This retrospective observational study evaluated the role of hypo-fractionated stereotactic radiotherapy (SRT) in patients with oligo-progressive metastatic renal cell carcinoma (mRCC) treated with first-line oral tyrosine kinase inhibitors (TKI). Data on local control, delay of further progression, and safety are reported.
Between January 2010 and December 2016, 28 patients with mRCC who showed oligo-progressive disease while receiving first-line pazopanib were treated with hypofractionated SRT to progressive metastatic sites to delay the change of systemic therapy. First and second progression-free survival (PFS-1 and PFS-2) were recorded, as well as objective response and toxicity.
After pazopanib therapy, nine partial remissions (32%), 12 stable disease (43%) and seven progressions (25%) were recorded. The median time to progression from first-line pazopanib until oligo-progression was 9.45 months (PFS-1 range=2-30 months). Seventeen patients (61%) showed progression at pre-existing tumor sites, and 11 patients (39%) showed the appearance of new metastases. Progression-free survival after radiation therapy was 4.55 months (PFS-2 range=1-11 months). PFS-1 plus PFS-2 was 14.0 months (range=3-41 months). Severe grade 3-4 toxicities were seen only occasionally.
Patients with oligo-progressive mRCC treated with first-line pazopanib may benefit from hypo-fractionated high-dose SRT at progressing sites achieving a further increase in median progression-free survival. Further studies and prospective validation are required to establish if this minimally invasive approach may have a positive impact on overall survival and reported outcomes.
Anticancer research. 2020 Dec [Epub]
Vittorio Gebbia, Andrea Girlando, Alfio DI Grazia, Ivan Fazio, NicolÒ Borsellino, Dario Piazza, Vincenzo Serretta, Stefano Pergolizzi, Antonio Pontoriero, Alberto Firenze, Maria Rosaria Valerio
Oncology Section, Department Promise, University of Palermo, Palermo, Italy; ., Radiation Therapy Unit, Istituto Clinico Humanitas, Catania, Italy., Radiation Therapy Unit, Istituto Oncologico del Mediterraneo, Catania, Italy., Radiation Therapy Unit, Casa di Cura Macchiarella, Palermo, Italy., Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo, Italy., GSTU Foundation, Group for the Study of Urologic Tumors, Palermo, Italy., Dipartimento Biomorf, Università di Messina, Messina, Italy., UO Radioterapia, Azienda Ospedaliera Policlinico G. Martino, Messina, Italy., Risk Management Unit, Policlinico, University of Palermo, Palermo, Italy., Medical Oncology Unit, Policlinico, University of Palermo, Palermo, Italy.