To date, several open questions remain in the management of oligometastatic renal cell carcinoma with SABR and the purpose of this study, supported by the European Society of Radiotherapy and Oncology (ESTRO) and the European Association of Urology, is to investigate expert opinion on the management of patients with oligometastatic and oligoprogressive renal cell carcinoma using SABR on extracranial metastases. For this purpose, the Delphi consensus methodology was applied by sending three rounds of questionnaires to clinicians identified as opinion leaders in the field of renal neoplasm treatment. At the end of the third round, consensus was reached on eight of the 37 proposed questions (Figure). In particular, the panel members agreed that there should be no restrictions on the age and clinical history of primary renal cell carcinoma for SABR candidates, on the maximum threshold of three lesions to offer ablative treatment in patients with oligoprogression, and on the possibility of concomitant administration of immunotherapy drugs together with radiotherapy. SABR was indicated as the treatment modality of choice for renal cell carcinoma oligometastases and for adrenal oligometastases. No consensus or major agreement was reached regarding the appropriate schedule. The results of this Delphi consensus highlighted that discordant opinions persist in oligometastatic renal cell carcinoma, given the lack of phase 3 studies, and that further efforts need to be made to develop studies that generate high-level evidence to guide clinical practice. This ESTRO consensus could serve as a practical guide for the use of SABR in oligometastatic renal cell carcinoma, emphasizes the essential role of the radiation oncologist in the multidisciplinary team, and highlights the main areas of disagreement, possibly guiding future efforts to fill knowledge gaps.
Figure. Overview of the main areas of consensus, major agreement, and divided opinion.
Written by:
- Mattia Zaffaroni, Biotechnologist Researcher, Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
- Giulia Marvaso, Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Giulia Corrao, Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy
- Barbara Alicja Jereczek-Fossa, Division of Radiation Oncology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy