At present, surgery is still the gold standard for the local treatment of renal cancer. Nonetheless, in several clinical scenarios, stereotactic body radiation therapy (SBRT) also known as stereotactic ablative body radiotherapy (SABR) is emerging as a highly effective ablative technique in fragile patients and those with significant comorbidities, as well as in cases where percutaneous therapy (cryoablation or radiofrequency) is not viable. However, considering the intrinsic radioresistance of renal tumors, the optimal treatment schemes have not been established. In oligometastatic patients, it has been reported that the control of the oligometastases can be a potentially curable approach. Being a technique than can be administered exclusively or in combination with systemic therapy, treatment individualization based on patient characteristics is key. Another scenario under investigation is oligoprogression, where SBRT offers the possibility of delaying further lines of systemic therapy by eliminating subclones of resistant tumor with ablative doses, with the additional opportunity of stimulating the immune system (immunomodulatory role). In this review, we have conducted an analysis of recently published studies that test the role of this technique in different clinical scenarios of this disease. We have found promising results that make SBRT a potent therapeutic approach with low toxicity. We also comment on ongoing studies that will generate the necessary evidence needed for the implementation of this technique in our daily clinical practice.
International journal of urology : official journal of the Japanese Urological Association. 2023 Feb 06 [Epub ahead of print]
Paloma Sosa-Fajardo, Jesús M Blanco-Suarez, Álvaro Pineda-Munguía, Luz Rubí-Olea, Paula Peleteiro-Higuero, Pablo Gajate, Juan Zafra-Martín, Shankar Siva, Alberto Bossi, Fernando López-Campos, Felipe Couñago
Department of Radiation Oncology, Instituto de Biomedicina de Sevilla (IBIS/CSIC/CIBERONC), University Hospital Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain., Urology Department, Hospital El Bierzo, Ponferrada, Spain., Radiation Oncology Department, University Regional Hospital, Málaga, Spain., Radiation Oncology Department, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain., Medical Oncology Department, Ramon y Cajal Hospital, IRYCIS, Madrid, Spain., Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), Institute of Biomedical Research in Malaga (IBIMA), University of Malaga (UMA), Malaga, Spain., Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia., Department of Radiation Oncology, University Hospitals Gasthuisberg, Leuven, Belgium., Radiation Oncology Department, Ramon y Cajal Hospital, IRYCIS, Madrid, Spain., Radiation Oncology Department, GenesisCare Madrid Clinical Director, San Francisco de Asis and La Milagrosa Hospitals, National Chair of Research and Clinical Trials, GenesisCare, Madrid, Spain.