Surgery is the standard of care for patients with primary renal cell carcinoma. Stereotactic body radiotherapy (SBRT) is a novel alternative for patients who are medically inoperable, technically high risk, or who decline surgery. Evidence for using SBRT in the primary renal cell carcinoma setting is growing, including several rigorously conducted prospective clinical trials. This systematic review was performed to assess the safety and efficacy of SBRT for primary renal cell carcinoma. Review results then formed the basis for the practice guidelines described, on behalf of the International Stereotactic Radiosurgery Society. 3972 publications were screened and 36 studies (822 patients) were included in the analysis. Median local control rate was 94·1% (range 70·0-100), 5-year progression-free survival was 80·5% (95% CI 72-92), and 5-year overall survival was 77·2% (95% CI 65-89). These practice guidelines addressed four key clinical questions. First, the optimal dose fractionation was 25-26 Gy in one fraction, or 42-48 Gy in three fractions for larger tumours. Second, routine post-treatment biopsy is not recommended as it is not predictive of patient outcome. Third, SBRT for primary renal cell carcinoma in a solitary kidney is safe and effective. Finally, guidelines for post-treatment follow-up are described, which include cross-axial imaging of the abdomen including both kidneys, adrenals, and surveillance of the chest initially every 6 months. This systematic review and practice guideline support the practice of SBRT for primary renal cell carcinoma as a safe and effective standard treatment option. Randomised trials with surgery and invasive ablative therapies are needed to further define best practice.
The Lancet. Oncology. 2024 Jan [Epub]
Shankar Siva, Alexander V Louie, Rupesh Kotecha, Melissa N Barber, Muhammad Ali, Zhenwei Zhang, Matthias Guckenberger, Mi-Sook Kim, Marta Scorsetti, Alison C Tree, Ben J Slotman, Arjun Sahgal, Simon S Lo
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia. Electronic address: ., Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada., Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA., Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia., Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia., Center for Advanced Analytics, Baptist Health South Florida, Miami, FL, USA., Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea., Radiosurgery and Radiotherapy Department, IRCCS-Humanitas Research Hospital, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy., Division of Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, Sutton, UK., Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands., Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA.