Stereotactic Body Radiation Therapy for Renal Cell Carcinoma with Inferior Vena Cava Thrombus – Initial Experience Report and Literature Review

Abstract

Background: Renal cell carcinoma (RCC) with inferior vena cava thrombus (IVC-TT) represents a relatively infrequent presentation. Curative treatment includes extirpative surgery; however, this is associated with high rates of recurrence and complications. Stereotactic body radiation therapy (SBRT) has been used to treat metastatic RCC with good results. SBRT may be used as part of multimodal therapy to provide local control of IVC-TT. Objective: We report our initial experience with SBRT to IVC-TT, including extended follow-up, and review the literature. Results: We report on two patients with level IV IVC-TT. Both had progressive disease while receiving systemic therapy and were eventually treated with SBRT to the IVC-TT, which showed good local control. Overall survival from the time of SBRT was 18 and 34 months, with no additional systemic therapy; one patient underwent additional SBRT and resection of metastatic sites. Conclusions: SBRT to RCC IVC-TT may be considered in selected patients for local tumor control.

Neoadjuvant stereotactic ablative body radiotherapy combined with surgical treatment for renal cell carcinoma and inferior vena cava tumor thrombus: a prospective pilot study

“…However, the radiographic response rate was not adequately reported in previous neoadjuvant studies and thus remains unclear. According to our results, no significant downgrading of the IVC-TT or reversal of IVC wall invasion was observed 2–4 weeks after SABR, but the radiographic results showed a decrease in enhancement, consistent with the observations of Freifeld et al and Hannan et al, which probably resulted from local edema and vascular reduction in the IVC-TT [ 17 , 18 ].…”

“…Three studies used SABR as an alternative therapy for surgery, and only one study focused on the safety of SABR as neoadjuvant therapy. Hannan et al and Freifeld et al were the earliest reporters to use SABRs for IVC-TT and metastasis treatment, with no occurrence of severe AEs [ 17 , 18 ]. Additionally, one patient showed an excellent oncologic prognosis of 54 months.…”

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

“…Three studies used SABR as an alternative therapy for surgery, and only one study focused on the safety of SABR as neoadjuvant therapy. Hannan et al and Freifeld et al were the earliest reporters to use SABR for IVC-TT and metastasis treatment, with no occurrence of severe AEs (15,16).…”

Preoperative stereotactic body radiotherapy combined with surgical treatment for renal cell carcinoma and inferior vena cava tumour thrombus: study protocol for a single-arm cohort trial

“…And the team’s long-term follow-up results of two cases showed that SABR to RCC with IVCTT could get good local tumour control in selected patients. 19 Its safety and effectiveness need to be further examined.…”