Technological advancements in stereotactic body radiation therapy (SBRT) have enabled increasingly precise delivery, often allowing us to overcome the radiation resistance of cancers by administering ablative doses to the tumour. This has been particularly true for renal cell carcinomas (RCC), which are an attractive target for non-invasive therapies due to their late onset, often in patients who are not optimal candidates for surgery. In our study, we conducted a systematic review and meta-analysis of prospective trials to consolidate high-quality evidence regarding the safety and oncological efficacy of this approach. We identified 13 single-arm trials encompassing 308 patients who underwent SBRT.
Our meta-analysis revealed that local tumour control was achieved in nearly all patients up to three years post-treatment, even in this presumably radio-resistant cancer. Furthermore, the precision of SBRT resulted in low treatment-related toxicity, with a pooled rate of severe adverse events of 3% (95% CI: 1%–11%). Safety was further confirmed by low early mortality rates, with an estimated one-year overall survival probability of 95% (95% CI: 88%–98%). Although heterogeneity in reporting precluded a meta-analysis of kidney function, individual study results support the hypothesis that SBRT may preserve some renal function in the treated kidney.The absence of comparative evidence from randomised controlled trials prevents us from definitively concluding that SBRT is as effective as surgery. Nevertheless, these excellent short-term results suggest that SBRT is a valuable, minimally invasive alternative for patients who are ineligible for or decline surgery. Importantly, many of the trials included in our review employed SBRT techniques that are readily available at most tertiary radiotherapy centres, enhancing access to this treatment. While surgical management remains the standard of care for operable patients, we encourage the readers to develop clinical SBRT programmes, to provide comprehensive personalised care for all RCC patients.
Written by: Agata Suleja,1 Marcin Miszczyk,2,3 and Shahrokh F. Shariat,2,4-9
- III Department of Radiotherapy and Chemotherapy, Maria Skłodowska-Curie National Research Institute of Oncology (MSCNRIO), 44-102 Gliwice, Poland.
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.
- Collegium Medicum-Faculty of Medicine, WSB University, 41-300 Dąbrowa Górnicza, Poland.
- Karl Landsteiner Institute of Urology and Andrology, 1010 Vienna, Austria.
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic.
- Division of Urology, Department of Special Surgery, University of Jordan, Amman 11942, Jordan.
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA.
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA.
- Research Centre for Evidence Medicine, Urology Department, Tabriz University of Medical Sciences, Tabriz 5166/15731, Iran.