The incidence of localized renal cell carcinoma (RCC) is on the rise among individuals aged 70 and older. While the gold standard for treatment remains surgical resection, some elderly and frail patients with comorbidities are not eligible for this procedure. In selected cases, percutaneous thermal ablation, such as cryotherapy, microwave and radiofrequency, offers less invasive options. General anesthesia is sometimes necessary for such treatments, but most of the procedures can be conducted using mild or deep conscious sedation. This approach is preferably recommended for small cT1a tumors situated at a distance from the renal hilum and/or ureter. Active surveillance remains an alternative in the case of small low grade RCC although it may induce anxiety in certain patients. Recent research has highlighted the potentials of Stereotactic Ablative Body Radiotherapy (SABR) as a non-invasive, well-tolerated, and effective treatment for small renal tumors. This narrative review aims to explore recent advances in SABR for localized RCC, including appropriate patient selection, treatment modalities and administration, as well as efficacy and tolerance assessment.
We conducted a literature review using the terms [Kidney cancer], [Renal Cell Carcinoma], [Stereotactic radiotherapy], [SBRT], and [SABR] in the Medline, PubMed, and Embase databases, focusing on prospective and relevant retrospective studies published in English.
Studies report local control rates ranging from 70% to 100% with SABR, highlighting its efficacy in treating RCC. The decline in glomerular filtration rate (GFR) is approximately -5 to -17 mL/min over the years following SABR. Common toxicities are rare, primarily CTCAE grade 1, include fatigue, nausea, chest or back pain, diarrhea, or gastritis.
Stereotactic Ablative Body Radiotherapy (SABR) may be considered as a viable option for patients with localized RCC who are not suitable candidates for surgery with a high local control rate and a favorable safety profile.. This approach should be discussed in a multidisciplinary meeting and results from ongoing clinical trials are awaited.
The French journal of urology. 2024 May 30 [Epub ahead of print]
Rita Bentahila, Karim Bensalah, Nicolas Benziane-Ouaritini, Philippe Barthelemy, Nathalie Rioux-Leclerc, Jean-Michel Correas, Sarah Belhomme, Pierre Bigot, Paul Sargos
Department of radiotherapy, Bergonié Institute, Bordeaux, France., Urology Department, Rennes University Hospital, Rennes, France., Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, Strasbourg, France., Pathology Department, Rennes University Hospital, Rennes, France., Adult Radiology Department, Necker Hospital, Paris, France., Department of medical physic, Bergonié Institute, Bordeaux, France., Urology Department, Angers University Hospital, Angers, France., Department of radiotherapy, Bergonié Institute, Bordeaux, France; Amethyst Radiotherapy Group, Paris, France. Electronic address: .