 92.8%. The median OS in the TKI + SBRT group was significantly longer than that of the TKI alone group (63.2 vs 29.8 months; P < 0.001). In multivariate analysis, IMDC intermediate (HR 1.96; 95% CI 1.10–3.48; P = 0.022) and poor risk (HR 2.43; 95% CI 1.25–4.75; P = 0.009), oligometastasis (HR 0.41; 95% CI 0.26–0.65; P < 0.001), and the addition of SBRT (HR 0.48; 95% CI 0.31–0.75; P = 0.001) were prognostic factors for OS. Patients with oligometastasis (P = 0.009) and those with IMDC favorable (P = 0.044) or intermediate (P = 0.002) risk had significantly longer OS with TKI + SBRT. The median TTS were 21.5, 6.4, and 9.0 months in patients receiving SBRT before first-line TKI failure, SBRT after first-line TKI failure, and first-line TKI alone (P < 0.001). Five patients (5.9%) experienced SBRT-related grade 3 toxicities.ConclusionsCombining SBRT with TKIs is tolerable and associated with longer OS in selected patients, such as those with oligometastasis and favorable or intermediate risk.

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Stereotactic ablative radiation therapy for oligometastatic renal cell carcinoma (SABR ORCA): a meta-analysis of 28 studies

Cited by 113 publications

References 49 publications

Stereotactic radiotherapy combined with immunotherapy or targeted therapy for metastatic renal cell carcinoma

Stereotactic radiotherapy combined with immunotherapy or targeted therapy for metastatic renal cell carcinoma

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

Survival After Combining Stereotactic Body Radiation Therapy and Tyrosine Kinase Inhibitors in Patients With Metastatic Renal Cell Carcinoma

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