Stereotactic Body Radiotherapy for the Treatment of Renal Tumors

Abstract

The purpose of this study was to evaluate the response of actively growing renal masses to stereotactic body radiation therapy (SBRT). We retrospectively reviewed our institutional review board–approved kidney database and identified 4 patients who underwent SBRT, 15 Gy dose, for their rapidly growing renal masses. Three patients had a decreased tumor size after radiation treatment by 20.8%, 38.1%, and 20%. The other patient had a size gain of 5.6%. This patient maintained a similar tumor growth rate before and after SBRT. Mean follow-up time was 13.8 months. SBRT represents an effective management option in select patients with larger rapidly growing kidney masses.

A Pilot Study of Stereotactic Body Radiation Therapy Combined with Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma

“…Clinically, a wide range of SBRT fractions (1–10) and doses (18 to 60 Gy) for inoperable RCC have been reported in the literature (29). In this study, 15 Gy in 1 fraction was utilized due to 3 factors: 1) clinical experience with this dose being well tolerated in our inoperable patients (18), 2) radiobiological data suggesting vascular effects with this dose (30), and 3) in vitro experiments (Fig. 1) showing that this dose has immunomodulatory effects.…”

“…This dose was chosen based on our recent experience with this treatment being well tolerated in inoperable renal cell carcinoma patients (18). Patients were followed for protocol related toxicity 30 ± 3 days following surgery or until resolution of any toxicity.…”

“…SBRT was delivered as previously described (18). Briefly, a stereotactic body immobilization system (BodyFIX, Medical Intelligence) was used with a 4-dimensional CT to assess tumor motion with respiration.…”

“…Preclinical tumor models and in vitro data utilizing other tumor types have revealed that radiation therapy can increase TAA expression (13, 15). While RCC appears resistant to conventional fractionated radiation therapy (16), recent publications have shown that high doses delivered with modern stereotactic body radiation therapy (SBRT) can produce local control with limited toxicity (17, 18). Treatment of patients with SBRT in combination with conventional high-dose IL-2 treatment has demonstrated partial and complete objective responses in melanoma and mRCC patients that correlate with increased proliferating T cells in peripheral blood (17).…”

Single-Fraction Stereotactic Body Radiation Therapy: A Paradigm During the Coronavirus Disease 2019 (COVID-19) Pandemic and Beyond?

“… 48 Several retrospective studies have reported outcomes of single-fraction SBRT to the kidney. Hanzly et al 49 retrospectively evaluated 4 patients who were prescribed 15 Gy × 1 fraction for rapidly growing renal masses without histologic confirmation. Three of the 4 patients had tumor size reduction (average 0.85 cm) at 13.8 months follow-up.…”