Traditionally, renal cell carcinoma (RCC) was considered a radioresistant tumor, thereby limiting definitive radiation therapy management options. However, several recent studies have demonstrated that stereotactic body radiotherapy (SBRT) can achieve high rates of local control for the treatment of primary RCC. In the setting of an expanding use of SBRT for primary RCC, it is crucial to provide guidance on practical considerations such as patient selection, fractionation, target delineation, and response assessment. This is particularly important in challenging scenarios where a paucity of evidence exists, such as in patients with a solitary kidney, bulky tumors, or tumor thrombus. The Radiosurgery Society endorses this case-based guide to provide a practical framework for delivering SBRT to primary RCC, exemplified by three cases. This article explores topics of tumor size and dose fractionation, impact on renal function and treatment in the setting of a solitary kidney, and radiation's role in the management of inferior vena cava tumor thrombus. Additionally, we review existing evidence and expert opinion on target delineation, advanced techniques like MRI-guided SBRT, and SBRT response assessment.
Practical radiation oncology. 2024 Jul 15 [Epub ahead of print]
Andrew B Barbour, Rituraj Upadhyay, August C Anderson, Tugce Kutuk, Ritesh Kumar, Shang-Jui Wang, Sarah P Psutka, Fatemeh Fekrmandi, Karin A Skalina, Anna M E Bruynzeel, Rohann J M Correa, Alan Dal Pra, Cesar Della Biancia, Raquibul Hannan, Alexander Louie, Anurag K Singh, Anand Swaminath, Chad Tang, Bin S Teh, Nicholas G Zaorsky, Simon S Lo, Shankar Siva
Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA., Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA., Department of Radiation Oncology, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA., Department of Urology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA., Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA., Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, USA., Department of Radiation Oncology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands., Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada., Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA., Department of Radiation Oncology, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, ON, Canada., Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada., Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA., Department of Radiation Oncology, Cancer Center and Research Institute, Houston Methodist Hospital, Houston, TX, USA., Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve, Cleveland, OH, USA., Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Center, University of Melbourne, Melbourne, VIC, Australia.